Diabetes

Introduction

Diabetes is a common life-long health condition which affects all age groups. It is a condition where the amount of glucose in the blood is too high because the body cannot use it properly. Public Health England data states that 6% of the population is affected by diabetes of which there are two main types:

• Type 1 – an autoimmune condition resulting in ‘insulin dependence’ as the person’s pancreas fails to produce any insulin to control blood glucose levels, and therefore requires insulin injections for life
• Type 2 – the more common type of diabetes is known as ‘insulin resistant’ and accounts for 90% of adults with diabetes

Type 2 diabetes (approximately 90% of diagnosed cases) is partially preventable by lifestyle changes (e.g. exercise, weight loss, healthy eating). Earlier detection of type 2 diabetes followed by effective treatment reduces the risk of developing diabetic complications.

Diabetes can have a major impact on the physical, psychological and material well-being of individuals and their families, and can lead to complications such as heart disease, stroke, renal failure, amputation and blindness. These risks can be reduced when the disease is well controlled in primary care.

It is a significant health concern as local, national and global prevalence rates are expected to increase with an associated increase in care and treatment costs.

Key inequalities and risk factors

The prevalence of diabetes increases with age, deprivation and ethnicity. Risk factors associated with developing type 2 diabetes include:

• having parents, or a brother or sister, with type 2 diabetes
• being overweight or obese – having a waistline greater than 94 cm (37 inches) for men or greater than 90 cm (35 inches) for men of South Asian origin. For women, having a waistline greater than 80 cm (31.5 inches)
• being more than 40 years old or, for people of South Asian origin, more than 25 years old
• being of Black African, Caribbean origin (3 times more likely to develop type 2 diabetes) or South Asian origin (6 times more likely to develop type 2 diabetes)
• the higher risk communities of South Asian, Chinese, African-Caribbean and those of black African descent tend to develop diabetes at a younger age and they also tend to progress from impaired glucose tolerance to diabetes much more quickly (Webb E.R et al, 2011, p. 280-285).
• being a woman who has had gestational diabetes or has had a baby weighing more than 4.5kg (9.9lbs) at birth
• being an overweight woman with a history of polycystic ovarian syndrome
• having a history of high blood pressure, a heart attack or stroke
• having ever experienced higher than normal blood glucose levels – impaired glucose regulation (IGR) – also known as impaired glucose tolerance, impaired fasting glucose, non-diabetic hyperglycaemia or pre-diabetes
• people with co-occurring high depressive symptoms and cardiometabolic abnormalities (such as cardiovascular disease) also have an increased risk of developing type 2 diabetes.

With the population of Bracknell Forest ageing in line with the national trend plans need to be put in place for prevention, early diagnosis and ongoing management of diabetes for residents.

Facts, figures and trends

There are approximately 3 million people currently diagnosed with diabetes in the UK.  Around 90% have type 2 diabetes, which usually appears in people over the age of 40 (and from the age of 25 in South Asian and black people who are at greater risk of developing diabetes). Annually it is estimated that 24,000 deaths are associated with diabetes (HSCIC, 2013)

Type 1 diabetes develops if the body cannot produce any insulin. It usually appears before the age of 40, especially in childhood. It is the less common of the two types of diabetes, and accounts for about 10 per cent of adults with diabetes. It cannot be prevented and it is not known why exactly it develops. Type 1 diabetes is treated by daily insulin doses by injections or via an insulin pump.

Type 2 diabetes develops when the body can still make some insulin, but not enough, or when the insulin that is produced does not work properly (known as insulin resistance). Type 2 diabetes is treated with a healthy diet and increased physical activity. In addition, tablets and/or insulin can be required.

This short video on diabetes and how to help manage the condition is from the council’s YouTube channel:

YouTube video link

Predicted prevalence

The Public Health England Diabetes Prevalence Model estimates the total (diagnosed and undiagnosed) number of people with diabetes. Estimates are adjusted for the age, sex, ethnic group and deprivation pattern of the local population.

