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The level of need in the population

Adults :: Diabetes :: The level of need in the population

Prevalence

Table 1 shows an increasing trend in the number of people diagnosed with diabetes in Medway, the South East Coast SHA and England as a whole.

2006/07 2007/08 2008/09 2009/10 2010/11
Number Prevalence Number Prevalence Number Prevalence Number Prevalence Number Prevalence
Medway PCT 10,377 5.0 11,562 5.3 12,583 5.8 13,421 6.0 14,065 6.3
South East Coast SHA 152,785 4.3 163,161 4.5 173,644 4.8 183,441 5.0 192,333 5.2
England 1,961,976 4.5 2,088,335 4.8 2,213,138 5.1 2,338,813 5.3 2,455,937 5.5
Table 1: General Practice recorded Diabetes prevalence (patients aged 17 years and over) [1]

Recorded and Expected prevalence

Figure 1 shows the proportion of potentially undiagnosed people for each general practice in Medway.

Figure 1: Recorded prevalence of Diabetes by general practice as at March 2011.
Figure 1: Recorded prevalence of Diabetes by general practice as at March 2011 [1] [2]

The Long Term Condition modelling, suggests that for people in Medway with a diagnosis of diabetes, 11,252 (80%) should be able to achieve blood glucose control (Table 2).

Table 2: Calculated using APHO prevalence model.
Table 2: Calculated using APHO prevalence model which is adjusted for age, sex, ethnicity and deprivation [3]

From QOF data, 6500 (46%) people have achieved glucose control, implying that 4,752 of the 5,326 poorly controlled patients would require additional support to achieve blood glucose control.

Diabetes complications

The complications of diabetes are the final outcomes of care. Of all aspects of diabetes they have the greatest costs to the patient and the health service. Complication prevalence is defined as the number of people who have had one or more records of a specific complication over the defined time period.

Diabetes is associated with a range of complications including eye and foot problems, heart attacks, angina, stroke, kidney disease, nerve damage, sexual dysfunction and short term complications such as hypoglycaemia or diabetes ketoacidosis.

These complications can lead to an increased need for secondary care (including, emergency services) and social care services. Diabetes data to support this are limited, mainly because the patient's primary diagnosis or cause of mortality is a complication due to diabetes, so it is unlikely that diabetes will be diagnosed or coded. Therefore, only a small number of cases of complications are recorded with a primary diagnosis of diabetes (Figure 2).

Figure 2: Prevalence of Diabetic Complications.
Figure 2: Prevalence of Diabetic Complications [4]

Hospital admissions for diabetes

Between 91–93% of patients with diabetes are admitted as emergencies. Poor diabetes control further contributes to the need for emergency admissions. In Medway, non-elective admissions have remained persistently higher compared to elective admissions (Figure 3). This is because most admissions are for short term complications such as diabetic ketoacidosis and hypoglycaemia. This is consistent with the variation in inpatient activity: diabetes tool, which showed that more people in Medway with diabetes (48.8%) are more likely to be readmitted as an emergency after a period of care than those without diabetes. [5]

Figure 3: Trends in hospital admissions by admission method all ages.
Figure 3: Trends in hospital admissions by admission method all ages (2006/07–2010/11 ) [6]

Diabetes Retinopathy

Diabetes retinopathy is the damage to the retina due to complications from the condition and it affects up to 80% of those who have had diabetes for 10 years or more.

Medway PCT South East Coast England
Percentage offered
screening
Percentage
uptake
Percentage offered
screening
Percentage
uptake
Percentage offered
screening
Percentage
uptake
Q3 2009/10 94.4 87.4 98.5 78.4 95.8 77.6
Q4 2009/10 100.0 82.7 98.1 80.6 96.1 77.8
Q1 2010/11 100.0 84.4 97.0 71.4 96.1 77.1
Q2 2010/11 100.0 83.6 97.9 75.1 96.8 77.8
Q3 2010/11 100.0 79.1 92.1 81.3 97.4 78.1
Q4 2010/11 100.0 92.6 93.6 84.3 98.2 79.3
Q1 2011/12 100.0 71.5 96.7 83.5 97.1 78.6
Table 3: Diabetic Retinopathy screening [7]

Between October 2009 and June 2011, the percentage of people with diabetes offered retinopathy screening in Medway PCT has remained consistently high and has been 100% for the past fifteen months. Over the same period, the percentage attending an appointment has shown a downward trend from 87% to 72%.

Diabetes and psychological health

Depressive symptoms affect one in four people with diabetes and it is associated with poor outcomes, lower levels of self care, more days off work and significantly higher medical costs. This group may need significant psychological support. [8]

Changes in need since last JSNA


• Increasing trend in diabetes prevalence: In 2010/11, 14,065 people with diabetes were registered with Medway GPs. An additional 2,503 people have been added onto the diabetes register since 2008/09, implying improved identification of people with diabetes as well as increasing trend in diabetes prevalence
• Establishment of an integrated diabetes service model: An integrated diabetes service is currently being developed for people with diabetes in Medway


References

[1]   The NHS Information Centre for Health and Social Care. The Quality and Outcomes Framework
[2]   Association of Public Health Observatories. Diabetes Prevalence Model
[3]   Department of Health. Supporting People with Long Term Conditions: An NHS and Social Care Model to support local innovation and integration 2005; Department of Health. http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4122574.pdf .
[4]   Yorkshire and Humber Public Health Observatory. Diabetes Community Health Profiles 2011; Yorkshire and Humber Public Health Observatory. http://yhpho.york.ac.uk/diabetesprofiles/default.aspx .
[5]   NHS Diabetes. National Diabetes Inpatient Audit: Full Report 2010; Yorkshire and Humber Public Health Observatory. http://www.yhpho.org.uk/Diabetes_inpatient_audit .
[6]   Health Informatics System Business Intelligence. Secondary User Service
[7]   Department of Health. Diabetic Retinopathy Screening Statement
[8]   Healthcare for London. Diabetes Guide for London 2009; Healthcare for London.