Diabetes

If you only read four things:

1.  Type 2 diabetes is far more common than Type 1, and 90% of all adults with diabetes have      Type 2 diabetes.
2.   In 2015/16 6.3% of Suffolk GP registered patients aged 17+ were recorded as having                 diabetes. This is equivalent to more than 40,000 people.
3.  Type 2 diabetes is 2-4 times more likely in people of South Asian, African-Caribbean, or             Black African ethnicities.
4.   It is estimated that there may be approximately 7,500 people with undiagnosed diabetes          in Suffolk.

 

1.Key points

There are two main types of diabetes1:

  • Type 1 diabetes – where the body's immune system attacks and destroys the cells that produce insulin.
  • Type 2 diabetes – where the body doesn't produce enough insulin, or the body's cells don't react to insulin.

Other types of diabetes include:  

Gestational diabetes: This affects pregnant women, usually during the second or third trimester of pregnancy. Women with gestational diabetes don’t have diabetes before their pregnancy, and after giving birth it usually goes away2

More information on the following types of diabetes can be found by clicking on the links. Maturity onset diabetes of the young (MODY), Neonatal diabetes, Wolfram Syndrome, Alström Syndrome

The numbers
  • 2016 data indicates that more than 4 million people in the UK are living with diabetes3.
  • Type 2 diabetes is far more common, and 90% of all adults with diabetes have type 2 diabetes1
  • Nearly 1 in 5 people with diabetes have clinical depression and for those with anxiety and/or depression, health care costs increase by around 50%4.
  • In 2015/16, 6.3% of Suffolk GP registered patients aged 17+ were recorded as having diabetes. This is equivalent to 40,321 people5.
  • It is estimated that there may be approximately 7,500 people with undiagnosed diabetes in Suffolk4.
Risk factors

There are certain factors that can increase the risk of type 2 diabetes in an individual.  Some are potentially modifiable (like being overweight) and some are non-modifiable (such as ethnicity). Some of the key risk factors are outlined below6:

  • Being over 40 years old (for those that are of white ethnicity) increases the risk of diabetes. For people that are African-Caribbean, Black African, or South Asian the risk increases at age 25 and over.
  • Type 2 diabetes is 2 to 4 times more likely in people of South Asian descent and African-Caribbean or Black African descent.
  • You’re two to six times more likely to get Type 2 diabetes if you have a parent, brother, sister or child with diabetes.
  • People that have had or have high blood pressure are more at risk.
  • People that are overweight (especially around the stomach/middle) are at increased risk.

Other people at increased risk:

  • People that have had a heart attack or a stroke.
  • People with schizophrenia, bipolar illness or depression, or if you are receiving treatment with antipsychotic medication.
  • Women who have had polycystic ovaries, gestational diabetes, or a baby weighing over 10 pounds.
The impact
  • Diabetes is an increasing burden of ill health, with Public Health England noting the need for urgent action to lessen the impact on individuals, as well as the health and social care system supporting them7.
  • For the patient themselves, the short-term complications relating to uncontrolled glucose levels in the blood are perhaps the more well-known complications of diabetes.  Namely, hypoglycaemia diabetic ketoacidosis (DKA), and hyperosmolar hyperglycaemic state (HHS).
  • Regular checkups are essential for these longer-term effects and regulation of blood glucose levels (HbA1c blood test), blood pressure and blood fat measurement.
  • Diabetes is the most common reason for end stage kidney disease and the most common cause of blindness in people of working age4.
  • If a person has diabetes, their eyes are at risk from diabetic retinopathy, a condition that can lead to sight loss if it's not treated.  Because of this, everyone with diabetes aged 12 or over should be invited to have their eyes screened once a year1.
  • Foot complications are common in people with diabetes with between 5-7% of people with diabetes having a current or previous foot ulceration8.
  • Diabetes is the most common cause of non-traumatic limb amputation, with diabetic foot ulcers preceding more than 80% of amputations in people with diabetes8.
  • Around 50% of people die within five years of developing a diabetic foot ulcer8.
  • Diabetes is also associated with an increased risk of stroke and heart attack7.

Explore more of the data here: 

2.What are the key inequalities in Suffolk?

A large proportion of the data collected relating to diabetes is collated at Clinical Commissioning Group (CCG) level.

Figure 1: Prevalence data for Diabetes, 2012 – 2016

Source: 9

Great Yarmouth & Waveney CCG has consistently had the highest prevalence of diabetes when compared to the other Suffolk CCGs, and when compared to England overall.  In 2015/16, the prevalence of diabetes in Great Yarmouth and Waveney CCG was 7.7%, significantly higher than the average for England at 6.5%. The lowest prevalence of diabetes was in Ipswich and East Suffolk CCG at 5.9%, the prevalence for West Suffolk CCG was 6.4%.

The three treatment targets for the diabetic population are controlling blood pressure (hypertension), blood sugar and cholesterol.  

Table 1: Diabetes control in Suffolk CCGs, 2015/16

 

Figure 2: Risk of other conditions/health events in population with diabetes compared to non-diabetic population, 2010-2013

Source: 9

With the exception of minor amputations, Great Yarmouth & Waveney CCG recorded lower risk compared to national levels. In particular, the risk of myocardial infarction, heart failure and angina were significantly lower in diabetics in this CCG than diabetics across the England population. West Suffolk CCG diabetic patients were significant less at risk from heart failure and angina than national diabetic patients, and had a lower risk of renal replacement therapy. Meanwhile, Ipswich & East Suffolk CCG diabetic patients were recorded as having lower risk of angina.

