series: Preventing Director of Research

Transcription

1 C3 Workplace health series: Preventing Type 2 diabetes 15 June 2012 Dr Iain Frame Dr Iain Frame Director of Research

2 Today s talk What is diabetes and why is it important? What are the complications of diabetes? Prevention of Type 2 diabetes- the evidence Prevention of Type 2 diabetes- the practice, specifically long-term behaviour change The Diabetes UK Healthy Lifestyle Roadshow Prevention of Type 2 diabetes in the workplace- Unilever s Fit Business Evaluation

3 What is diabetes- and why is it important?

4 A collection of health conditions where the amount of glucose in the blood is too high. Pancreas does not produce enough insulin or insulin does not work properly p ( insulin resistance ). Usually insulin enables glucose to enter the body s cells, where it is the primary source of energy. Insulin unlocks cells for glucose

5 What forms of diabetes exist? Type 2 diabetes (90% of cases) Type 1 diabetes (10% of cases) Other forms of diabetes Maturity Onset Diabetes of the Young or MODY (1-2% of cases) Gestational diabetes (3-10% of all pregnancies) Neonatal diabetes (less than 100 cases in UK) Prediabetes / borderline diabetes (epidemic) i

6 What causes diabetes? Type 1: Insulin-producing beta cells destroyed by the immune system - genetic and environmental factors involved but not fully understood Type 2: Fat, muscle and liver cells unable to respond to insulin and insufficient i production of insulin genetic and lifestyle factors involved MODY: single genetic mutations that disrupt insulin production Gestational diabetes: precise mechanisms unknown Neonatal diabetes: single genetic mutation that disrupts insulin production

7 What are the symptoms? Increased urination, thirst and hunger Blurred vision Extreme tiredness Unexplained weight loss (more common in Type 1) Slow healing Nausea, vomiting or abdominal pain (more common in Type 1)

8 Complications of diabetes Increased risk of cardiovascular diseases (heart disease and stroke) Diabetic retinopathy (eye damage) Diabetic nephropathy (kidney disease) Diabetic neuropathy potentially leading to foot problems and amputation

9 What are the key statistics? 2.9 million people in the UK have been diagnosed with diabetes. Type 2 = 90% of cases, Type 1 = 10% of cases An estimated 850,000 people p have Type 2 diabetes but are not aware of it) 7 million are at high risk of developing eop Type 2 Diabetes cost the UK 23.7 billion in Diabetes projected to cost 39.8 billion per year by and use 17% of total NHS budget

10 Prevention of Type 2 diabetesthe evidence

11 Prevention of Type 2 diabetes Wealth of research evidence showing that 80-90% of all cases of Type 2 diabetes could be prevented through changes in lifestyle, such as doing more physical exercise and improving your diet Lifestyle interventions have been shown to reduce the risk of Type 2 diabetes by 40-60% (USA, Finland, China, India, Germany and Japan)

12 But what about in the real world? Interventions used in international RCTs tend to be very resource intensive i Not suitable for translation into routine care Traditional diabetes prevention programmes in the UK have shown to be of limited effectiveness

13 Quantitative Background Tracking study Objective The aim of the study was to measure:- Understanding of the severity of diabetes as a condition Knowledge of : Risks, Symptoms, Complications Awareness and understanding of the 2 main types of diabetes Sample 2015 respondents in England, Wales and Scotland (NI to follow) Margin of error +/-3% of general population of GB Results weighted to match the profile of the general population Methodology Part of a Capibus survey In-home questionnaire Undertaken by Ipsos Mori

14 Key findings - Awareness of risk factors (T2) Risk factor March 2012 Being overweight and inactive 78% F Eating too much sugar 59% F Having a relative with diabetes 55% Having high blood pressure 44% Having too large a waist 37% Eating too much salt 21% Being white and over 40 years old 18% Being black or Asian 14% High levels of awareness of some risk factors of type 2 esp being overweight and inactive. High proportion mistakenly think that eating sugar is a risk factor and salt (identified by F) Low levels of awareness that age and ethnicity are a risk.

