Diabetes Network

Diabetes Key Facts

  • In 2013 the total prevalence of diabetes in adults in England is estimated to be 7.4%, and approximately 508,000 of the estimated 3,211,000 adults with Type 2 diabetes in England have not been diagnosed.
  • The prevalence of diabetes is increasing and it is estimated that there will be over four million adults with the condition in England by 2030.
  • People with diabetes are at significantly greater risk than the general population of developing other conditions such as heart failure, heart attack, stroke and chronic kidney disease.
  • Diabetes is a lifelong metabolic condition in which the body does not produce sufficient insulin to regulate blood glucose levels. The two main types of diabetes, that account for about 98% of all diagnosed patients, are Type 1 and Type 2.
  • Type 1 diabetes is an auto-immune condition in which the cells that produce insulin are destroyed and requires lifelong treatment with insulin to prevent death. About 10% of people with diagnosed diabetes have Type 1 diabetes.
  • Type 2 diabetes occurs when the body stops producing enough insulin for it’s needs and is usually accompanied by resistance to the effect of insulin. The condition is progressive requiring lifestyle management (diet and exercise) at all stages. At some point a person with Type 2 diabetes may need tablets and possibly insulin.

  

Work Priorities

The following areas have been agreed as priorities for the Diabetes Network:

  • Diabetes Prevention Programme
  • Foot Care
  • Supported Self Care

In addition to the above there is ongoing work on various areas of the diabetes pathway including work on reducing variation, raising awareness and specific work around improving diabetes services in care homes.

Supported Self Care

Empowering individuals to feel both confident and comfortable with managing their diabetes is central to optimising healthcare outcomes for people with diabetes and other long-term conditions.  The individual must be the starting point for any decisions about their own care a model of personalised care planning and the effective implementation and delivery of structured education, are key elements of services that can support patients in better managing their condition.

The NICE Structured Education Quality Statement advocates that ‘people with diabetes and/or their carers receive a structured educational programme that fulfils the nationally agreed criteria from the time of diagnosis, with annual review and access to ongoing education.’

Our Task & Finish group will determine aspects of good practice in Yorkshire & the Humber and beyond that empower service users, with appropriate support from services, to self-manage their diabetes. By working in partnership with key stakeholders from across the Yorkshire & Humber region, the focus of this work stream will be to make recommendations to commissioners and providers to ensure that a more holistic person-centred approach for people living with diabetes is a reality, based on the “House of Care” model.

Diabetic Foot Care

It is widely recognised that the management of foot disease in diabetes is inconsistent, with tenfold variation in the incidence of major amputation being reported between PCTs in England in 2007-2010. Some variation may relate to social deprivation and to ethnicity (the incidence in South Asians and Blacks is 25% and 50% that of Caucasians, respectively), but there is strong suggestive evidence that the dominant cause is uneven provision of the required care.

The SCN group will draw together and develop data and resources from across the region and England to support the commissioning and provision of diabetic foot care services in Yorkshire & The Humber. 

Outputs of Footcare Group:

  • The SCN will be supporting providers participate in the new National Diabetes Foot Care Audit (NDFA) which launches in July 2014.
  • Collating and presenting a Y&H foot care data pack at CCG level (attached) to identify variation in a range of diabetic foot care metrics.
  • Sharing approaches to and encouraging major amputation root cause analysis.
  • Identify and share good practice in the commissioning and delivery of risk stratified, integrated foot care pathways.
  • Facilitating the utilisation of Diabetes UK putting feet first patient education leaflets in all GP practices in Yorkshire & the Humber.
  • Share good practice in the commissioning and delivery of integrated foot care pathways
  • Report on access to Y&H Acute Foot care MDT / Diabetic Foot MDT as per NADIA audit and feedback at Sub Regional level (NEYHCOM, 10CC, SYBCOM).
  • Creating a directory of diabetic foot services in Yorkshire and the Humber.

Background to Work Priorities

Self-Care background:

Diabetes is one of the most important diseases confronting the NHS in England with associated high levels of demand and subsequent costs. As its prevalence increases year on year the costs and demand for healthcare provision will continue to rise at a rapid rate. There are currently around 2.7 million people diagnosed with diabetes in England.   Prevalence of diabetes among the adult population is predicted to soar to 8.5% in 2020 and to 9.5% by 2030 according to the APHO Diabetes Prevalence Model published by the Yorkshire & Humber Public Health Observatory (YHPO). Diabetes is estimated to have cost the UK £9.8 billion in direct costs in 2010/11, which is equivalent to around 10% of total healthcare expenditure and it is estimated that 80% of these costs incurred are as a result of treating potentially avoidable diabetic complications. The majority of diabetic complications can be either prevented or minimised with good glycaemic control in conjunction with the effective management of other broader cardiovascular disease (CVD) risk factors. Transformation is needed for the NHS to survive, as health needs arising from long-term conditions are threatening to overwhelm the NHS if the status quo is maintained.

Foot care background:

A major driver of high amputation rates is the lack of a specific patient pathway for dealing with peripheral arterial disease patients. Our Freedom of Information request showed that from 2009 to 2012, Clinical Commissioning Group areas without a patient pathway had 11% more amputations on average than those with a patient pathway.  Expert opinion suggests that once a patient is diagnosed with critical limb ischaemia, early intervention is likely to hold the key to reduced lower limb amputation rates. All Party Parliamentary Group on Vascular Disease report March 2014.

All patients with factors which increase the risk of foot ulceration such as neuropathy, skin integrity or impaired vasculature require timely and regular access to a Foot Protection Service / Community Podiatry Service for assessment and education by appropriately trained staff - (see Diabetes UK minimum skills framework). A podiatry service should be commissioned to sufficiently enable patients risk stratified as ‘Moderate Risk’ to be seen regularly and those at ‘High Risk’ to be seen more frequently.

The provision of a 24/7 facility to receive patients with acute diabetic foot problems at any time of the day, seven days a week by a competent representative/member of the MDfT team for evaluation and treatment. This could include provision of a phone number and access through A&E or the OoH service. Amputations have been reduced by over 50% where hospitals have introduced multidisciplinary foot care teams and promoted rapid access to them. In addition, through the reduction of costly amputations, such teams can save over four times their cost. Commissioning Intentions for Foot care – Diabetes UK.
 

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