State of the Nation

A new year and a chance to reassess the state of diabetes care. This was the purpose of the ‘State of the Nation’ report from Diabetes UK – the nation being England, covering the period 2011-2012. The report examined the Diabetes UK health care essentials, 15 basic health checks and services that everyone with diabetes (Type 1 or Type 2) should receive from their healthcare team. These include the 9 care processes recommended by NICE but also cover specialist care availability, emotional support and in patient care.

The headline figure from this report seems to be that previous improvements in diabetes care do not seem to be continuing and in some situations are actually in reverse. For example 91.2% of people had their HbA1c recorded in 2011-2012 of whom 65.9% reached their target compared to 93.5% and 66.5% respectively in 2010-2011. Furthermore, between 2006 and 2011, there has been an increase in unnecessary complications ranging from 46% (amputations) to 104% cardiac failure. However, it is likely that the increased prevalence of diabetes and improvements in data collection have influenced these figures. The other major issue in this report is the variability of diabetes care across various CCGs where people living in the best performing areas are 4 times more likely to be given 8 of the NICE recommended health checks than the worse areas.

As pointed out by Diabetes UK chief executive, funding, uniquely in the NHS is unlikely to be the challenge with up to 10% of NHS funding spent on Diabetes, most of it on treating complications. Actions are recommended to all those involved in health care ranging from NHS England reviewing the variation and ensuring an action plan to improve the poorest CCGs to local authorities and commissioners. The latter are key in ensuring improvements in patient education, integrated care planned around the individual and most importantly, effective promotion of lifestyle for those at risk of developing diabetes.

Dr. Mark Freeman