15 In summary key points The general public are likely to over-estimate prevalence of diabetes but they know it affects many people and is likely to affect them They are well aware of complications Some risk factors (being overweight & inactive) are better understood than others They are less familiar with the symptoms

16 Long-term behaviour change For both individual and population based approaches there remain many questions about what influences successful behaviour change; What behavioural determinants predict if a regimen will be successful? What are the reasons that some people are more resistant to behaviour change, and what support do these people require?

17 Long-term behaviour change For both individual and population based approaches there remain many questions about what influences successful behaviour change; What are the key behaviour changes that influence risk of developing Type 2 diabetes and the outcomes associated with this condition? What are the barriers or opportunities that particular groups or communities face or miss to reduce their risk of Type 2 diabetes?

18 HEALTHY LIFESTYLE ROADSHOW

19 Background Started ,000 undiagnosed and 7 million people high risk Raise awareness of Type 2 diabetes and it s risk factors in high risk communities Quick, easy and convenient Risk assessments (vs. finger prick test) Focus on healthy lifestyle and prevention

20 Audience Hard to reach communities/less likelytogotogp High risk areas (variables) E.g. socially deprived, BAME, rates of obesity, diabetes prevalence, older population p Referral rates

21 2011 Results 52 Locations 11,000 risk assessments, over 5000 referrals 88% of visitors remembered weight to be a risk factor 80% of visitors stated their intent to eat more healthily 73% of visitors stated their intent to exercise more 43% of those referred to their GP had already made an appointment to see them and a further 26% were planning to make an appointment

22 OBJECTIVES

23 Objectives Raise awareness of Type 2 diabetes and risk factors Educate people about their personal risk Promote healthy lifestyles and encourage behaviour change Spread our messages to local stakeholders

24 FORMAT AND RESOURCES ON THE DAY

25 On the day- customer journey Passing by, becoming engaged: Welcoming Fun Engaging Layout (marquee, bike etc)

26 Measure Up Eye catching Clear Engaging g g Context Feedback

27 On the day- customer journey Having a risk assessment Waiting room, consent and measuring

28 On the day- customer journey cont Risk assessment Trained staff and volunteers Enclosed booth Introduction Questions BMI- visual Waist measurement Score

29 On the day- customer journey cont Risk, advice, possible referral Risk level- what it means Traffic lights (script and visual representation) Individualised explanation and advice (staff) Referral (high/moderate risk), GP letter Sign post to dietitian, local services, MEND Hand out: healthy eating, physical activity, traffic lights

30 On the day- customer journey cont Dietitian and healthy lifestyle marquee Personalised dietary advice- dietitian Eat well plate game Local services Demonstrations (future)

31 On the day- customer journey cont Physical activity zone Fun, easy, engaging, visually appealing E.g. Hula hooping, skipping, steps Competition- visually appealing

32 Prevention of Type 2 diabetes in the workplace- the Unilever pilot

33 Unilever Pilot- strategic design Engagement: providing information and education to help people make healthy choices Empowerment: giving employees practical tools and resources to manage their own health Environment: making a healthy lifestyle accessible to everyone through company facilities Encouragement: rewarding and incentivising employees choosing to lead a healthy lifestyle Evaluation: attaching clear KPIs and tangible metrics in order to demonstrate ROI

34 Unilever Pilot- key lessons learnt Promote a culture of health and wellbeing Promote ownership Be inclusive Keep it simple Use creative approaches to drive interest Monitor and evaluate progress

35 Future developments The Copenhagen Roadmap- outcomes of the European Diabetes Leadership Forum Use the workplace environment as an opportunity to promote healthy behaviour and ensure that employee health is embedded in the employer s policies and practices. Prioritise a healthy food selection, establish access to physical activity and offer support to healthy lifestyles

36 Future developments NICE guidelines Prevention of Type 2 diabetes in populations and communities (published) Prevention of obesity in local communities (in consultation) ti Preventing the progression of prediabetes to Type 2 diabetes in adults (July 2012)