Prevention of Type 2 diabetes: Merseyside Impaired Glucose Regulation Pathway

Prevention of Type 2 diabetes: Merseyside Impaired Glucose Regulation Pathway featured image
What has been developed? A multi-stakeholder group of professionals and patients in Merseyside have developed and implemented a pathway for the prevention of Type 2 diabetes.

The Merseyside Impaired Glucose Regulation pathway (IGR) is designed to prevent or delay the onset of type 2 diabetes for those at highest risk by the identification and management of IGR (Otherwise known as non-diabetic hyperglycaemia).

Identification of IGR supported by evidence based lifestyle interventions represents a significant opportunity to prevent or delay the onset of Type 2 diabetes.

The pathway, guidelines and supporting materials are evidence based and freely available. For access to full guidelines, patient information material and a range of other resources please use the link below.

IGR can be described as blood glucose levels above the normal range, but below that required for a diagnosis of Type 2 diabetes. Those with IGR are 5 – 15 times more likely to develop Type 2 diabetes compared to people with normal blood glucose. Without intervention the majority of people with IGR will develop Type 2 diabetes within 5-10 years. For those people at highest risk of developing Type 2 diabetes evidence suggests modest lifestyle changes can delay or even prevent the onset of diabetes.

Pathway overview  The pathway is initiated via the NHS Health Checks programme or opportunistically in primary care. Identification is usually via HbA1C testing with a result of 42-47mmol/mol confirming IGR. Each individual with IGR is given IGR specific lifestyle literature and is supported by primary care colleagues to develop achievable aims using an individualised goal planner. Patients are recorded on the primary care IGR register and offered an annual review. A referral is made to lifestyle services which offer one-to-one individually tailored IGR lifestyle advice and facilitated access to lifestyle services. Lifestyle providers have been specifically trained in IGR with both primary care and lifestyle providers using consistent literature and advice based on detailed insight work.

Insight work undertaken as part of pathway development used the Department of Health’s Healthy Foundations Life-stage Segmentation model to develop the key messages that support people to make lifestyle changes.

A key finding was the importance of language when discussing IGR. A number of terms for IGR were tested including ‘pre-diabetes’, ‘high risk’ and ‘non-diabetic hypo-glycaemia’. People who had risk factors for IGR selected the term ‘borderline diabetes’ as it was felt they could do something to prevent or delay the onset of Type 2 diabetes.

The term ‘borderline diabetes’ has been a challenge for many professionals who did not recognise this as valid however as the insight demonstrated that ‘borderline diabetes’ was the most effective term to communicate IGR and motivate for lifestyle change, the decision was made that this would be the primary term to use throughout the patient literature.
  • Fabulous Stuff
  • Integrating health and social care
  • education
  • Service pathway improvements
  • The 4 Candles Award
  • The HMS Victory Award
  • Preventative Health Care
  • Diabetes
  • Patient Empowerment
  • Public health
  • Transforming the patients pathway
  • Acute > Fabulous Stuff
  • Acute
  • Leadership and Management > Fabulous Stuff
  • Leadership and Management
  • Primary Care > Fabulous Stuff
  • Primary Care
  • Community Services > Fabulous Stuff
  • Community Services
  • Mental Health > Fabulous Stuff
  • Mental Health
  • Social Care > Fabulous Stuff
  • Social Care
  • Commissioning and Procurement > Fabulous Stuff
  • Commissioning and Procurement
  • Commissioning and Procurement > Integrating health and social care
  • Social Care > Integrating health and social care
  • Primary Care > Integrating health and social care
  • Acute > education
  • Leadership and Management > education
  • Primary Care > education
  • Community Services > education
  • Mental Health > education
  • Social Care > education
  • Commissioning and Procurement > education
  • Leadership and Management > Service Design/Innovation > Service pathway improvements
  • Leadership and Management > Service Design/Innovation
  • Primary Care > Preventative health care
  • Acute > Diabetes
  • Primary Care > Diabetes
  • Acute > Patient Empowerment
  • Community Services > Patient Empowerment
  • Primary Care > Patient Empowerment
  • Primary Care > Public health
  • Community Services > Public health
Download acrobat reader