Diabetes

Headlines

  • Diabetes prevalence is increasing for Wakefield from less than 6.0% in 2009 to over 6.6% in 2014/15
  • The burden is unequally felt with the severest consequences experienced by our most vulnerable.
  • Diabetes prevention services are mobilising in the area.

The Population

Type 1 diabetes accounts for about 10 per cent of all adults with diabetes and is treated by daily insulin doses – taken either by injections or via an insulin pump. It is also recommended to follow a healthy diet and take regular physical activity. Type 1 diabetes can develop at any age but usually appears before the age of 40, and especially in childhood. It is the most common type of diabetes found in childhood.

Type 2 diabetes usually appears in people over the age of 40, though in South Asian people, who are at greater risk, it often appears from the age of 25. It is also increasingly becoming more common in children, adolescents and young people of all ethnicities. Type 2 diabetes accounts for between 85 and 95 per cent of all people with diabetes and is treated with a healthy diet and increased physical activity. In addition to this, medication and/or insulin are often required

It’s thought Type 2 diabetes is related to factors associated with a Western lifestyle, since it’s most common in people who are overweight and who don’t get enough exercise. The last 30 years has seen a threefold increase in the number of cases of childhood diabetes in the UK. This is especially worrying in respect of the rising numbers of children and teenagers with type 2 diabetes, usually only seen in older people, and which reflects obesity levels in young people.

 


Source: Public Health Outcomes Framework

The Burden

Diabetes across Wakefield has continued to rise in terms of prevalence and conditions as a consequence of the disease. Poor levels of physical activity and increased adult obesity are the driving force behind this increase in disease. The trend is both a Wakefield and a national one, however Wakefield’s starting position was far more burdened than the national. Below demonstrates the distribution of people with diabetes.

An increasing area of focus for the area in response to a national drive is to prevent people from developing Type 2 diabetes. Those identified by General Practice who have prediabetes, defined as non-diabetic hyperglycaemia (NDH) with a HbA1c of 42 – 47 mmol/mol.

People who have NDH and are at high risk of developing Type 2 diabetes follow a similar pattern to those who are diagnosed with diabetes. The National Diabetes Prevention Programme is now being implement in Wakefield, the structured education programme is a behaviour change intervention for those people with NDH lasting over nine months

Below demonstrates the distribution of people with Type 2 Diabetes and NDH (prediabetes).

Prediabetics follow a similar pattern to those who are diabetic, however there is likely to be some error involved. There is no national incentivisation to identify those who are prediabetic unlike Diabetes that has a Quality and outcomes Framework Payment.

The Inequality

The disease has been strongly correlated with poverty overtime, the magnitude of the obesity epidemic that the nation and local area is facing, is beginning to cloud this pattern. given that over two thirds of the adult population now have excess weight, seeing social patterning in the wake of a precursor for disease will become more difficult.

It is true locally that the more deprived areas have greater prevalence’s and this is where the more severe consequences of diabetes are found. The severest being death from cardiovascular disease. Locally we have seen increasing trends in premature deaths from Cardio Vascular Disease’s which are in part attributable to diabetes.

ethnicity matters for this condition as BME groups particularly those of South-East Asian decent are more likely to experience diabetes. This was recognised in the NICE guideline for this area, recommending a lower population BMI if for those from a South-East Asian heritage here

Service Provision

National Diabetes Prevention Program
Exercise on referral and weight management
DESMOND – Diabetes Structured Education Programme for people with Type 2 Diabetes
DICE – Structured Education Programme for people with Type 1 Diabetes

Community Assets

Resources & Evidence

Type 2 Diabetes Prevention: Population and Community Level Interventions PH35 (May 2011)
https://www.nice.org.uk/guidance/ph35/resources/type-2-diabetes-prevention-population-and-communitylevel-interventions-pdf-1996299153349

Type 2 Diabetes: Prevention in People at High Risk PH38 (July 2012)
https://www.nice.org.uk/guidance/ph38/resources/type-2-diabetes-prevention-in-people-at-high-risk-pdf-1996304192197
Type 2 Diabetes in Adults: Management NG28 ( May 2017)
https://www.nice.org.uk/guidance/ng28/resources/type-2-diabetes-in-adults-management-pdf-1837338615493

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