According to the estimated prevalence report for Bracknell Forest, if current trends in population change and obesity persist the total prevalence of diabetes is expected to rise to 6.7% by 2020 and 7.6% by 2030.

Recorded prevalence

The Public Health Outcomes Framework reports the prevalence of diabetes recorded in the population registered with GP practices aged 17 and over:

The data shows that in 2014/15, the prevalence of diabetes is lower in Bracknell Forest than the south east and England averages.  This rate is increasing year on year, but is doing so at a lesser rate in Bracknell Forest compared to the south east region and nationally.

It is promising that the 2014/15 recorded figure (5.3%) is less than the 2015 predicted prevalence for Bracknell Forest  (6.2%), but this should be treated with caution as the 0.9% difference between actual rates and expected rates may be due to the ‘missing’ undiagnosed population in the area.

The Bracknell Forest and Ascot CCG Intelligence pack (Public Health England, 2016) cites data from the Health Survey for England to suggest a further 2.4% of adults have undiagnosed diabetes and that approximately 30% of all diabetes is undiagnosed. Left untreated, it can lead to a range of serious conditions including kidney disease, arterial damage that increases the risk of a heart attack, peripheral nerve damage (neuropathy) and damage to the retina of the eye (retinopathy) which can lead to blindness.

Diabetic retinopathy

Diabetic retinopathy is one of the most common causes of sight loss among people of working age. It is is caused by high blood sugar levels damaging blood vessels in the eye. They may become blocked, have excess fluid or leak, causing blurred visions, and in worst case, blindness.

Regular screening allows prompt identification and effective treatment if necessary of sight threatening diabetic retinopathy.  The NHS Diabetic Eye Screening Programme is essential for identifying retinopathy at an early stage. Every individual over the age of 12 with diabetes should be invited for a screening once a year.

Prevention

NHS Health Checks are for patients between the ages of 40 and 74 who will be invited (once every five years) to have a check to assess, raise awareness and support them to manage their risk of developing type 2 diabetes.

Modelling suggests that high uptake will lead to substantial reductions in premature mortality and local authorities have a legal duty to make arrangements to provide the NHS Health Check programme to 100% of the eligible population over a five year period and to achieve continuous improvement in uptake.

The percentage of people the eligible population in the Bracknell Forest and Ascot CCG area, aged 40 – 74 years:

• offered  an NHS Health Check per financial year has improved from 14.3% in 2013/14 to 19.3% in 2014/15 which compares favourably with the 19.7% England average
• in receipt of an NHS Health Check per financial year has also improved from 10.5% in 2013/14 to 12.3% in 2014/15 which exceeds the 9.6% England average

The National Diabetes Prevention Programme (NDPP) is a nationally endorsed personalised healthy lifestyle service to help people reduce their risk of developing diabetes.    A  nine month community-based behaviour change programme to help people prevent the onset of Type 2 diabetes was launched across Berkshire from November 2016.

Care and Management

Much of the management and monitoring, particularly for patients with Type 2 diabetes, are undertaken in primary care.

Data on achievement of target levels for blood sugar, blood pressure and cholesterol are measured in the Public Health Outcomes Framework 2014/15.  All are managed well for patients with diabetes, with performance above the England averages. (This is also represented visually on the Healthier Lives: Diabetes portal.) In 2014, there were 5,314 registered deaths attributable to diabetes in England and Wales.

Key care processes

Eight essential care processes (in addition to retinal screening) were established by the National Service Framework for Diabetes and the National Institute for Health and Care Excellence (NICE).

CCG level data from the National Diabetes Audit 2014/15 shows that Bracknell and Ascot CCG perform as well as or better than the England and Wales average on all standards for Type 1 diabetes:

And also for Type 2 and other diabetes:

The  National Diabetes Audit 2013-2014 and 2014-2015 sets out a number of key findings for individuals and care practitioners to consider:

• The percentage of people in England with Type 1 diabetes receiving all 8 care processes was 39.6% compared to 59% with Type 2 diabetes
• People with Type 1 and Type 2 diabetes aged under 40 are less likely to receive all their annual care processes
• Whilst there has been a large increase in records of structured education being offered within one year of diagnosis, more people with Type 2 diabetes are recorded as being offered education (78%) than people with Type 1 (32%)

The 2016 Diabetes UK State of the Nation report brings together evidence from recent national diabetes audit reports covering care processes and treatment targets, inpatient care, pregnancy and foot care.  The report sets out recommended actions to improve the delivery of the 15 healthcare essentials for adults with diabetes, and to improve care for children and young people.

