Preventing diabetes in high-risk people


Preventing diabetes in high-risk people
  • NHS England is to spearhead a national diabetes prevention program
  • The program aims to prevent diabetes in high risk people by 2025
  • 35% of adults in the UK are living with pre-diabetes
  • The program MUST report outcomes NOT delivered services
  • Type-2 diabetes devastates millions of lives and costs billions
  • Big Data strategies can help NHS England improve patient outcomes

Early in 2015, NHS England, Public Health England, and Diabetes UK (the Troika), announced a national joint initiative to prevent diabetes developing in high-risk people by 2025, and declared that England should be, “The most successful country on the planet at implementing a national diabetes prevention programme.” 

Forced to act
About 35% of adults in the UK are living with pre-diabetes, a condition in which your blood sugar level is higher than normal, but not high enough to be classified as type-2 diabetes. It’s caused by obesity, sedentary lifestyles, dietary trends, and an ageing population, and without appropriate action, pre-diabetics will develop type-2 diabetes; a disease that reduces life-expectancy, and can lead to complications such as blindness, and amputation that seriously affect quality of life, and costs billions.       

Dr Roni Saha, a consultant in acute medicine, diabetes and endocrinology at St George’s Hospital, London describes pre-diabetes: 

Importance of patient outcomes.
It’s important that the Troika uses patient outcomes, and NOT delivered services as an indicator of its performance. Diabetes agencies regularly report services they deliver, while the prevalence and the cost of diabetes continue to escalate. Outcome data help people take an active role in their healthcare, and provide health providers important feedback, which informs the re-allocation of scarce resources to further enhance patient outcomes, and reduce costs.  

Immediately, the Troika announced its initiative, doctors raised concerns about the additional burden it would place on GPs. World renowned heart surgeon Devi Shetty, the founder and Chairman of Narayana Health, India, views doctors as significant obstacles to the introduction of technologies, which can improve significantly patient outcomes:


Big data
The Troika might consider using Big Data to enhance the performance of its diabetes initiative. Big Data can pool the experiences of people with pre-diabetes, suggest which regimens work best for which individuals, allow health providers to evaluate diet and lifestyles practices, and compare them within and across organizations and communities. Information about blood sugar levels, and hypertensive blood pressure can be transmitted directly into electronic health records of people with pre-diabetes. Data systems can notify health providers of problematic trends with individuals, which gives them an opportunity to intervene early, perhaps with just a telephone call, rather than waiting for an emergent and costly episode.

NHS England is selectively using the John Hopkins’ Adjusted Clinical Groups (ACGs) system, which should be a contender to support the Troika’s diabetes prevention initiative. ACG is a clinically inspired risk stratification and predictive modeling tool, which draws on demographic, diagnostic, pharmacy, and utilization data from primary and secondary care, to assess the health status of a population in order to plan services, budget and manage resources, and assess patient outcomes. 

Beyond the clinic
Big Data can also monitor people living with pre-diabetes outside the clinic. By linking patients’ shopping histories, social media, and location information through third-party data vendors, health providers can gain a window into peoples’ daily health behavior, thought to determine up to 50% of peoples’ overall health status. This is important for preventing diabetes developing in high-risk groups.

Instead of thinking from the patient level up, there are now enough good data to examine whole populations, and extrapolate what will happen to an individual at risk of developing type-2 diabetes. Big Data can create a convenient, real-time healthcare experience for people living with pre-diabetes. Insights gleaned from the data can improve the quality and accessibility of peoples’ care, and help foster a spirit of cooperation between patients, communities and health providers.

No data is more personal than health data, and patients expect extra privacy protection if they are to participate in Big Data projects. One simple approach is to anonymize the data. Even for internal reporting and research, providers would not be able to gain access to identity information, and this is reassuring to patients..

Will England become, “The most successful country on the planet at implementing a national diabetes prevention program”? Will the Troika successfully prevent pre-diabetics from developing type-2 diabetes? If the Troika’s program fails to improve patient outcomes, who will be held responsible?