Today, we’re launching Healthier Lives, Diabetes: a new tool to track how we’re tackling diabetes in different areas of England.
What’s new is the way it illustrates the risk factors for and care of people with diabetes across different communities – allowing users to see, for example, how the care for people with diabetes can vary by local authority, by Clinical Commissioning Group (CCG), and even by GP practice.
We’re hoping that by presenting the information through interactive maps, we’ll make it easier for the public as well as health professionals and local authorities to understand where and how to focus our resources so we can do better to prevent and manage diabetes.
This is the scale of the problem we face: last year, 2.7 million adults (aged 17 years and over) had diagnosed diabetes – or 6% of the adult population. But once you take into account the large numbers of people who have the condition and who haven’t been diagnosed, the true prevalence is probably closer to 7.5%. These numbers include the two main types of diabetes, Type 1 (an auto-immune condition) and Type 2 (which occurs when the body stops producing enough insulin or becomes resistant to the effect of insulin produced – accounting for the vast majority of diabetes cases).
The numbers of people with diabetes is set to rise, driven primarily by an ageing population and worsening trends in obesity, which is closely linked to Type 2 diabetes: people who are overweight have a threefold increase in risk of Type 2 diabetes, which rises to seven times for those who are obese. On current trends, it’s estimated that there will be over 4 million adults with diabetes, both diagnosed and undiagnosed, by 2030.
There are several messages we hope this tool will help us get across.
The first is that diabetes can be a devastating condition: it’s a major cause of premature death and disability; people with Type 1 diabetes are 129% more likely to die than their peers in the general population whilst those with Type 2 diabetes are at 34.5% additional risk of dying.
Diabetes can lead to several long-term conditions. One of the diseases that’s increased in people with diabetes is cardiovascular disease. People with diabetes have a 73.7% greater chance of being admitted to hospital with heart failure, are 55.4% more likely to have a heart attack and are 34.3% more likely to have a stroke than the general population. Approximately 120 people with diabetes have a limb amputated each week. A recent review found that depression was nearly twice as high in people with Type 2 diabetes compared to those without the disease, although the study doesn’t allow us to say that there’s a causal relationship between depression and diabetes.
The second message is that the risk of developing Type 2 diabetes can be reduced. In the US, a randomised controlled trial – the strongest form of evidence we can collect – found that an intervention to intensively promote a healthy lifestyle in adults at high risk of diabetes managed to reduce the incidence of Type 2 diabetes by over 50% over nearly three years, compared with placebo. The lifestyle intervention involved sustained weight loss through a combination of diet and increased physical activity (giving medication was also effective, but less so). A long term follow-up showed that benefits of this lifestyle intervention can last ten years and are cost-effective.
And finally, we think it’s important that the Healthy Lives tool highlights variations in the care that’s offered to people with diabetes as well as variations in how well their condition is managed. Diabetes is a disease that we know a lot about: we know what good care and treatment look like. There are eight care processes recommended by the National Institute for Health and Care Excellence (NICE) that people with diabetes can expect, shown in the tool. They include things like monitoring blood glucose, blood pressure and cholesterol and tests to identify complications early (foot checks and eye screening for example).
If we’re going to improve the outcomes for people who have diabetes, it’s key that we understand and tackle the pattern of variation shown in the tool that we’re publishing today. The percentage of people with diabetes that have received all the recommended care processes ranges from 30% to 78% at Clinical Commissioning Group (CCG) level. There is also considerable variation in the proportion of people where the future risk of diabetes-related complications is minimised: 48% of people with diabetes meeting blood glucose, blood pressure and cholesterol targets in the best performing CCG compared to only 28% in the lowest CCG. The extent of variation at GP practice level is even greater and is not linked to the level of deprivation in the local population.
There is clear scope to improve the quality of diabetes care across all areas of England as nationally only 6 in 10 people with diabetes received all care processes and only about 1 in 3 are meeting all treatment targets. Improving the achievement of these indicators in the worst performing areas to the national average would go a long way to improving outcomes in people with diabetes across England. But it’s also crucial that we improve the average as well.
Ultimately, our ambition is that this tool drives action. As individuals we can take steps to reduce the risk of developing Type 2 diabetes altogether or reduce the risk of complications through a healthy lifestyle. Taking up an offer of an NHS Health Check is another positive thing we can do as individuals. But we’re also hoping that by publishing this tool, we’ll kick-start a constructive debate – in GP practices, hospitals, local authorities, voluntary groups, CCGs – about what more we can do collectively to reduce variation and improve both the prevention and treatment of diabetes across the population.