We campaign with people with diabetes and with healthcare professionals to improve the ... year's State of the Nation re
STATE OF THE NATION Challenges for 2015 and beyond
England
The state of the nation: diabetes in 2014
4
Care for children and young people
28
The challenges for 2015 and beyond: what needs to happen over the next five years
7
Inpatient care
30
Pregnancy care
31
Preventing Type 2 diabetes
9
Specialist care
32
15 Healthcare Essentials for everyone with diabetes
11
Emotional and psychological support
33
Variations in diabetes care and outcomes
12
References
34
HbA1c
14
Blood pressure
15
Cholesterol
16
Actions to improve care processes and outcomes
17
Eye screening
19
Foot checks
20
Kidney function
22
Weight
23
Smoking
24
Personalised care planning
25
Education and support for self-management
26
About Diabetes UK Diabetes UK is the leading UK charity that cares for, connects with, and campaigns on behalf of people affected by and at risk of diabetes: • We help people manage their diabetes effectively by providing information, advice and support. • We campaign with people with diabetes and with healthcare professionals to improve the quality of care across the UK’s health services. • We fund pioneering research into care, cure and prevention for all types of diabetes. • We campaign to stem the rising tide of diabetes.
Takeda UK Ltd. has financially supported the production of this State of the Nation report. Takeda has had no input into the development or content of this document.
Foreword If it was announced that a new condition had emerged that was doubling in prevalence every 17 years, and 13 million people were already directly affected or at serious risk, this would be seen as an epidemic and a national crisis. Last year’s State of the Nation report commented on the absence of national plans to improve the quality of diabetes care and reduce complications, and to tackle the rising incidence of this condition. While the former has not yet materialised, we are encouraged by the announcement of a Type 2 diabetes prevention programme in the NHS Five Year Forward View. With nearly 10 million people in England at high risk of developing Type 2 diabetes, such a programme is due urgently, and – as highlighted in this year’s report – it is not too late to reverse the rise of Type 2 diabetes. During 2014, we welcomed four national diabetes audit reports, covering care processes and treatment targets, inpatients, children and young people, and – for the first time – pregnancy in women with diabetes. We also launched ‘Diabetes Watch’ – our online tool for people with diabetes and professionals to look at and compare CCG-level data. This means we now have comprehensive national and local pictures of the healthcare received by people with diabetes. Unfortunately, while the audit reports indicate some signs of progress, there is clearly a long way to go before everyone with diabetes receives high quality care. What is particularly striking is that some people with diabetes – those with Type 1, working age people, and people living in certain parts of the country – are receiving considerably worse routine care than other people with diabetes, and are achieving poorer outcomes. This puts them at greater risk of serious complications, which can lead to disability and premature death, and are very expensive for the NHS.
People with diabetes are also failing to receive the support they need to self-manage their condition effectively – again, elevating the risk of long-term complications. Few people are offered or attend diabetes education, have personalised care plans, or have access to emotional support and specialist psychological care. As well as highlighting this situation, our State of the Nation report sets out a range of actions to address the challenges England faces. There are real opportunities for the incoming government, health services, local authorities, and others, to prevent millions of people from developing Type 2 diabetes, and help make the impact less severe for those who are diagnosed with diabetes of all types. We urge these organisations to act on our proposals and implement them over the coming months. The overarching messages from this State of the Nation report are that good care now for everyone with diabetes, and a greater focus on prevention, can save money in the longer term – money that would otherwise be spent on treating avoidable complications, and on caring for people with avoidable cases of Type 2 diabetes. We all have to act before the number of people with diabetes overwhelms our health and social care systems and consumes an even greater proportion of the NHS budget. These are messages that the Government, the NHS, and the country as a whole cannot afford to ignore.
Barbara Young Chief Executive
3
The state of the nation: diabetes in 2014 Diabetes is an increasingly urgent health issue Diabetes is the fastest growing health threat of our times and an urgent public health issue1. Since 1996, the number of people living with diabetes has more than doubled.
Prevalence of diabetes is more than three times higher than prevalence of all cancers combined, and is increasing
3.2 million people in England now have diabetes: 8
8
7
7
6
6
5
5
Another 9.6 million people in England are at high risk of getting Type 2 diabetes, and that number is rising dramatically every year 5.
3
If nothing changes, by 2025 more than four million people in England will have diabetes6.
1
Diabetes is expensive to treat and manage
2
0
4 3 2 1
0 2008–2009 2009–2010
2010–2011
2011–2012
2012–2013
Diabetes accounts for around 10 per cent of the annual NHS budget. This is nearly £10 billion a year, or £1 million every hour7.
Diabetes
Future diabetes projection
Cancer
Future cancer projection
Eighty per cent of NHS spending on diabetes goes on managing complications, most of which could be prevented8.
Coronary heart disease
One in 20 people with diabetes incurs social services costs. More than three-quarters of these costs are associated with residential and nursing care9.
Dementia
The total cost (including direct care and indirect costs) associated with diabetes in the UK is currently estimated at £23.7 billion. These costs are predicted to rise to £39.8 billion by 2035–367. 4
4
Percentage of population with this condition
• 2 .7 million people – or 6 per cent of the adult population – have been diagnosed with diabetes2 • a further 500,000 people are estimated to have Type 2 diabetes, but do not know it3 • more than 700 people learn they have diabetes every day – that’s one person every three minutes4.
Stroke and mini stroke
Source: Quality and Outcomes Framework prevalence data, 2009–2014
2013–2014
Diabetes can cause serious complications and early death
Poor diabetes care and outcomes now will drive up future costs and complications
Every year, around 20,000 people with diabetes die early10. People with diabetes are also at greater risk of developing one or more severe health complications.
Too many people with diabetes are still not receiving all of the vital annual checks for the effectiveness of diabetes treatment, cardiovascular risk factors, and the emergence of early complications15.
• responsible for more than 100 amputations a week11 • the leading cause of preventable sight loss in people of working age12 • a major contributor to kidney failure, heart attack, and stroke13.
Between 2007 and 2012, avoidable complications increased significantly14
•
67%
130%
106%
ANGINA
CARDIAC FAILURE
STROKE
33%
95%
60%
RETINOPATHY
RENAL REPLACEMENT THERAPY*
AMPUTATIONS
Some population groups, particularly those with Type 1 diabetes, and working age people, routinely receive poorer care and are less likely to meet treatment targets.
There has been little change in the percentage of people with diabetes receiving recommended care processes – and some things are getting worse Percentage of people with diabetes receiving care processes*
Diabetes is:
100
Blood pressure Serum creatinine HbA1c Cholesterol BMI Smoking Foot surveillance Urine albumin All
80
60
0 2010–2011
2012–2013
*Excluding eye screening Source: National Diabetes Audit 2012–13 (figures for England and Wales)
*Term used for life-supporting treatments required to treat end stage kidney disease
5
It is not too late to reverse these trends There are significant variations between clinical commissioning group areas. People with diabetes living in some areas receive better care and treatment than people living in other areas. They are also more likely to meet recommended treatment targets.
Across CCGs, there are large variations in achievement rates for HbA1c, cholesterol and blood pressure treatment targets Cholesterol
