We are delighted that NHS England have now decided to roll out the National Diabetes Prevention Programme (NDPP).  This new Programme starting in July 2016 incorporates and mirrors one specific strand of this Pre-Diabetes Project, namely the offering of a lifestyle approach to counselling and support for patients who already have signs of Pre-Diabetes.  The criteria are to be over 18yrs old, known to be at risk, with an HbA1c of 42-47, or raised Fasting Plasma Glucose.  Exclusions include known diabetes, and pregnancy.  Falkland Surgery has been selected to be one of the earliest adopters, based on our previous experiences, and we have already (May 2016) sent out our first invitations to 64 patients.

As a result we expect to “wind down” our local initiatives, but will continue to strive for earlier detection and recording of patients at risk of developing diabetes and hope as the National Programme develops it too recognises the importance both of treatment but also detection of risk.


This site is dedicated to recording our particular experience of identifying patients at risk of developing Diabetes Mellitus within a local health economy of around 100,000 patients surrounding Newbury, Berkshire in the UK.

We are going to implement the QDiabetes tool from QResearch in Nottingham. This is a software tool that can be used to identify future risk of developing Diabetes Mellitus either for individuals or across a population.

We will be using Eat4Health as our lifestyle intervention, as it is already established in the area and combines both healthy eating and exercise/lifestyle education.

We will be logging our progress and uploading files and resources as we find and identify them. We hope others will be able use this as a source of inspiration and advice to reproduce the process elsewhere.

Funding for the actual intervention has come from Newbury and District Clinical Commissioning Group as a Quality Improvement project.  This website and associated information and analysis kindly supported by a QInnovation grant from QResearch (a joint not-for-profit partnership between Emis plc, Emis NUG and University of Nottingham).


Final Results back from those practices signed up for the Enhanced Service

Results in from the practices reporting back (covering 55,000 patients)  we have

Average increase in Diabetic Register 24 patients per practice

Average increase in Pre Diabetes Register 78 patients per practice

Average reduction in miscoded / uncoded Diabetes 18 patients per practice

Falkland Surgery reported an increase in Diabetes Prevalence of 100 patients over a two year period.