NHS Diabetes Prevention Programme

NHS Diabetes Prevention Programme

Notes
031 NHS Diabetes Prevention Programme v2

031A NHS DPP Eligibility

The NDPP provides specifications for eligibility for the programme, but different areas of the country occasionally have differing requirements in relation to the age of the qualifying results.

Alert
There are important clinical factors that may affect the accuracy of HbA1c (listed below), PCIT searches do not take account of these because many of them can't be accurately extracted from the records and so it is incumbent upon the user to check the validity of HbA1c when assessing the individual patients.  Users may wish to use the PCIT HbA1c result decision support tool to check if any coded issues exist and be made aware of other issues that can affect HbA1c validity when assessing the patient
Factors affecting HbA1c validity (taken from Radlin et al):

Condition

Effect on A1c

Comments

Anemias associated with decreased red cell turnover

False Increase

I.e., iron deficiency, vitamin B-12, folate deficiency anemias

Asplenia

False Increase

Increased erythrocyte lifespan

Uremia

False Increase

Formation and detection of carbamyl-hemoglobin

Severe hypertriglyceridemia

False Increase

When level >1,750 mg/dL

Severe hyperbilirubinemia

False Increase

When level >20 mg/dL

Chronic alcohol consumption

False Increase

Formation of acetaldehyde-HbA1 compound

Chronic salicylate ingestion

False Increase

Mechanism uncertain, may interfere with assay

Chronic opioid ingestion

False Increase

Mechanism uncertain

Lead poisoning

False Increase

Mechanism uncertain

Anemia from acute or chronic blood loss

False Decrease

Includes hemolytic anemia

Splenomegaly

False Decrease

Decreased erythrocyte lifespan

Pregnancy*

False Decrease

Decreased erythrocyte lifespan

Vitamin E ingestion

False Decrease

Reduced glycation

Ribavirin and interferon-alpha

False Decrease

Possibly due to hemolytic anemia

Red blood cell transfusion†

False Increase or   False Decrease

High glucose concentration in storage medium (False Increase)
Dilutional effect (False Decrease)

Hemoglobin variants

False Increase or   False Decrease

Depends on method and assay used
A1c generally reliable for heterozygous variants, but not homozygous   variants (See Table 3)

Vitamin C ingestion

False Increase or   False Decrease

May increase A1c when measured by electrophoresis
May decrease levels when measured by chromatography due to   competitive inhibition of glycosylation

Eligibility criteria for the NDPP are:
  1. Patients aged 18 or older (some areas may have an upper age limit)
  2. Not diagnosed with diabetes
  3. Not frail
  4. Not receiving palliative care
  5. No recent episodes relating to an eating disorder in the previous 3 years
  6. No history of bariatric surgery in the previous 2 years
  7. Not pregnant
This folder takes all of the above criteria into account to produce a cohort that is 'Eligible for NHS DPP' (this search can be found in the Denominators folder).


Patients have been stratified into varying groups based on their blood result:
      a) the most recent HbA1c was reported in the past 12 months and was between 44 and 47.
      b) the most recent HbA1c was reported in the past 12 months and was 42 or 43.
      c) the patient did not have a raised HbA1c in the past 12 months, but there is a recorded fasting blood glucose which is at least 5.5
      d) the most recent HbA1c was between 12 and 24 months ago and was elevated between 44 and 47. In some areas this result will be sufficient for referral, but in other areas request repeat test ASAP.
      e) the most recent HbA1c was recorded more than 2 years ago and was in the pre-diabetic range. Patients should be reviewed and repeat tests arrange as appropriate.
      f) the most recent HbA1c (in the past 2 years) is at least 48 but there is no formal diabetes diagnosis. Facilitate urgent review.

Each report has been designed to pull out additional information which may be useful to clinicians prior to selecting patients for invite.


  1. Fasting blood glucose and HbA1c pull out the most recent value
  2. Latest Diabetes UK risk score (if recorded)
  3. Diabetes resolved will display where patients have a code which removed them from the QOF Diabetes register
  4. Latest code relating to gestational diabetes
  5. Latest code relating to QOF NDH register
  6. Incorrect (non-QOF) codes relating to NDH. If codes exist in this column but adjacent NDH column is blank, ensure that a valid QOF code is added to the record if appropriate
  7. NHS Diabetes Prevention Programme shows all codes relating to the NDPP; programme started, completed, not completed, declined, unsuitable. This will help to identify if the patient has previously had an interaction with the NHS Diabetes Prevention Programme

031B NHS DPP Participation

If patients who have been referred to the NDPP have various progress or outcome codes on their record, this collection of searches will help Practices understand the situation across their currently registered patients. Patients who have left or died are not shown for the top 3 searches so they are not necessarily reflective of all historic activity.

Patients Referred to NHS DPP in last 2 years does account for patients who have left or died, meaning this search can be used to understand overall recent activity.

 

There are no reports associated with these searches.

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