Leicester Joint Strategic Needs Assessment (JSNA). Health and social care needs associated with diabetes, 2016.
Diabetes is a chronic disease that occurs when the pancreas does not produce enough insulin, or when the body cannot effectively use the insulin it produces.
There are two main types of diabetes:
- Type 1 diabetes (T1D) usually develops in childhood and adolescence and patients require lifelong insulin injections for survival.
- Type 2 diabetes (T2D) usually, but not exclusively, develops in adulthood and is related to obesity, physical inactivity, and unhealthy diet. This is the more common type of diabetes (representing 90% of diabetic cases worldwide) and treatment may involve lifestyle changes and weight loss alone, oral medications or even insulin injections.
- Another important type of diabetes is gestational diabetes (a state of hyperglycemia which develops during pregnancy).
Who’s at risk and why? (national and local data)
Diabetes is a national health priority and is of particular importance in Leicester, owing to its high prevalence locally. It is associated with significant morbidity and early mortality, and has a substantial impact on healthcare costs in the UK.
The main risk factors for developing type 2 diabetes are:
- family history
- being overweight or obese
- ethnicity, particularly South Asian, Chinese, African-Caribbean or black African origin
- certain medical conditions such as:
- cardiovascular disease
- polycystic ovary syndrome
- gestational diabetes or having given birth to a baby over 10 pounds
- severe mental health conditions
- impaired glucose metabolism
- high socio-economic deprivation (because of higher levels of obesity and smoking and lower levels of physical exercise and consumption of fruit and vegetables).
The level of need in the population
Based on GP register data, Leicester has a higher prevalence of diabetes in its adult population (over 17+ years) - 8.9% compared to 6.4% nationally, with 93% of people with diabetes having T2D. It is estimated that every year there are approximately 1,000 new cases of diabetes in Leicester City.
Diabetes prevalence in Leicester is more common in older ages where around 1 in 4 people aged over 65 has diabetes, with the rate in the Asian population almost four times as high as in the white population.
The latest available NHS benchmarking data (2012/13) indicate that the rate of emergency admission for diabetes in Leicester is very similar to the national average (30 per 100,000 population). However, there is a significant variation in rates across different population groups, linked to prevalence of risk factors for diabetes.
Among over 6,000 diabetes emergency hospital admissions in 2014/15, the majority involved patients over 85 years of age, Asian or Asian British residents and those residing in areas of significant socio-economic deprivation.
There are around 30 deaths per year with an underlying cause of diabetes, around one-third in men and two-thirds in women.
Current services in relation to need
The majority of estimated spend on diabetes in Leicester is on primary prescribing, at 68%, with 28% spent on secondary and critical care.
The Leicester City Clinical Commissioning Group (CCG) commissions a number of services for diabetes patients. The CCG and these services are working towards an agreed local agenda for diabetes - “Transforming Diabetes Care”. This aims to reduce clinical variation in general practice, improve uptake of patient education programmes, improve care and outcomes for patients with diabetes, deliver better in-patient care and reduce avoidable hospital admissions.
All GP practices provide the core diabetes services, such as screening, prevention, review and surveillance, prescribing and audit.
Some GP practices provide an enhanced level of service, such as initiating a newer class of T2D drugs, more intensive care for patients with poor control, proactive care for those at risk of hospital admissions and complications and actively managing discharge of patients who attend acute diabetes out-patient clinics.
The third component of primary care is the Integrated Community Diabetes Service which provides a specialist, community based support for complex patients who receive only core services from their GP.
There are also local health professional and patient educational programmes.
There is a programme of monitoring of people diagnosed with diabetes and measurements captured include blood pressure (BP), cholesterol levels and blood sugars. The data gathered through this are regularly assessed and benchmarked against national figures.
Projected services use and outcomes in 5 years and 10 years
If current trends in population change and obesity persist, the total prevalence of diabetes in Leicester can be expected to rise to almost 12% in 2025. Across England, approximately a third of the projected rise in diabetes prevalence can be attributed to the increasing prevalence of obesity. If obesity levels in Leicester remained at 2010 rates, there would be nearly 1,700 fewer people with diabetes in 2025.
Unmet needs and service gaps
Unlike other disease areas, Leicester’s detection of diabetes is more in line with predictive prevalence, with the GP registration rate now exceeding the epidemiological estimates derived from national prevalence data. It is thus likely that the majority of people with diabetes in Leicester have been diagnosed and are receiving care.
However, variation in hospital admission rates, particularly emergency hospitalisation, may be an indication of a need for further patient education and better support for clinicians to deliver more targeted care, and develop and maintain their skills.
Recommendations for consideration by commissioners
Recommendations for commissioners include working with all stakeholders to ensure main risk factors for diabetes are addressed through effective health improvement programmes, improving awareness of lifestyle factors in the development and management of diabetes, investigating and understanding existing variation in care, and working closely with Leicester’s healthcare providers to develop and deliver effective education programmes to patients, their families and providers.