Comment: Diabetes – the crisis
By Barbara Young
Diabetes is the health crisis the general public, the government and the health service should have at the top of their agenda.
The numbers are already alarming with 2.9 million people across the country diagnosed with the condition and an estimated 850,000 who have Type 2 diabetes but don't know. And the current crisis is only worsening. If the country's unhealthy lifestyle continues, the diabetes population, the vast majority of whom have Type 2 diabetes – the form of the condition primarily linked to lifestyle – will reach a staggering five million by 2025.
The problem with diabetes is many people do not realise just how serious the condition is. It is not 'just having a touch of sugar' and is never 'mild'. There's nothing mild about the complications diabetes could lead to such as having a heart attack or stroke, or losing your limbs and your sight. But diabetes is both a preventable and manageable condition and there is no reason why people should not live long and healthy lives if they have access screening and risk assessments, healthy lifestyle support, early diagnosis, high quality care and are informed and empowered to manage their condition.
There are two main types of diabetes. Type 1 diabetes develops when insulin-producing cells in the pancreas are destroyed. This type of diabetes usually appears before the age of 40 and accounts for around 10 per cent of all people with diabetes. Type 1 diabetes cannot be prevented, it is not known why it develops and it is not connected with being overweight. People with Type 1 diabetes have to take insulin either via a pump or by injections several times a day to stay alive.
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. Type 2 diabetes usually affects people over 40 (over 25 in people from South Asian and Black backgrounds). It can be treated with a healthy diet and physical activity but Type 2 diabetes is a progressive condition and people often go on to take medication and insulin injections. In around 80 per cent of cases the condition is linked with being overweight and can go undetected for up to ten years.
Alarm bells have been ringing for some time, but the state of the country’s health and that of the NHS hangs in the balance. The NHS currently spends ten per cent of its budget, the equivalent of one million pounds an hour, on diabetes. However, the vast majority of this is used in treating the complications of diabetes and not the condition itself. The health service needs to ensure people are screened for their level of risk to enable prevention and early diagnosis. Ensuring people diagnosed with diabetes are able to manage their diabetes effectively in order to reduce their risk of developing long term complications such as heart disease, stroke, kidney failure, blindness and amputation should also be the long term goal of the health service.
As diabetes is a condition affecting many different parts of the body, it often requires a complex web of care from different healthcare specialists including a consultant or GP, Diabetes Specialist Nurse, podiatrist, dietician and ophthalmologist. There are also a number of basic health checks such as blood glucose, blood pressure, blood cholesterol, eyes and feet checks which should be carried out at least once a year.
Every person with diabetes should expect and receive a minimum but good standard of care. However, Diabetes UK is aware that some people may not even know that there is a minimum level of care that their health service should be providing them or what this level of care is. So Diabetes UK has produced the 15 measures, a 15-point checklist outlining what annual checks you should be receiving and the results recorded.
The tragedy is that for many people with diabetes, complications could have been avoided if the health checks were in place to spot any signs and if the appropriate care and treatment were applied. Ninety per cent of cases of sight loss could have been avoided if diabetic eye disease had been identified early enough and treated appropriately. Data also shows that diabetes causes 100 amputations a week, of which an estimated 80 per cent could have been avoided if feet checks and appropriate treatment were carried out early enough.
The 15 measures are not just about the basic health checks that should be undertaken, but they also inform people of the types of specialist services they should expect to help them with their diabetes management. For example, if a person with diabetes feels they require emotional or psychological support to help them manage their diabetes, their health service should provide them with the opportunity to see a qualified psychologist or trained counsellor.
More than ever, now is the time for people to take control of their health against the backdrop of the government's health reforms. Many of the principles of the government's plans sound fine such as the pledge of "no decision about me without me", as patient-centre care is now widely understood to be the way forward. However, Diabetes UK is greatly concerned with the plans around competition and choice. People with diabetes, some of whom may be struggling with controlling their condition, do not want to 'shop' around for the different elements of their care. They want healthcare professionals to work together to provide them with the integrated care they need.
Diabetes UK is concerned that competition will only succeed in creating a more fragmented diabetes care service, which could have dire consequences on the long-term health of people with diabetes and impact on an already over-burdened health service budget.
Diabetes is a ticking timebomb for people and the health service. But with the right resources and high quality care, it can be defused.
Barbara Young is chief executive of Diabetes UK
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