Diabetes

Diabetes

Diabetes is a lifelong condition that causes and individual’s blood sugar levels to increase to very high levels. There are two main types of diabetes these are called type 1 and type 2. The distinction between type 1 and type 2 diabetes is important to understand.
 

Type 1 diabetes which occurs following destruction of cells which usually make insulin (a hormone made in the pancreas), affects more than 370,000 adults in the UK. The lack of insulin results in raises blood glucose levels and associated long and short term impacts on health. It is important that it is detected and treated early to prevent potential blindness, kidney failure, ulceration, heart disease and stroke. Treatment is a combination of insulin replacement therapy with management of cardiovascular risk factors.

    

Type 2 diabetes is much more common, and in 2013,it was estimated that 6% of adults in England were affected (over 3.2 million people).It is characterised by insulin resistance, the body cannot effectively used insulin, and high blood glucose levels result. Some preventable conditions, such as obesity and physical activity are associated with the development of the 2 diabetes, and can result in reduced quality of life, health and life expectancy. There is an increasing rate of diagnosis in children, and it is more common in those of African, African-Caribbean and South Asian origin.

    

Evidence based advice to support the care of adults with type 1 diabetes can be viewed at the NICE website for more information

    

In addition to those people currently diagnosed with diabetes, there are two groups which cause concern: those who live with the condition but for whom it is undiagnosed (estimated to be up to 1 million people), and those who are “pre-diabetic”, whose lifestyle, including a poor diet, resultant obesity and inactivity mean that in the future they are likely to develop diabetes if they do not modify , long term, these lifestyle factors.

     

In summary, the possible resultant conditions if diabetes is left undiagnosed and untreated are kidney disease, vascular problems, and sight damage. The risk factors for developing type 2 diabetes,( Diabetes UK, 2012), in addition to  being overweight, and certain risks associated with family history and ethnicity, include previous gestational( pregnancy related diabetes), a history of hypertension, or cardiovascular conditions. 

         

Patient education and awareness are important to prevent an increase in rates of diabetes, as diabetes care accounts for up to 10 percent of the NHS expenditure, and is preventable in many incidences.

     

The incidence of type 2 diabetes is rapidly rising, and it has been estimated that by 2025 5 million people in the UK will have it as stated in.Public Health England’s diabetes prevalence model. Additionally, the rise in type 2 diabetes in young people and children, attributed mainly to childhood obesity and inactivity, causes concern.

         

The rates of type 2 diabetes in Wokingham are similar to those in the West of Berkshire, and lower than those in the East of the county (see figure 1).

    

Disease prevelance

Source: Health and Social Care Information Centre, 2016

 

The estimated prevalence of diabetes in the Wokingham CCG is 6.4% which is below the England prevalence of 7.3%.

 

Figures demonstrate that the admissions for diabetic foot disease are lower in the Wokingham CCG area, which would be expected with the lower prevalence (Figure 2), however, the cost of medication is comparable with those from the rest of England( Figure 3).


Figure 2:

Episode in office

Source: Public Health England, 2013


Figure 3:

Cost of diabetic prescriptions

Source: Public Health England, 2015

 

This demonstrates that the costs have fallen recently and are not significantly different in Wokingham to elsewhere in England.

Diabetes and pre diabetes are key local priorities for Berkshire’s Clinical Commissioning Groups (CCGs), public health, and adult social care, as the risk myocardial infarction, stroke or a heart admission related to heart failure is higher in those with diabetes than the general population.

         

People with diabetes have a higher risk of retinal damage (Diabetic Retinopathy). The NHS Diabetic Eye Screening Programme involves those over the age of 12 being invited for a screening annually.