Diabetes

What is Diabetes?

Diabetes is a common life-long health condition. There are 3.8 million people diagnosed with diabetes in the UK and an estimated 850,000 people who have the condition but don’t know it.

Risk Factors

Risk factors associated with diabetes include lack of physical activity, obesity and smoking.

Age is also a key factor in diabetes prevalence. Type 1 diabetes tends to be diagnosed in childhood but the prevalence of Type 2 diabetes increases steadily after the age of 45 years. Type 2 diabetes prevalence is higher in areas experiencing deprivation. People living in the 20% most deprived neighbourhoods in England are 56% more likely to have diabetes than those living in the least deprived areas. It is known that people from Asian and Black ethnic groups are more likely to have diabetes and tend to develop the condition at younger ages (source: Yorkshire and Humber Public Health Observatory, YHPHO).

Impacts

Diabetes significantly increases the risks of heart attacks, strokes, blindness, kidney failure and amputation and reduces life expectancy by more than fifteen years for someone with Type 1 diabetes and up to ten years for someone with Type 2 diabetes (source: YHPHO).

In 2016 it was estimated that Type 2 diabetes, the most common and preventable type, causes 22,000 additional deaths (2013) and costs the NHS £8.8 billion a year.

Nationally, hospital lengths of stay are on average 20% higher than those for patients without diabetes, and prescribing costs for patients with diabetes increased by 88% between 2002 and 2007. In addition to direct health costs, there is a considerable impact on social care expenditure as diabetes complications are estimated to increase costs four-fold.

Key issues for Somerset:

• The number of patients aged 17 or older diagnosed with diabetes is increasing rapidly in Somerset. In the last decade, the total has increased by more than 50% to 29,656 in 2015.
• At 6.5% of the 17+ population, this is broadly in line with the national rate and that of areas with similar population characteristics.
• Based on local presence of risk factors, there could be a further 11,000 people with undiagnosed diabetes.
• Based on the National Cardiovascular Intelligence Network's (NCVIN) 2016 prevalence model, there are more than 41,000 people in Somerset estimated to have diabetes, diagnosed or undiagnosed, in 2015.
• Age is a major factor in developing Type 2 diabetes. As Somerset has an older population than the national average, and the 65+ age group is projected to rise the fastest in the next two decades, the number of people with diabetes is projected to rise by almost a third to 54,000 by 2035.
• While few deaths are directly attributed to diabetes, there were around 300 a year in Somerset for which the condition is a contributory factor.
• Patients with diabetes admitted to hospital with other conditions (such as heart attacks or hip replacements) tend to stay longer than those without diabetes.
• The incidence of complications arising from diabetes is higher in Somerset than in similar areas of England
• The additional risk of major and minor amputation among people with diabetes is higher in Somerset than England generally.
• The additional risk of angina among people with diabetes is lower in Somerset than the national average
• 77% of people with diabetes had their feet checked for 2014/15, below the national average.
• Among people with diabetes in Somerset, the risk of a stroke is 43.9% higher and the risk of a heart attack is 65.2% higher compared with the general population.
• The vast majority of GP practices monitor diabetic patients' blood sugar, blood pressure and cholesterol levels appropriately, although successful control of these indicators vary across the county. 
• The total spending by the NHS Somerset CCG on prescribing for anti-diabetic items in 2012/13 was over £7.1million.
• A summary has been produced as part of the 2014 Cardiovascular Profile for Somerset. Please go to our Health Profiles section. 

Projected Trends of Diabetes in Somerset

The chart below shows the projected trend in numbers and percentage of the population aged 16 and over in Somerset up to 2035. The estimates take into account the age, sex, ethnicity profiles and deprivation in the county.

Source: National Cardiovascular Intelligence Network. The estimates are modelled using data from NHS Digital, ONS 2014-based sub-national population projections and Health Surveys for England 2012, 2013 and 2014

Public Health England has an interactive tool Healthier Lives: Diabetes enabling the user to access a range of diabetes-related indicators and compare figures for all counties/unitary authorities, Clinical Commissioning Group (CCG) areas and GP Practices.

There is a companion Diabetes profile tool which includes up-to-date trends and comparisons of data between local authorities and CCGs. Indicators are grouped by:-

• Prevalence and Risk
• Treatment targets
• Care processes
• Complications

A detailed profile on diabetes in Somerset, produced by the NCVIN, can be downloaded below: 

• Diabetes Profile for Somerset
  A Diabetes profile for Somerset produced by the National Cardiovascular Intelligence Network (NCVIN).

Control and Screening

The National Institute for Health and Care Excellence (NICE) recommends nine care processes for diabetes. These are five risk factors (body mass index, blood pressure, smoking, glucose levels (HbA1c) and cholesterol) and four tests to identify early complications (Urine Albumin Creatinine Ratio, serum creatinine, foot nerve and circulation examination and eye screening.

There are three treatment targets GPs can record as part of effective structured care for people diagnosed with diabetes:-

• control of blood-glucose levels (% of those with diabetes aged 17+ whose last HbA1c (measured in the preceding 12 months) is 59mmol/mol or less);
• blood pressure checks (% of those with diabetes aged 17+ whose last blood pressure (measured in the preceding 12 months) is 140/80 or less);
• cholesterol screening (% of those with diabetes aged 17+ whose last cholesterol (measured in the preceding 12 months) is 5mmol/L or less)

People with diabetes also have annual foot checks for lower limb nerve damage or impaired circulation which can cause foot ulcers which in turn can lead to lower limb amputations.

Somerset Partnership offers:-

• an Intermediate Care Service (between GPs and acute hospitals)
• Retinal screening at least once a year to all patients within Somerset who have a diagnosis of diabetes who are over the age of 12 years. This screening can improve quality of life through the early detection and treatment of diabetic eye disease.

Prevention

It is important to note that Type 2 diabetes is to a degree preventable by lifestyle interventions: 

• diabetes is approximately three times more common in people who have gained around 10kg in weight during adulthood than in those who maintain their weight
• the risk of developing Type 2 diabetes is increased by 30-40% in sedentary people, compared with people who are regularly physically active.
• lifestyle interventions (such as exercise combined with dietary advice) have been found to reduce the incidence of diabetes by 58%
• for people who are obese, losing a fairly modest amount of weight (up to 10kg) has been shown to reduce diabetes-related mortality by 30-40%

People who are overweight or obese (and particularly if they have a family history of diabetes) can substantially reduce their risk of developing the condition if they lose some weight and adopt a more active lifestyle. There is also emerging evidence which suggests that Type 2 diabetes may be reversible by gastric surgery or by a very low calorie diet under medical supervision.