Non-diabetic hyperglycaemia (NDH) - QOF indicator

Non-diabetic hyperglycaemia in QOF

This QOF area covers annual blood glucose monitoring for people with non-diabetic hyperglycaemia (NDH) or previous gestational diabetes, to help detect progression to type 2 diabetes. For 2026/27, NDH003 replaces NDH002 and extends the indicator to women with a history of gestational diabetes mellitus (GDM).

Records

Why this indicator set is included

• NDH, also termed prediabetes, means an HbA1c of 42-47mmol/mol or a fasting plasma glucose (FPG) of 5.5-6.9mmol/l. In March 2025, more than 4.2 million people in England had NDH — approximately half a million more than a year earlier.

• General practice records in March 2025 contained coded histories of GDM for approximately 420,000 women. Hospital records identified an additional 240,000 women with previous GDM.

• Both NDH and GDM substantially increase the risk of type 2 diabetes. NICE guidance PH38, NG3 and QS109 supports offering annual glycaemic testing to people with NDH or previous GDM to detect whether diabetes has developed.

• Substantial NHS investment in behavioural support aims to prevent or postpone type 2 diabetes in these groups. Healthier You: NHS Diabetes Prevention Programme (NHS DPP) is the world's largest programme of this type, with over 1 million participants since its launch in 2016. An independent evaluation found evidence of benefit: completing the programme, defined as attendance at >60% of sessions, was associated with a 37% relative reduction in the risk of developing type 2 diabetes.

• Practices throughout England can refer patients to the NHS DPP. Eligibility requires patients to be aged 18 years or over and either have a blood test showing NDH in the 12 months prior to referral or have had GDM at any time. Women with previous GDM also have the option of self-referral. Participation excludes anyone who is pregnant, has ever had a type 2 diabetes diagnosis, has moderate/severe frailty recorded, has an active eating disorder or has undergone bariatric surgery within the previous 2 years.

NDH003

NDH003 draws on NICE IND172 and IND173.

Rationale

• Under NICE guidance PH38 on preventing type 2 diabetes, all people with NDH should be offered a blood test annually to establish whether they have developed type 2 diabetes.

• The 2026/27 revision broadens the former NDH002 indicator to cover women with previous GDM. NICE guidance NG3 on diabetes in pregnancy already recommends annual blood testing for these women to detect progression to type 2 diabetes. However, National GDM Audit data suggest that only around 50-60% receive annual glycaemic monitoring, leaving substantial scope to increase testing.

• NDH003 seeks to strengthen continuing surveillance of these high-risk groups and identify type 2 diabetes promptly when it develops. Recognising and managing diabetes early is associated with better long-term outcomes. The diabetes section of the guidance sets out the diagnostic criteria.

Reporting and verification

• The indicator definition in the table specifies the requirements for NDH003.

• For the Adjusted Practice Disease Factor (APDF) calculation, the register includes all patients aged 18 or over whose record contains non-diabetic hyperglycaemia, pre-diabetes or GDM, provided this has not been superseded by a diabetes diagnosis other than GDM recorded before the start of the financial year.