NHS England has announced a new strategy document for diabetes care, called Action for Diabetes. The document is for Clinical Commissioning Groups (CCGs), to serve as a reference on the work that is going on across NHS England.
It will also be of interest to the wider community interested in diabetes care to see what action NHS England is taking.
There are two key themes:
- Driving the prevention of Type 2 diabetes and earlier diagnosis of all diabetes
- Supporting better management of diabetes in primary care
A key priority area identified in the report is the failure to meet NICE treatment targets for type 1 diabetes. The report includes details on how performance improvement can be managed:
- Publication of clinical indicators via HealthWatch
- Performance improvement tools and indicators
The report presents a very useful summary of the current state of diabetes in England. This type of data will be useful to students, clinicians, researchers and commissioners.
Risk and prevalence:
- There are 2.7 million people diagnosed with diabetes in England, a number that is increasing by about 5% per year.
- About 10% of people with diagnosed diabetes currently have Type 1 diabetes.
- In England, people from south Asian and black ethnic groups have a greater chance of developing Type 2 diabetes than people from white ethnic groups.
- The risk of diabetes also increases with age. In 2010 the prevalence of all types of diabetes was 0.4% for people aged 16 to 24 years, rising to 15.1% for people aged 70 to 84 years old.
- Diabetes is a major cause of premature mortality with over 22,000 additional deaths each year.
- Diabetes doubles the risk of cardiovascular disease (heart attacks, heart failure, angina, strokes).
- Diabetes is the most common reason for end stage kidney disease and the most common cause of blindness in people of working age.
- Up to 100 people a week have a limb amputated as a result of diabetes, and in many cases this is avoidable.
- Diabetes is estimated to have cost the UK £9.8 billion in direct costs in 2010/2011, this equates to approximately ten per cent of the total health resource expenditure.
- It is estimated that 80 per cent of these costs are incurred in treating potentially avoidable complications.
- In 2012/13 42.5 million items were prescribed to treat diabetes, £764 million was spent on drugs to treat diabetes in primary care.
- Many people with diabetes have complications of diabetes and/or other long-term conditions as well, and there is predicted to be a 252% increase the number of people with multiple long-term conditions by 2050.
- Nearly 1 in 5 people with diabetes have clinical depression and for those with anxiety and/or depression health care costs increase by around 50%.
NICE care standards
The document provides a very useful index of NICE guidance, covering education, nutrition, care planning, glycaemic targets, insulin use, management of cardiovascular risk and complications. The index links directly to the relevant NICE guidance or technology assessments.
- Although the report cites the findings of the National Diabetes Audits, it does not cite the 2011-12 audit, which encouraged a greater focus on prevention and treatment heart failure. Users of these documents should read both together.
- There is not much that is altogether new in this report. However it does bring together key strands from various health policies, such as risk management, outcomes framework, shared decision-making and electronic health information.
Medical Directorate, NHS England. Action for Diabetes. NHS England, January 2014.