Concerns raised over diabetes care

Poor management of diabetes (such as not receiving basic healthcare checks, leading an unhealthy lifestyle and not taking medication appropriately) can increase the risk of death from causes including critically high or low blood sugar, heart failure or kidney failure. Unfortunately, thousands of people with diabetes are dying needlessly, each year, from causes that could be avoided,1 while the NHS is failing to provide basic heathcare for up to half of patients with the condition.2 As the number of new cases of diabetes continue to rise, experts warn that mortality figures are set to increase unless urgent action is taken to improve diabetes care in the UK. The first ever report into mortality, from the National Diabetes Audit, revealed that up to 24,000 people with diabetes are dying each year from causes that could be avoided through better management of their condition. The report also found that death rates among women aged 15 to 34 with diabetes are up to nine times higher than the average for this age group. The report showed that about three quarters of the 24,000 people with diabetes who die each year are aged 65 and over. However, the gap in death rates between those who have and do not have diabetes becomes more extreme with younger age. About one in 3,300 women in England will die between the ages of 15 to 34; but this risk increases nine-fold among women with type 1 diabetes to one in 360, and six-fold among women with type 2 diabetes to one in 520. A similar picture is true for young men with diabetes; men aged 15 to 34 in the English population are much more likely to die than women – at one in every 1,530; but this risk rises four-fold for men with type 1 diabetes to one in 360, and by just under four-fold among those with type 2 diabetes to one in 430. This means two young people aged 15 to 34 may be dying each week from avoidable causes. The findings echo conclusions made by the National Diabetes Audit, which found nearly 450,000 children and younger adults (aged 0 to 54) with diabetes have high risk blood sugar levels that could lead to severe complications. The audit, which is managed by the NHS Information Centre and commissioned by the Healthcare Quality Improvement Partnership (HQIP), also found this age group was the least likely to receive all the basic care checks required to monitor their condition. The report into mortality analysed data for 2.5 million people recorded between 2003/04 and 2009/10 in the National Diabetes Audit; linked to death certificate data from the Office of National Statistics. The report also found there is a strong link between deprivation and increased mortality rates. Among under-65s with diabetes; the number of deaths among people from the most deprived backgrounds is double that of those from the least deprived backgrounds. In addition, death rates among people with diabetes vary according to where they live. London has the lowest rates for both type 1 and type 2 diabetes, at 1.8% and 1.2% respectively, while the highest rate for both type 1 and type 2 diabetes was in the North East, at 2.4% and 1.7% respectively. Audit lead clinician Dr Bob Young, consultant diabetologist and clinical lead for the National Diabetes Information Service, said: “For the first time we have a reliable measure of the huge impact of diabetes on early death. Many of these early deaths could be prevented. “The rate of new diabetes cases is increasing every year. So, if there are no changes, the impact of diabetes on national mortality will increase. Doctors, nurses and the NHS working in partnership with people who have diabetes should be able to improve these grim statistics.”

Variation in healthcare

Publication of the mortality statistics coincided with figures from The NHS Atlas of Variation in Healthcare (from Right Care), which revealed that up to half of people with diabetes in England are missing out on basic health checks recommended by NICE. The NHS Atlas of Variation in Healthcare reported that two thirds of people with Type 1 diabetes (68%) and almost half of people with Type 2 diabetes (47%) did not receive all the nine recommended healthcare checks between 2009 and 2010. The nine NICE recommended healthcare checks for people with diabetes include: measurements of HbA1c, cholesterol, creatine, micro-albuminuria, blood pressure and BMI; a record of whether or not the person smokes (or has ever smoked); and eye and foot examinations. Diabetes UK points out that this report shows no improvement from when the Atlas was first published in 2010, when it stated that 68% of people with type 1 and 49% of people with type 2 diabetes failed to receive the relevant healthcare checks. The level of care received also varied greatly depending on where people lived. People with type 1 diabetes were found to be more than two-and-a-half times more likely to receive all their basic healthcare checks if they lived in some areas of England when compared to others. A similar figure was reported for people with type 2 diabetes, where people living in some Primary Care Trusts (PCTs) were more than twice as likely as others to receive all the basic healthcare checks. The Atlas also reported a great variation in the number of people with diabetes having major lower limb amputations, with those in some areas being nearly four times more likely to undergo an amputation as those under other PCTs. This is of great concern, as diabetes causes 100 amputations a week, of which around 80 are potentially preventable. Barbara Young, chief executive of Diabetes UK, said, “Diabetes is one of the biggest health challenges facing the UK today, so the Government needs to stand up and make this their top priority… People with diabetes need and deserve to receive high-quality care, regardless of where they live, so it is scandalous that we have to fight for this basic right.” Diabetes UK believes that that although healthcare checks are important, people with diabetes also need access to specialist support, co-ordinated care, structured education and emotional and psychological support. “There is no reason why people with diabetes cannot live long and healthy lives if they receive the right care and support to help them manage their conditions,” Barbara Young continued. “Selfmanagement is very important, but it is also vital that people with diabetes receive the care they need to help them manage their condition in the first place… It is imperative we take action now to stop even more lives being needlessly cut short.” To help people with diabetes receive the care they need, Diabetes UK has launched the ‘15 healthcare essentials campaign’ which outlines the 15 diabetes checks or services that every person with diabetes should receive or have access to.