Document type
Patient information
Hertfordshire and West Essex ICB
Output type
Clinical Pathways

Pre Diabetes

Patients are considered to be high risk of diabetes with a HbA1c between 42-47 mmol/mol (6.0-6.4%) or Fasting Plasma Glucose between 5.5-6.9 mmols/I within the last 12 months.

All patients at high risk of diabetes should be advised on lifestyle, exercise and diet, personalised to their needs.  GPs should supply local advice leaflet on lifestyle and self-management.

Dietary advice for prevention of type 2 diabetes:

  • Energy restriction to induce 5-7% weight loss
  • Dietary modification
    • Moderate total fat intake (<35% total energy intake)
    • Reduced saturated fat intake (<10% total energy intake)
    • Increased dietary fibre intake (>15g/1000kcal)

Avoid: High fat, high glycaemic index or low dietary fibre diets e.g. red and processed meat, potatoes, sugar sweetened beverages, refined carbohydrates.

Dietary patterns with decreased risk (should be individualised to each patient): Plant based, vegan and vegetarian, Mediterranean, Nordic, DASH (Dietary approaches to stop hypertension), moderate carbohydrate restriction e.g. wholegrain products, fruit and vegetables, dairy products, coffee and tea.

(Dietary advice from Diabetes UK – Evidence-based nutrition guidelines for the prevention and management of diabetes – March 2018)

Physical activity - aim for at least 30 mins/day or 150 mins/week of moderate/vigorous activity (following risk assessment for safety to exercise – see physical activity pathway for more detail).

Overweight or obese patients should be managed as per the management of overweight and obese adults’ pathway, including raising the issue of weight, assessing motivation, brief intervention/motivational interviewing and considering Tier 2 referral (consider referral to the NHS Digital Weight Management Programme), Tier 3 if BMI >50.    

Higher risk patients (HbA1c between 42-47 mmol/mol or Fasting Plasma Glucose between 6.5-6.9 mmols/I) can be referred to the Hertfordshire Diabetes Prevention Programme. Once identified as eligible, clinicians should assess patients’ motivation for change and encourage uptake to the programme. Provide the patient with a "Diabetes Prevention Programme – Healthier You” leaflet, and follow referral process as below.


Referral criteria for Hertfordshire Diabetes Prevention Programme:

Your patient is eligible if they are motivated to take part in light exercise and meets the following criteria:

  • Aged over 18
  • Not pregnant
  • Registered with a GP in Hertfordshire or west Essex
  • Patients with HbA1c results between 42–47mmol/mol or Fasting plasma glucose result between 5.5-6.9 mmols/l within past 12 months - consider for referral to the NHS National Diabetes Prevention Programme Referral
  • How to refer

To refer an individual to the Healthier You Programme, please ensure they meet the eligibility criteria then complete the referral form which is embedded into your clinical system and send it to:

              NHS email: