Jonathan Valabhji
National Clinical Director for Obesity and Diabetes, NHS England
Diabetes costs around 10% of the NHS budget and it is a leading cause of sight loss and lower limb amputation. NHS England are therefore investing significant effort into reaching people who are at risk.
With around 415 million people living with diabetes across the world, World Diabetes Day seems an appropriate time to reflect on where we have got to through recent efforts in England to both prevent onset of Type 2 diabetes, and to improve the treatment and care for people already living with diabetes.
…sight loss, lower-limb amputation, kidney failure, heart attack and stroke.
Around 2.9 million people have a diagnosis of Type 2 diabetes, and around 250,000 have Type 1 diabetes in England. It is estimated that a further 900,000 have undiagnosed Type 2 diabetes and five million more are at risk of developing it.
Diabetes costs roughly £10 billion every year to treat, around 10% of the NHS budget. It is a leading cause of sight loss and lower limb amputation, and can contribute to kidney failure, heart attack and stroke. With up to 1 in 6 of patients in hospital having diabetes at any given time, the disease is clearly challenging the NHS right now.
Around 2.9 million people have a diagnosis of Type 2 diabetes, and around 250,000 have Type 1 diabetes in England. It is estimated that a further 900,000 have undiagnosed Type 2 diabetes and five million more are at risk of developing it.
What’s the plan?
NHS England are therefore investing significant effort into reaching people who are at risk of developing Type 2 diabetes. In the last 18 months, we have been rolling out The Healthier You NHS Diabetes Prevention Programme to help people at high risk of developing Type 2 diabetes reduce that risk and potentially avoid diabetes by getting face to face support.
Reduce risk and potentially avoid diabetes by getting face to face support.
So far there have been almost 100,000 referrals into the programme, reflecting acceptability by both members of the public and the healthcare professionals involved in the referral process. Over 40,000 people have already started on the programme and geographically, three quarters of England now has coverage, so that people identified to be at risk can get the support they need.
Early analysis suggests that just under half of those taking up the programme are men – a much higher proportion than typically attend weight loss programmes, while roughly a quarter are from black, Asian and minority ethnic communities, groups that are at significantly greater risk of developing Type 2 diabetes.
The programme, run collaboratively by NHS England, Public Health England and Diabetes UK, officially launched last year and early analysis is encouraging. As set out in the recently published ‘Next steps on the NHS Five Year Forward View’, by April 2018 we aim to have achieved full national coverage with as many as 200,000 people referred by 2018/19.
What’s the solution?
Type 2 diabetes can be delayed or prevented in those at high risk through lifestyle interventions that promote better nutrition, weight loss, and increased physical activity. Therefore people on the programme get tailored, personalised help, including education on healthy eating and lifestyle choices, a bespoke physical exercise programme and advice on portion control.
Tailored, personalised help, including a bespoke exercise programme and advice on portion control.
But one thing we realised when we started the programme was that face-to-face sessions did not reach as many people as we could potentially help with technology.
So, for 2018 we have plans to use new technology including apps, digital coaches, wearable devices and other innovations to help people make changes to their lifestyle.
Aside from our efforts to tackle the rising numbers of people with Type 2 diabetes, it is crucial that we also join with our partner health organisations Public Health England and Diabetes UK to tackle and manage all forms of diabetes through supporting proven interventions to reduce the harm that can arise.
To this end there has been further investment in diabetes as a whole, with around £42 million of national funding this year ploughed into advancing the care and treatment for people with diabetes.
Who will benefit?
2.8 million adults and children diagnosed with Type 1 and Type 2 diabetes live in areas that will benefit from the money and receive an improved service, which will see structured education to empower people to look after themselves and stay healthy, with the number of places offered increasing from 54,000 to 148,000 nationally.
Education to empower people to look after themselves and stay healthy.
It will also go towards improving further achievement of the NICE-recommended treatment targets for controlling blood sugar levels, blood pressure and cholesterol. This can reduce the risk of complications such as sight loss, kidney disease and renal failure, limb amputation, stroke and heart attack.
It will also be invested to more directly reduce the risk of amputations by improving access to multi-disciplinary foot care teams in approximately 80 hospital sites or community teams; and it will improve care in hospitals for those with diabetes by improving access to specialist inpatient support in approximately 70 hospitals across England.
Behaviour and lifestyle change is a challenge for us all but for those with diabetes and at risk of Type 2 diabetes it is an essential challenge – by putting people in control of their health the programme is helping to save and change the lives of thousands of people and hopefully next year this will add up to many more thousands as the gift of technology extends our horizons.