Costs of diabetes

According to the Diabetes UK 2012 State of the Nation report, NHS spending on diabetes was almost £10 billion in 2011, or £1 million per hour, which is 10 per cent of the NHS budget. 80 per cent of NHS spending on diabetes goes into managing avoidable complications. People with diabetes accounted for around 19 per cent of hospital inpatients at any one time, and had a three day longer stay on average than people without diabetes. Most of Type 2 diabetes costs are due to hospitalisation.

In 2014 there were 46.7 million items prescribed for diabetes at a cost of £849,000, an increase from 44.6 million items in 2013 (HSCIC 2014, accessed 01/06/2016.)

In 2014-15 there were 48,581 hospital admissions (84% emergency admissions) with a main diagnosis of diabetes compared to 48,555 in 2013-14 when 81% were emergency admissions. Hospital episodes increase with age and poor achievement of target levels for glucose control, blood pressure and cholesterol for people under 65 may be a contributory factor.

Want to know more?

Diabetes in Adults (NICE, 2011 updated 2015) – defines clinical best practice and provides specific, concise quality statements, measures and audience descriptors to provide patients and the public, health and social care professionals, commissioners and service providers with definitions of high-quality care for adults excluding children, young people and pregnant women.

Diabetes Guidance and Care Pathways (NICE) – a range of interactive care pathways covering risk identification, service commissioning, intervention planning, design and communications, and  training relating to diabetes in children and young people, pregnancy, type 2 prevention, type 1 and 2 in adults, footcare and hyperglycaemia.

Health matters: getting every adult active every day (Public Health England, 2016) – summary facts and figures, descriptions of  physical activity and how benefits extend beyond physical health to include mental wellbeing, and how it can be used in a number of care pathways for cancers, diabetes, dementia, cardiovascular disease, falls and hip fractures.

Impact of body mass index and waist circumference on the long-term risk of diabetes mellitus, hypertension, and cardiac organ damage (Bombelli M. et al, 2011) – Obesity is associated with a higher risk of developing diabetes mellitus (DM), hypertension (HT), and left ventricular hypertrophy (LVH). The present study assessed in the general population the impact of body weight and visceral obesity on the development of alterations in glucose metabolism and cardiac structure, as well as of elevation in blood pressure.

National Diabetes Audit – 2013-2014 and 2014-2015: Report 1, Care Processes and Treatment Targets (NHS Digital, 2016) – a comprehensive view of Diabetes Care and measures the effectiveness of diabetes healthcare against NICE Clinical Guidelines and NICE Quality Standards, in England and Wales. This national report presents key findings and recommendations on care processes and treatment target achievement rates from 2013-2015 in all age groups along with information on offers and attendance for structured education places.

National Service Framework for Diabetes (Department of Health, 2001) – sets out government standards for the provision of high quality services in 9 areas, which include the prevention, identification, empowerment and self-care of patients with diabetes, clinical care, reduction in hospital admissions, management and support for long-term complications.

State of the Nation report (Diabetes UK, 2016) – brings together evidence from recent national diabetes audit reports covering care processes and treatment targets, inpatient care, pregnancy and foot care.  The report sets out recommended actions to improve the delivery of the 15 healthcare essentials for adults with diabetes, and to improve care for children and young people.

This page was created on 19 March 2014 and updated on 2 June 2016.

Cite this page:

Bracknell Forest Council. (2016). JSNA – Diabetes. Available at: jsna.bracknell-forest.gov.uk/living-working-well/health-conditions/diabetes (Accessed: dd Mmmm yyyy)

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