Tackle the diabetes time bomb with better management

When someone makes a scary prediction it’s tempting to disregard it. It’ll probably turn out okay in the end. Someone will sort it. If you want to be clever, say “reversion to the mean”. But when we warn about the need to deal with the rise in diabetes this is a prediction that is coming true.

‘It is estimated that by 2025, five million people in the UK will be living with diabetes’

Last month we highlighted figures which showed a frightening 60 per cent increase in the number of people diagnosed with diabetes in the UK during the past decade – that’s a staggering additional 1.2 million people who are now living with the condition compared with in 2005.

So now we have 3.3 million people diagnosed with diabetes and this doesn’t even take into account the almost 600,000 people who are estimated to have Type 2 diabetes but don’t know it as they are yet to be diagnosed.

That’s not where it ends. It is estimated that by 2025, 5 million people in the UK will be living with diabetes and that will mean even more people having to endure the serious complications that poorly managed diabetes can lead to, such as heart disease.

We know that the NHS is already under strain. Diabetes accounts for about 10 per cent of the annual NHS budget, costing nearly £10bn a year. Projected figures show that the proportion of the entire spend on diabetes from the NHS budget will mushroom to 17 per cent during the next 20 years.

So what will this mean for the NHS? Talking in billions can feel remote but the reality is that we are talking about an extra 7 per cent of the overall budget for diabetes and its complications. Diabetes is a cause of the rising number of older people who have multiple morbidities.

But the good news is that it does not have to be like this. Currently, an estimated 80 per cent of NHS spend on diabetes goes on managing diabetes related complications – heart attacks, strokes, blindness, amputations, kidney failure. Managing diabetes better, and from the earliest possible stage, is essential to delaying and even preventing these complications from developing, saving both human suffering and the costly blow these complications wield on the NHS.  

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Empowering people

A key step in effectively tackling this issue is empowering people with diabetes to manage their condition to the best of their ability. Education courses are a proven way of doing this. While a limited number of areas have rolled out education courses, there are still far too many places where we need to see more of these.

‘Education programmes for peoples with Type 1 diabetes in particular are vital’

Bexley is an example of an area that has turned around its education course offering to people in the local area. Improving access to diabetes education courses was made a priority during a recent service redesign.

Local healthcare professionals were engaged and people with diabetes consulted to identify convenient venues. As a result, attendance to the courses increased from 40 people in 2009 to more than 1,000 people a year later. In turn the area has seen big improvements in people’s self-management of their diabetes and this will lead to relatively fewer diabetes related complications over coming years.

Education programmes for peoples with Type 1 diabetes in particular are vital. An economic evaluation of the leading education programme for Type 1 diabetes, DAFNE, showed that, by reducing the onset of costly complications – such as blindness, end stage renal disease, foot ulceration/amputation and ketoacidosis – the course would pay for itself within four and a half years and save the NHS £2,237 over 10 years.

Beyond better treatment for people who are living with diabetes, we can reduce the number of people being diagnosed with the condition. The new National Diabetes Prevention Programme, launched earlier this year by NHS England, Public Health England, and which we are supporting, should play a vital role in achieving this, and is currently operating in pilot sites with targeted rollout planned for next year.

Better regulation

However, this is just one part of a much wider conversation needed to reach the 5 million people who are at high risk of diabetes; we also need to do this through changing our obesogenic environment. While this is a big task, we need better regulation of the food and drink industry and more responsibility taken by manufacturers.

We want the government to consider encouraging healthy lifestyles through introducing taxation on unhealthy foods, including sugar.

‘The National Diabetes Prevention Programme has the potential to be good value for money’

This is one of a number of steps we would like them to take to help us all to lead healthier lives which also include: placing tougher restrictions on marketing junk foods to children, introducing legislation to take out fats and sugars in food and reducing portion sizes to reduce overall calorie intake, as well as putting greater investment into making it easier for people to be more physically active.

The National Diabetes Prevention Programme has the potential to be good value for money and, importantly, it has political support. It is a real opportunity for us to help turn the obesity tide and make a significant change to the nation’s waistlines and we should all get behind it.

There are record numbers of people now living with diabetes in the UK and better care, with improved and more flexible education options for people living with diabetes, as well an increased focus on the prevention of Type 2 diabetes must be prioritised. Doing nothing will see people continue to suffer avoidable health complications and diabetes costs continue to spiral out of control.

There is no time to waste; the government and commissioners must act now.

Robin Hewings is head of policy at Diabetes UK