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Written on 17th April 2023 by Richard Money-Kyrle

Leading diabetes charity, Diabetes UK, is calling on the government to prioritise a national recovery plan for long term conditions to prevent delayed diabetes care from causing further harm to the NHS and its patients.

The charity has reported that more than 5 million people in the UK are living with diabetes. Their latest estimate is based on national data which shows that more than 4.3 million people in the UK are already known to have the condition, whilst a further 850,000 people may be unaware that they have diabetes but have not yet been diagnosed. 

These figures are the highest ever recorded for diabetes in the UK. They also come at a time when people at risk of developing type 2 diabetes are not receiving adequate support to reduce risk and prevent the condition, and those who have diabetes are struggling to access safe levels of care.  Type 2 diabetes and its risk factors disproportionately affect people of Black and Asian ethnicity and those living in deprived areas but these people are also worst affected by failings and gaps in NHS and community based diabetes care.

Diabetes is serious. Its life-threatening complications can lead to heart failure, stroke, kidney failure, blindness, amputations and increase the risk of death from other conditions such as covid-19.

Diabetes UK’s Diabetes is Serious 2022 report: Recovering diabetes care: preventing the mounting crisis reveals that the UK is facing an unprecedented, escalating diabetes crisis which needs urgent intervention, supported by adequate government funding, to prevent further avoidable harm and provide equitable care.

What is diabetes?

Diabetes is a serious condition in which the affected person’s blood glucose (sugar) is too high because the body does not produce enough insulin to control the blood sugar effectively. Around 8% of people with diabetes have type 1 diabetes, which is caused by the immune system destroying the cells which produce insulin. Around 90% of people with diabetes have type 2, which is caused by the body developing resistance to insulin, and is often related to specific risk factors and lifestyle. 

Signs and symptoms of diabetes include feeling very thirsty, frequent urination particularly at night, feeling more tired than usual or losing weight without trying. Many people with type 2 diabetes don’t realise that they are developing the condition, missing opportunities to reverse or delay it with changes to their weight, diet and lifestyle, and reduce the risk of serious harm to their cardiovascular system, eyesight, limbs and general health.

Diabetes risk factors and complications

Risk factors for type 2 diabetes include age, family history, ethnicity and obesity. Social factors such as poorer income, education, housing, and poor access to healthy food and healthcare also increase the likelihood of poor health, obesity and type 2 diabetes. Asian, Chinese, Black African and Black Caribbean people are between two to four times more likely to have diabetes than White people, and develop type 2 diabetes at lower weight levels.

Diabetes is serious.  It can cause life-threatening complications if not managed with proper care and support. Diabetes UK report that diabetes leads to more than 190 amputations, 770 strokes, 590 heart attacks and 2300 cases of heart failure in the UK each week. Having diabetes as a comorbidity or additional health condition also increases the mortality (death) risk from other conditions. During the first wave of the pandemic, one in three people who died from covid-19 also had diabetes. The higher covid mortality rate continues to affect people with diabetes, even amongst those who have been vaccinated. 

Diabetes is becoming increasingly expensive for the NHS, costing £10 billion or 10% of its total budget each year. People with diabetes occupy one in six of all hospital beds. In 2021/22, 60.3 million items were prescribed for people with diabetes in England, compared with 42.5 million prescriptions 10 years ago.

NICE guidelines say that people with diabetes should regularly receive eight ‘care processes’, including measurement of their blood sugar (HbA1c) and blood pressure, and foot checks, and treatment should ensure that their HbA1c, cholesterol and blood pressure are within target levels.  Diabetes UK says that safe diabetes care must also include regular reviews and a care plan agreed with a health care professional, access to education about how to manage diabetes, emotional and psychological support with access to more specialist support including weight management when needed, and access to diabetes technology and facilitated peer support to help them manage their condition.

Findings and statistics from Diabetes UK’s report: Diabetes is Serious 2022

Diabetes UK reports that there is a diabetes crisis in the UK:

·       One in 14 people in the UK now have diabetes, with diabetes registrations having doubled in the last 15 years.

·       More than 2.4 million people in the UK are at high risk of type 2 diabetes based on their blood sugar levels.

·       850,000 people in England may have undiagnosed type 2 diabetes, possibly increased during the pandemic.

Diabetes UK believes the most significant modifiable risk factor for diabetes is obesity or being overweight. Reducing obesity is key to lowering the numbers of people with type 2 diabetes and address inequalities in health outcomes. This makes it all the more concerning that the UK is now the third most overweight country of all G7 economically developed countries. In 2018/19, 87% of new diagnoses of type 2 diabetes were in people in the overweight or obese BMI categories. 64% of adults in England are now overweight or obese, and the UK has recently seen the greatest increase in childhood obesity since records began. 

Diabetes is now becoming more common in younger people. 122,780 people under the age of 40 have type 2 diabetes. More than 1,500 of these are under 19 years old. This is a particularly worrying trend because type 2 diabetes in children is often more aggressive than in adults, with more rapid onset of complications at a younger age, threatening their long-term health and future quality of life.  

Diabetes UK conducted a survey which asked 10,000 people with diabetes about their experience during the pandemic. The responses revealed that:

·       47% had difficulties managing their condition during 2021. 

·       29% had no contact with their diabetes healthcare team during 2021 and 18% have had no contact with their diabetes healthcare team since before the pandemic.

·       A quarter had at least one consultation cancelled that had still not taken place by the end of 2021, with nearly a third waiting between one and two years, and a tenth waiting over two years.

·       In 2020/21 only 37% of people with diabetes received all eight care processes, compared to 58% in 2019/20 particularly in the most deprived areas. In addition, fewer people received screening for diabetic eye conditions.

·       80% of 18 to 25-year-olds had difficulty managing their diabetes in 2021, finding it hard to access emotional and psychological support from their diabetes healthcare team, and causing anxiety, worry or stress.

·       People living in poverty and deprivation were less likely to be able to access digital healthcare introduced since the pandemic.

Meanwhile, NHS health checks to prevent and diagnose type 2 disease were severely reduced during the pandemic, leading to reduced rates of diagnosis particularly in older people, men, and in those from deprived areas.

Risk of harm to people with diabetes from mistakes in hospital care

The report also highlighted concerns raised in other reports, such as by GIRFT, about the risk of harm to people with diabetes in hospital from a lack of medical knowledge about their condition and specialist care.  Specialist diabetologists’ general medicine and emergency workloads have increased, especially since the pandemic, leaving them less available to provide specialist input for patients with diabetes receiving inpatient and outpatient care.  

Other healthcare staff often lack knowledge about diabetes and its treatment, leading to medication errors in almost one third of inpatient stays for patients with diabetes. Despite the growing numbers of patients with diabetes, 18% of hospitals do not have a Diabetes Specialist Nurse DSN service. Diabetes UK says that poor management of diabetes in hospital has a devastating impact on an individual’s healthcare and leads to delays in surgery and other important treatments. Avoidance of harm for people with diabetes in hospital depends on diabetes inpatient care teams providing expert knowledge and care plans to support safer and shorter hospital stays for patients in A&E and other specialties such as surgery and cardiology.

The charity is calling on the government to prioritise a national recovery plan for long term conditions to prevent the consequences of further delayed diabetes care for the NHS and the harm that will be suffered by its patients.

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