Preventing progression from prediabetes to type 2 diabetes

Lifestyle behaviour-change programmes should offer ongoing tailored advice, support and encouragement to help people:

·     lose weight towards a healthier body weight

Use defined behaviour-change techniques, including:

·     Providing information: check and build on what individuals already know about healthy behaviours that help to achieve and maintain a healthy weight.

·     Exploring and enhancing individuals’ motivation about behaviour change and their confidence about making changes.

·     Goal setting: identify what positive long-term outcomes people want, and help them to set short-term goals related to a specific eating behaviour or physical activity to achieve this.

·     Action planning: support individuals to develop a plan focusing on a specific eating behaviour or physical activity they intend to change, including when, where and how they will do this.

·     Coping plans and relapse prevention: support individuals to identify and problem-solve barriers to maintaining healthful eating habits and physical activity. The aim is to review progress, adjust goals and move towards long-term, sustainable healthy habits.

Encourage people to:

·     increase their consumption of wholegrains, vegetables and other foods that are high in dietary fibre

·     reduce the total amount of fat in their diet

·     eat less saturated fat.

Advise and encourage people living with overweight and obesity to reduce their weight by reducing their calorie intake. Explain that losing 5–10% of their weight is a realistic initial target that would help reduce their risk of type 2 diabetes and also lead to other significant health benefits.

Offer people with prediabetes or type 2 diabetes a structured weight-loss programme, in line with Public Health Scotland standards for weight management.

Routinely discuss the individual’s level of physical activity. Where someone is not meeting the recommended minimum, explore the barriers to this. Explain that even small increases in physical activity, such as reducing sedentary behaviour, will be beneficial and can act as a basis for future improvements.

Consider referring people who want structured or supervised exercise to an exercise referral scheme or supervised exercise sessions.

When planning local or national services to deliver evidence-based, quality- assured programmes where the availability of places is limited, prioritise people with an HbA1c of 44–47 mmol/mol (6.2–6.4%) or a fasting plasma glucose of 6.5-6.9 mmol/L.

Provide specially designed and quality-assured intensive lifestyle-change programmes for groups of people at high risk of developing type 2 diabetes.

Involve the target community (including community leaders) in planning the design and delivery of the programme to ensure it is sensitive and flexible to the needs, abilities and cultural or religious norms of the community. For example, the programme should offer practical learning opportunities, particularly for those who have difficulties with communication or literacy or whose first language is not English.

Ensure programmes are delivered by practitioners with relevant knowledge and skills who have received externally accredited training. Where relevant expertise is lacking, involve health professionals and specialists (such as dietitians and health psychologists) in the design and delivery of services.

Ensure programmes adopt a person-centred, empathy-building approach. This includes finding ways to help participants make changes by understanding their beliefs, needs and preferences. It also involves building their confidence and self efficacy over time.

Ensure programme components are delivered in a logical progression. For example, discussion of the risks and potential benefits of lifestyle change; exploration of someone's motivation to change; action planning; self monitoring and self regulation.

Ensure groups meet at least eight times over a period of 9 to 18 months. Participants should have at least 16 hours of contact time either within a group, on a one-to-one basis or using a mixture of both approaches.

Offer more intensive support at the start of the programme by delivering core sessions frequently (for example, weekly or fortnightly). Reduce the frequency of sessions over time to encourage more independent lifestyle management.

Allow time between sessions for participants to make changes to their lifestyle and to reflect on and learn from their experiences. Also allow time during sessions for them to share this learning with the group.

Deliver programmes in a range of venues such as workplaces, leisure, community and faith centres, and outpatient departments and clinics. Run them at different times, including during evenings and at weekends, to ensure they are as accessible as possible.

Accredited, certified technology-assisted type 2 diabetes prevention programmes should be considered as part of a standard menu of options for delivery.

As part of the programme, offer referral to, or seek advice from, people with specialist training where necessary. For example, refer someone to a dietitian for assessment and specialist dietary advice if required.

Following the initial intervention, offer follow-up sessions at 3-month intervals usually up to 12–15 months, and thereafter at appropriate intervals according to clinical need. The aim is to reinforce behaviour change and to provide ongoing support. Larger group sizes may be feasible for these maintenance sessions, depending on service provision and individual’s needs.

Link the programmes with ongoing weight management and other prevention initiatives that help people to change their diet or become more physically active.

Individuals should be encouraged to use self-monitoring techniques. Discuss with and support them to review their progress towards achieving their goals, identify and find ways to solve problems and then revise their goals and action plans, where necessary. The aim is to encourage them to develop confidence in their own self-management skills.