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Diabetes
What is diabetes?
Diabetes is a health condition in which there is too much glucose (sugar) in the blood and this causes damage to the body. There are
two main types of diabetes. Type 1 typically affects young people and children, and requires insulin for treatment. The most common type
of diabetes (90% of all diabetes) is Type 2 which can be treated with diet, exercise or medication, and it is related to:
- Increasing age
- Ethnic origin. (For example, people of South Asian and African/Caribbean descent have four to six times higher risk than White
Europeans).
- Family history of diabetes.
- Increasing levels of obesity and overweight, which in turn are associated with low levels of physical activity and high intake
of calories from food, as well as socio-economic deprivation.
- Gestational diabetes (diabetes during pregnancy).
As obesity levels are increasing in all groups, there is now an emerging epidemic of Type 2 diabetes in young people and children,
as well as older people.
It is estimated that between a third to a half of the people who have Type 2 diabetes do not know that they have the condition. It
can remain hidden for a few years before presenting with symptoms such as increased thirst, passing large quantities of urine, weight
loss or general tiredness. Sometimes diabetes is first diagnosed when one of its complications occurs such as a heart attack, stroke
or foot ulcer.
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Why is diabetes important?
Diabetes can affect nearly all parts of the body - if not well managed it can lead to heart disease, kidney failure, blindness and
amputation, increased risk of infections and other disorders. The good news is that if diabetes is well controlled most long-term
complications of diabetes can be prevented or delayed.
Because of the huge impact of diabetes on individuals and the Health Service, the Government has issued a National Service Framework
(NSF) to work towards providing a quality service for people with diabetes, and to reduce its onset and complications.
(1-3)
However, diabetes can be prevented. There is now good evidence that individuals at increased risk of developing Type 2 diabetes can
reduce their risk if they are supported to change their lifestyle by eating a balanced diet, losing weight and increasing their physical
activity levels. (4)
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How much diabetes do we have in London and in England?
The best estimates of the burden of diabetes have come from the Health Survey for England, which showed that between 2 to 3%
of people in England suffer from known diabetes. However, data have not been available at sub-national level, with no data for
London.
To help with the implementation of the Diabetes NSF, it is crucial to know how many people there are with diabetes in any given
area (prevalence). Thus a model has been developed to estimate the prevalence of diabetes at the national, regional, and primary care
trust (PCT)/Local Authority level. The PBS Model (Public Health Observatory, Brent, ScHARR Model) has been developed by the Yorkshire
& Humber Public Health Observatory (YHPHO) in collaboration with Brent PCT and Sheffield School of Health & Related Research (ScHARR),
and was launched in July 2004. It can be accessed at YHPHO.
A paper describing the prevalence of diabetes in London using this model can be accessed by clicking here.
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What is happening about diabetes services in London?
There are 12 standards in the Diabetes NSF, (1) while the delivery strategy
(2) focuses on setting up systems for regular retinal screening (screening for eye complications) for all persons with diabetes, and on setting
up diabetes registers in primary care practices.
There are Diabetes Networks and Diabetes Development Groups across the five health sectors in London to take this work forward.
At PCT level there are multi-disciplinary NSF implementation teams or groups such as the Diabetes Priority Action Group, actively
working across primary care, secondary care and the community to improve services for people with diabetes. Developments taking
place within some PCTs in London include:
- A programme of education of patients and healthcare staff. Several patients have received training to become "expert
patients"; they can go on to teach other patients.
- Diabetes management guidelines.
- Care pathways to help improve the provision of foot care to avoid foot ulcer disease.
- A pilot of a "one-stop-shops" for diabetes.
- Development of diabetes registers is taking place across all PCTs.
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