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.
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
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 transfusionâ€
|
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:
- Patients aged 18 or older (some areas may have an upper age limit)
- Not diagnosed with diabetes
- Not frail
- Not receiving palliative care
- No recent episodes relating to an eating disorder in the previous 3 years
- No history of bariatric surgery in the previous 2 years
- 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.
- Fasting blood glucose and HbA1c pull out the most recent value
- Latest Diabetes UK risk score (if recorded)
- Diabetes resolved will display where patients have a code which removed them from the QOF Diabetes register
- Latest code relating to gestational diabetes
- Latest code relating to QOF NDH register
- 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
- 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.