Recently analysed data at Sustainability and Transformation Partnership (STP) level shows variation in emergency hospital admissions by age below. the Suffolk and North East Essex STP area covers: Ipswich and East Suffolk, West Suffolk and North East Essex. 

Figure 3: Sustainability and Transformation Partnership (STP) emergency admissions

Source: 10

3.Costs

The 2014 Cost of Diabetes Report, highlights the financial cost of diabetes on NHS with £10 billion spent each year. This represents £27.4 million per day or nearly £20,000 per minute.  NICE estimates that each diabetic patient costs £141.78 per year in primary care prescribing costs alone.

4.What are we doing?

A large proportion of Type 2 diabetes cases could be prevented. The recently launched National NHS diabetes prevention programme, which is a joint initiative between NHS England, Public Health England and Diabetes UK, aims to significantly reduce the four million people in England otherwise expected to be living with Type 2 diabetes by 2025.

OneLife Suffolk provides free tips and practical advice on a number of health and wellbeing topics including eating smart, losing weight, stopping smoking and getting active. The NHS Health Check programme available to all 40 – 74 year olds in Suffolk includes a diabetes check.

The Ipswich Hospital Community Diabetes team is part of the integrated service working in both primary and secondary care. The team was also involved in a joint project with the Caribbean & African Health Support Forum and Suffolk County Council, to produce a DVD about type 2 diabetes.

In relation to Diabetes care, Suffolk has a wealth of knowledge and expertise available. Through the Diabetes and Endocrine Centre and the Diabetes Research Unit at Ipswich Hospital NHS Trust, Suffolk is at the forefront of active research. The Specialist Diabetes Team includes diabetologists, specialist diabetes nurses and a specialist dietitian.

In addition, there is a Children and Young Person’s Diabetes Team based at Ipswich Hospital. The team comprises paediatric and adult Diabetes consultants, paediatric, adolescent and adult Diabetes specialist nurses, specialist Diabetes dietitians and a clinical psychologist. This offers comprehensive care for all children with diabetes living in the Ipswich and East Suffolk area, including those with type 1 and type 2 diabetes, as well as rarer causes of diabetes including genetic-related and cystic fibrosis-related diabetes.

5.What else could we do?

Whilst there is no evidence that population-wide screening for diabetes is clinically or cost effective, the actions that have been effective elsewhere include:

  • Ensuring that the uptake of the NHS health check is as high as possible. The health check can detect those already with diabetes, and those at high risk of developing it, and support people to change their lifestyles and reduce their risk.
  • An increased focus on improving performance in relation to the coverage of care processes and the achievement of treatment targets.

6.Recommendations

Complications of diabetes are disability, and are potentially life threatening. There is a significant opportunity to reduce the complications of diabetes, through both identifying and treating the undiagnosed diabetics in Suffolk, together with optimising the management of existing diabetics. Although it is difficult to quantify the potential clinical and financial impact of this, it is likely to be significant – treatment is very effective at preventing complications.

7.Useful links

Diabetes UK: https://www.diabetes.org.uk

NHS Choices: http://www.nhs.uk/Conditions/Diabetes/Pages/Diabetes.aspx

One life Suffolk:  http://onelifesuffolk.co.uk/

8.References

1.       NHS choices. Diabetes. http://www.nhs.uk/Conditions/Diabetes/Pages/Diabetes.aspx. Published 2016. Accessed May 1, 2017.

2.        Diabetes UK. Gestational Diabetes. https://www.diabetes.org.uk/Diabetes-the-basics/Gestational-diabetes/. Published 2016. Accessed May 1, 2017.

3.        Diabetes UK. Number of people with diabetes reaches over 4 million - Diabetes UK. https://www.diabetes.org.uk/About_us/News/Number-of-people-with-diabetes-reaches-over-4-million/. Published 2016. Accessed May 24, 2017.

4.        Suffolk County Council. Suffolk Annual Public Health Report 2015. 2015. http://www.healthysuffolk.org.uk/assets/JSNA/Annual-Report/19673-APHR-2015-LR-20151209.pdf.

5.        Public Health England. Fingertips Disease and Risk Factor Prevalence. http://fingertips.phe.org.uk/prevalence#gid/8000021/ati/102. Published 2017. Accessed April 1, 2017.

6.        Diabetes UK. Diabetes risk factors - Diabetes UK. https://www.diabetes.org.uk/Preventing-Type-2-diabetes/Diabetes-risk-factors/. Published 2017. Accessed May 30, 2017.

7.        Public Health England. 3.8 million people in England now have diabetes - GOV.UK. https://www.gov.uk/government/news/38-million-people-in-england-now-have-diabetes. Published 2016. Accessed May 30, 2017.

8.        NHS England. NHS England » New framework to improve care for patients with diabetic foot disease published. https://www.england.nhs.uk/2016/05/diabetic-foot-disease/. Published 2016. Accessed May 30, 2017.

9.        Public Health England. Diabetes Profile - April 2017. https://fingertips.phe.org.uk/diabetes. Published 2017. Accessed April 1, 2017.

10.       Suffolk Knowledge and Intelligence Team analysis of Hospital Data Interrogation System (HDIS) data Published June 2018.

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