Why is it an issue?
Diabetes is a condition where the blood sugar level is higher than normal. There are two main types of diabetes: Type 1 diabetes or insulin-dependent diabetes. It is usually seen in young people. Type 2 diabetes – usually non insulin-dependent diabetes. It tends to affect adults over 40 and overweight people.
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.
What’s the local picture and how do we compare?
How do we compare?
What do things look like locally?
- The prevalence of diagnosed diabetes among people aged 17 years and older in Wakefield District PCT is 5.8% compared to 5.4% in all PCTs with similar diabetes risk factors. In 2009/10 there were 16148 people aged 17 years and older diagnosed with diabetes (IC Health Profile, 2011; Diabetes Profile, 2011).
- Using SystmOne estimates, we can evidence the age distribution within the diagnosed population. Prevalence rises steadily from age 55 onwards, peaking at the 75-79 age range.
- There is also an estimated 3646 adults with undiagnosed diabetes (Diabetes Profile, 2011)
- In Wakefield District PCT 53.4% of all people with diabetes aged 17 years and older have an HbA1c of 7% or less. This is not statistically significantly different from PCTs with populations with similar diabetes risk factors and not statistically significantly different from England as a whole (Diabetes Profile, 2011).
- The emergency admission rate for diabetic ketoacidosis and coma in Wakefield District PCT is 5.9 per 1000 people with diabetes compared to 5.4 per 1000 for all PCTs in its cluster group. In Wakefield District PCT there were 2.5 lower limb amputations per 1000 people with diabetes between 2007/08 and 2009/10 compared to 2.5 per 1000 across England (Diabetes Profile, 2011).
- Prevalence of Diabetes is high in our priority neighbourhoods but this is matched by treatment levels (HEA, 2010)
- ACE inhibitor therapy in diabetes patients is above the national rate (92% locally compared to 89% nationally) (NCHOD… at a glance, 2010).
- Analysis of total spending on diabetes care compared to HbA1c outcomes shows that Wakefield District PCT is not statistically different from England in spending and not statistically different from England in terms of outcomes (YHPHO, Diabetes Profile, 2011).
What’s the trend and what can we predict?
- Diabetes prevalence has continued to rise, although this may be as a result of improved casefinding (QOF 2010, QMAS Analysis 2004-10).
- Diabetes mortality in Wakefield has maintained a yearly rate close to or below the national average. Although this rate only constitutes 20-30 deaths per year, it is an important measure of how the disease is managed.
- The percentage of patients with diabetes whose blood sugar is better controlled (HbA1c is 8.0 or less) has increased from 71% in 2009/10 to just under 76% (EOY Trust Board Report, 2011).
- The total population aged 65 and over predicted to have doctor-diagnosed diabetes is set to rise from 6,700 to 10,500 by 2030, assuming Health Survey for England rates remain static (POPPI, 2010)
What are we doing and what can be done differently?
The diabetes service redesign has now mainstreamed across the Wakefield District. Specialist diabetes clinics are held in primary care bringing care closer to home. The consultant diabetologists and the diabetes specialist nurses attending the practices are upskilling the practice staff in the management of diabetes including the initiation and management of insulin in people with Type 2 diabetes. This in turn will help to increase the percentage of patients whose blood sugar is better controlled.
National audits undertaken within Wakefield
- 100% of practices within NHS Wakefield and the Mid Yorkshire Hospital Trust take part in the National Diabetes Audit (NDA).
- DiabetesE is a web based, self assessment, diabetes care performance improvement tool that supports the implementation of the NICE Quality Standard for Diabetes in Adults and is updated each year. DiabetesE measures and benchmarks the performance of all aspects of a system of diabetes care and actively encourages continuous improvement to meet and surpass the NICE Quality Standard for Diabetes in Adults.
- Mid Yorkshire Hospital Trust takes part in the National Diabetes Inpatient Audit