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. 2025 Jun 26;15(6):e093955.
doi: 10.1136/bmjopen-2024-093955.

Expert consensus on solutions to improve implementation of NICE type 2 diabetes guideline (NG28) by health systems in England: a Delphi panel by the INNOVATE-28 Working Group

Waqas Tahir  1 , Hannah Beba  2   3 , Gail Fortes-Mayer  4 , Partha Kar  5 , Nazish Khan  6   7 , Nicola Milne  8 , Jim Moore  9 , Sharvanu Saha  10 , Marc Atkin  11
Affiliations

Expert consensus on solutions to improve implementation of NICE type 2 diabetes guideline (NG28) by health systems in England: a Delphi panel by the INNOVATE-28 Working Group

Waqas Tahir et al. BMJ Open. .

Abstract

Objectives: To provide expert consensus recommendations to support health systems in England to improve prioritisation and implementation of cardiovascular and renal risk-based type 2 diabetes (T2D) care, achieving quality improvement in line with the National Institute for Health and Care Excellence (NICE) NG28 guideline.

Design: A two-round modified Delphi panel was conducted.

Setting: Participants represented health system leadership from a cross-section of integrated care systems across England. Delphi panel statements were relevant to both primary and secondary care.

Participants: A panel of 28 participants took part in the Delphi panel (10.7% drop-off rate between rounds). Statement development was guided by a separate committee of 11 topic experts, forming the Implementing NICE NG28 by harnessing Opportunities for adVanced integrated cAre Transformation and Excellence (INNOVATE)-28 Working Group.

Results: In total, 84% (n=32/38) statements reached consensus across both Delphi rounds. There was agreement that health systems need to prioritise prevention of cardiovascular and renal complications in T2D, particularly for those at 'high' or at 'rising' cardiovascular and renal risk. Consensus was also reached that quality improvement should be incentivised based on local population needs, with investment into digital systems and supporting roles to aid this. Panellists further agreed that investment should be channelled into community-led resources to reinforce a preventative approach and help to ensure people living with T2D receive care in the most appropriate setting. Finally, collaboration between health and social care, health innovation networks and industry partners was highlighted as an opportunity to leverage support for the delivery of risk-based T2D care.

Conclusions: The recommendations from this Delphi panel are intended to support health systems to consistently implement the NG28 guideline and facilitate quality improvement to deliver equitable T2D care and mitigate cardiovascular and renal risk. By being innovative and bold with commissioning and ways of working, and leveraging partnerships, health system leaders can enact the transformational and sustainable change needed to improve outcomes for people living with T2D, tackle healthcare inequalities and optimise system resilience.

Keywords: Cardiovascular Disease; Delphi Technique; Diabetes Mellitus, Type 2; Kidney & urinary tract disorders; Risk management.

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Conflict of interest statement

Competing interests: WT: Funding received from the following companies for providing educational sessions, attendance at conferences and for attending advisory boards: Abbott, Amarin, AstraZeneca, Bayer, Boehringer Ingelheim, Dexcom, Eli Lilly, European MedTech, Menarini, MSD, Napp, Novo Nordisk, Roche and Sanofi. HB, GFM, PK: No conflicts of interest disclosed. NK: Recipient of an NIHR Research for Patient Benefits grant. NM: Funding received from the following companies for providing educational sessions, attendance at conferences and for attending advisory boards: Abbott, Ascensia, AstraZeneca, Bayer, Boehringer Ingelheim, Eli Lilly, Menarini, MSD, MyLan, Napp, Novo Nordisk, Roche, Sanofi, and Takeda. JM: Funding received from the following companies for providing educational sessions, attendance at conferences and for attending advisory boards in the past year: AstraZeneca, Bayer, Boehringer Ingelheim- Lilly, Cuviva, Daiichi-Sankyo, Novartis, Medtronic, Roche. SS: Funding received from the following companies for providing educational sessions, attendance at conferences and for attending advisory boards: AstraZeneca, Boehringer Ingelheim, Eli Lilly and Novo Nordisk. MA: Consulting for AstraZeneca, Boehringer Ingelheim, Eli Lilly, Janssen, MSD, My mHealth, Novo Nordisk and Sanofi.

Figures

Figure 1
Figure 1. Summary of Delphi panel participants. (A) Geographical spread of panellists; (B) roles within integrated care systems occupied by panellists recruited. *One participant with this role did not complete Round 2.
Figure 2
Figure 2. Key consensus recommendations from the Delphi panel. AHP, allied health professional; CV, cardiovascular; CVD, cardiovascular disease; HIN, health innovation network; NHS, National Health Service; T2D, type 2 diabetes.
See this image and copyright information in PMC

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