The 2012 version of the guideline recommended that intensive lifestyle-change programmes should be offered to people at high risk of type 2 diabetes. The new recommendations recognise that commissioners may need to prioritise subsets of the population for these programmes, in order to make the most of resources. Implementing these recommendations will allow the NHS Diabetes Prevention Programme to be initially targeted at groups of the population who will benefit most, in a way that is consistent across the UK.
The results of economic modelling showed that lifestyle-change programmes are more clinically and cost effective than metformin; however metformin is cost effective in the high-risk population overall, and for most subgroups, when compared to control. The updated recommendation is as follows:
1.19.1 Use clinical judgement on whether (and when) to offer metformin to support lifestyle change for people whose HbA1c or fasting plasma glucose blood test results have deteriorated if:
· this has happened despite their participation in intensive lifestyle-change programmes or
· they are unable to participate in an intensive lifestyle-change programme, particularly if they have a BMI greater than 35 [the model showed that metformin is particularly clinically and cost effective for this group]
As the updated recommendation reflects current practice, it should not have any impact.