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Part of: Ill Health and Disability

Related to: Ageing Population, Alcohol, Diet and Malnutrition, [[Health Checks]], Heart Failure, Hypertension, Major Causes of MortalityHealthy Weight, Smoking, Stroke, Physical Activity, Food Poverty

Key Facts:

  • There are 7,460 (2012/13 financial year) people 17 years and diabetes_infographicover registered with diabetes mellitus in GP practises in Bath and North East Somerset
  • The prevalence rate in B&NES is significantly lower than the South West and England
  • This prevalence is expected to increase by approximately 150-200 per year, or approximately 34% from 2005 to 2025.

Diabetes is a lifelong condition that causes a person's blood sugar level to become too high.  It is also known as diabetes mellitus. The amount of sugar in the blood is usually controlled by the hormone insulin, which is produced by the pancreas. Those with diabetes are unable to break down glucose into energy because there is either not enough insulin to move the glucose, or the insulin produced does not work properly. The main symptoms of diabetes are: feeling very thirsty, urinating frequently, particularly at night, feeling very tired, weight loss and loss of muscle bulk. 

The two main types of diabetes are: type 1 and type 2. In type 1 diabetes, the body's immune system attacks and destroys the cells that produce insulin. As no insulin is produced, your glucose levels increase, which can seriously damage the body's organs. Type 1 diabetes is often known as insulin-dependent diabetes or as juvenile diabetes or early-onset diabetes because it usually develops before the age of 40, often during teenage years. Type 2 diabetes is where the body does not produce enough insulin, or the body's cells do not react to insulin. This is known as insulin resistance. Type 2 diabetes is often associated with obesity. Obesity-related diabetes is sometimes referred to as maturity-onset diabetes because it is more common in older people.

 

During pregnancy, some women have such high levels of blood glucose their body is unable to produce enough insulin to absorb it all, this is known as gestational diabetes. Pregnancy can also make existing type 1 diabetes worse. Gestational diabetes can increase the risk of health problems developing in an unborn baby. In most cases, gestational diabetes develops during the second trimester of pregnancy and disappears after the baby is born. However, women who have gestational diabetes are at increased risk of developing type 2 diabetes later in life. 1

People with diabetes are at risk of a range of health complications, including cardiovascular disease2, blindness, amputation 3, kidney disease 4 and depression 5

What does the data says?

In the UK, diabetes affects approximately 2.9 million people. There are also thought to be around 850,000 people with undiagnosed diabetes. Type 1 diabetes is less common than type 2 diabetes. About 10% of all people with diabetes have type 1 diabetes. 6

Gestational diabetes affects around 5% of pregnant women in the UK. Women who have gestational diabetes are at a 30% increased risk of developing type 2 diabetes later in life, compared to a 10% risk for the general population. 7

 

Age is a key factor in diabetes prevalence. type 1 diabetes tends to be diagnoses in childhood but the prevelance of type 2 diabetes increases steadily after the age of 40 years. People living in the 20% most deprived neighborhoods in england are 56% more likely to have diabetes than those in the least deprived areas (see Socio-economic Inequality). 8

 

Bath and North East Somerset

 

There are 7,460 (2012/13 financial year) people 17 years and over registered with diabetes mellitus in GP practises in Bath and North East Somerset.*  9 It is estimated that there are a further 3,259 adults in the B&NES CCG GP Practice population with undiagnosed diabetes. 10

The prevalence rate of diabetes mellitus in those 17 years and over has been steadily increasing locally, and nationally.  In B&NES  it has increased slightly from 4% in 2008-2009 (financial year) to 4.6% in 2012-2013 (financial year).* 11

The prevalence rate in B&NES is significantly lower than England which has had prevalence rates of 5.1% and above between 2008-2013 (6% in 2012/13 financial year ).* 12

diabetes_17_yrs_rate_in_bnes_and_england_gp_17_pop_2008-2013

Figure 1: Diabetes Mellitus prevalence (ages 17+) in B&NES and England 17 years + GP registered populations (2008/09 – 2012/13 financial years) 13

*It is important to note that the above prevalence rates are based on the GP registered population of Bath and North East Somerset and so some of these people may not be residents of Bath North East Somerset. Nevertheless, the vast majority of people will be registered with a GP in their county of residence.

For more up to date prevalence figures for diabetes recorded as part of the NHS Quality and Outcomes Framework (QOF), see the Ill Health and Disability section. 

Because of the impact of obesity on type 2 diabetes, the rising prevalence of obesity has led, and will continue to lead, to a rise in the prevalence of diabetes.  The local resident based prevalence of diabetes is forecast to rise from 6.3 per cent in 2012 (approximately 9,598 people) to 7.4 per cent by 2030 (approximately 12,712 people), a 32 per cent increase over the next 16 years (due to the large margins of uncertainty the modelled prevalence by 2030 could be between 5.3per cent and 13 per cent. 14

 

Admissions for diabetes are lower than regionally and nationally (0.6 per 1000, 1.1 per 1000 nationally and regionally 2010/11), and overall costs for all admissions are lower, however, cost per admission is higher. 15

 

People with diabetes in NHS BAth and North East Somerset CCG were 44.3% more likely to have a myocardial infarction, 32.4% more likely to have a stroke, 72.7% more likely to have a hospital admission related to heart failure and 44.4% more likely to die than the general population in the same area. 16

 

Spending on prescriptions for items to treat diabetes in 2012/13 cost £281.69 per adult with diabetes in NHS Bath and North East Somerset CCG compared to £281.52 across england (this is not statistically significant). 17

Estimated diabetes prevalence to 2030 in the B&NES resident population 18

Diabetes prevalence to 2030

Figure 2: B&NES estimated diabetes prevalence to 2030 in the B&NES resident population (YHPHO tool).

Note: the bars show in the chart represent ‘uncertainty limits’.  Uncertainty limits have been calculated to give an indication of the likely range of this uncertainty. These have been based on the principles of multi-variate sensitivity analysis.19

The local resident based prevalence of diabetes is forecast to rise from 6.3% in 2012 (approx. 9,598 persons) to 7.4% by 2030 (approx. 12,712 persons), a 32% increase over the next 16 years. Note that due to the large margins of uncertainty (see figure 2), the modelled prevalance by 2030 could be between 5.3% and 13%.

 

Are we meeting the needs?

 

Diabetic retinopathy is a common complication of diabetes. It occurs when high blood sugar levels damage the cells at the back of the eye, known as the retina. If it is not treated, it can lead to blindness. Therefore, it is important for everyone with diabetes who is 12 years old or over to have their eyes examined once a year for signs of damage. 20

Retinal screening for diabetes in Bath and North East Somerset both in terms of uptake (89.3%) and coverage (80.7%) were above the national average in 2010/2011. 21

A key quality issue for the screening program is to build in better failsafe systems to track patients from the screening program in to the hospital eye service and then back again. 22

What can we realistically change?

National Institute for Health and Clinical Excellence (NICE) (2011-2013) guidance