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Summary

Adults :: Diabetes :: Summary

Diabetes is a disease in which the amount of glucose in the blood is too high because the body cannot use it properly. There are two main types of diabetes:
• Type 1 diabetes — where the body fails to produce insulin, accounting for 10% of people with diabetes
• Type 2 diabetes — where the body cannot produce enough insulin and is resistant to what is produced, accounts for the remaining 90% of people with diabetes.

Type 2 diabetes is often associated with being overweight and usually appears in people over 40, or over 25 in south Asian and African Caribbean people. More recently, a greater number of children are being diagnosed with Type 2 diabetes.

Diabetes can have profound effects on health. People with diabetes are at increased risk of developing various forms of cardiovascular disease (e.g. angina, heart attacks, heart failure, strokes, pain in the legs on walking and foot ulcers that may result in the need for amputation).[1] Approximately 75% of people with diabetes develop cardiovascular disease. Prolonged exposure to raised blood glucose levels can also damage the eyes, kidneys and nerves. Diabetes is the leading cause of blindness in people of working age, the largest single cause of end stage renal failure and the second most common cause of lower limb amputation. This places a significant burden on health and social services.

Life expectancy is reduced, on average, by more than 20 years in people with Type 1 diabetes and by up to 10 years in people with Type 2 diabetes.[1]

Key issues and gaps


• Diabetes is on the increase in Medway. This might be explained by the increasing prevalence of obesity and an ageing population.
• There are over 14,065 adults aged over 17 (6.3%) known to have diabetes in Medway (QOF March 2011)
• By 2030, it is estimated that over 19,000 will have diabetes in Medway. Most of these cases will be Type 2 diabetes mainly because of our ageing population and the rising numbers of people who are overweight or obese
• Proportion of people with diabetes receiving all 9 care processes
• There is variation in the management of diabetes in primary care
• Care for adults with Type 1 on insulin pump is patchy
• Information on the provision of diabetes services for children and young people
• Information is on the provision of diabetes services for women with gestational diabetes

Recommendations for Commissioning

Commissioning plans for all services for people with diabetes should include:
• The projected growth in the number of people with diabetes

Prevention and early intervention


• Proactively identify people with undiagnosed diabetes and promote timely and appropriate access to services
• Address increasing incidence of diabetes by targeting high risk groups, promoting prevention, and increasing detection
• Continue the roll out of Health Checks Outreach programme focusing on men and young age groups. The early detection and active management through the NHS Health Check, tackling: obesity, smoking, poor diet, blood pressure and physical activity should contribute towards prevention of diabetes.
• Raise public awareness of diabetes and the importance of the screening programme and ensure the service is commissioned to provide at least 80% screening uptake and that appropriate activity is commissioned in secondary care for ongoing treatment and monitoring of people with diabetic eye disease

Primary care and Community services


• Implement agreed local pathways for patients' care that would reduce fragmentation and delay
• Ensure appropriate training and education for health professionals
• Ensure structured integrated care between primary care, community, acute care and self management
• Addressing the variations in clinical outcomes between practices will contribute to the reductions in complications and related hospital admissions
• Review prescribing of drugs for diabetes with a view to discouraging excess prescription of the newly available drugs for diabetes
• Ensure the provision of a seamless personalised patient centred care plan

Hospital services


• Review current service provision for children, young adults and pregnant women
• Review the commissioning of insulin pumps


References

[1]   Department of Health. The National Service Framework for Diabetes: Standards 2002; Department of Health. http://bit.ly/ICJaSC .