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Diabetes: a ticking time bomb for the NHS?

8040889-article-diabetesDiabetes is one of the fastest growing conditions worldwide, with the International Diabetes Federation predicting that at least one in ten adults could have the illness by 2030.

There are currently 3.8 million people living with diabetes in the UK. This is expected to rise to 6.25 million by 2035/6.

But in spite of growing numbers developing condition, research shows that not enough is being done to tackle it in this country.

A report published in May by the National Audit Office (NAO) reveals that many are still not receiving expected standards of care, leading to avoidable deaths, and increased expenditure for the NHS.

Figures show that in 2009/10, just half of people with diabetes in the UK received the nine essential NICE-recommended checks and services for people with the condition.

Furthermore, in some areas of the country a mere 6 per cent of people received these necessary checks.

A separate report also underlines the costs that diabetes and its associated complications could pose to the NHS unless properly tackled.

Published in the April edition of Diabetic Medicine, the report suggests that the total cost of diabetes, including indirect costs relating to death and illness, could rise to £39.8 billion by 2035/6.

While the figures are projections based on current trends and so likely to change over time, they indicate the severity of the epidemic, and the need for awareness among healthcare professionals and the public alike.

Carry out checks to prevent complications

There are two forms of diabetes, with type 2 diabetes being the most common, accounting for 85 per cent of all adult cases.

The Diabetic Medicine report says that around 79 per cent of the current NHS budget for the condition goes towards treating complications resulting from type 2 diabetes.

It adds that earlier detection and management of diabetes in primary care would lead to fewer people developing complications, and so requiring expensive specialist treatment.

Bridget Turner, Head of Policy and Care Improvement Diabetes UK, comments: "People with diabetes are at increased risk of developing complications such as heart and kidney disease, stroke and blindness.

"It is important that patients receive the NICE-recommended checks so that they can avoid developing complications, and can receive treatment that will slow disease progression."

She adds that the tests "present an opportunity to identify problems early on and to give information to people as soon as possible, so that they can manage their care appropriately".

NICE says that regular checks for diabetes should cover weight, blood pressure, smoking status, a marker for blood glucose control called HbA1c, urinary albumin, serum creatinine, cholesterol, and should assess whether the eyes and feet have been damaged by diabetes.

Since the latest NAO report suggests that less than half of people are currently receiving these checks, Ms Turner adds that more should be done to ensure people are receiving them across the country.

She says: "Of the 50 per cent who are receiving the NICE checks, only 40 per cent are meeting the targets that they need to meet to avoid complications.

"Annual care planning reviews are necessary to ensure that people with diabetes get their risk factors assessed on a regular basis."

Preventative the onset type 2 diabetes

8040967-article-exerciseWhile the exact cause of type 2 diabetes is not fully understood, there are known factors that can increase the risk of developing it, namely obesity and being overweight.

And since the number of people becoming obese is steadily growing, it is likely that this is contributing towards the increasing numbers now developing type 2 diabetes.

NICE has published guidance on the prevention type 2 diabetes, and in July 2012, we will be publishing a second piece of guidance which gives advice for individuals at high risk of developing the condition.

Our existing guidance recommends that many could avoid developing the disease through education and early diagnosis. The guidance also suggests that taking measures to achieving or maintaining a healthy weight and lifestyle can prevent onset of the disease.

The current guidance says large waist circumferences increase the risk of the condition, with men at high risk if they have a waist circumference of 94-102 cm (37-40 inches) and women at high risk if they have a waist circumference of 80-88 cm (31.5-35 inches).

Professor Mike Kelly, Director of the Centre for Public Health Excellence at NICE, says: "Obesity is one of the general principles that underpin the guidance recommendations, because it is a major risk factor for type 2 diabetes.

"So reducing or controlling body weight, usually measured by body mass index (BMI), to make sure it is within a healthy range will correspondingly reduce the risk of developing type 2 diabetes."

The guidance recommends following several principles to make it easier to maintain a healthy weight, by balancing the calories taken in through food and drink, with calories spent through exercise.

Examples of healthy diet practice include basing meals on starchy and fibre-rich foods wherever possible, consuming as little fried food as possible, eating breakfast, and adopting low-fat diets.

Physical activity can be increased by building activities such as walking, cycling and gardening into daily routines, and by minimising sedentary activities such as watching television or playing video games for long periods of time.

Professor Kelly says: "Maintaining a healthy weight and staying physically active are probably the most important things an individual can do to reduce their risk of type 2 diabetes - and the earlier that risk factors can be tackled, the better.

"Effective primary prevention of type 2 diabetes needs health professionals and the public to be aware of the risk factors so that they can stop the disease in its tracks."

NICE also recommends that promoting healthy diets and active lifestyles should be tackled at both local and national level.

Government departments, the commercial sector, the voluntary sector and local commissioners and providers should work jointly to promote healthier food choices.

This includes ensuring using healthier cooking methods, working with retailers to provide a range of portion sizes and working with food manufacturers to provide clear and consistent nutritional information.

Welfare benefits should be promoted, such as free school meals and Sure Start schemes, and local planning departments should ensure that there are opportunities available for people to be as physically active as possible.

More recommendations from NICE on preventing type 2 diabetes among people at high risk of the condition will be available in July.

In the meantime, you can find all of NICE's current recommendations on the prevention of type 2 diabetes in the NICE pathway, which presents the information in an easily accessible online format.

June 26 2012

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Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.