Whilst significant time and effort is spent looking after patients with diabetes, this is merely the tip of a larger iceberg of people at risk of diabetes and cardiovascular. This ‘iceberg’ forms the basis for recent (July 2012) NICE guidance on preventing type 2 diabetes, risk identification and interventions for individuals at high risk . This guidance follows the adoption by the WHO of the use of HbA1c as a diagnostic tool (HbA1c >48mmol/mol/ 6.5%) and the identification of people with HbA1c 42-47mmol/mol (6.1-6.4%) as being at high risk – although it is acknowledged that this elevated risk may extend to people with an even lower HbA1c.

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