The number of people with diabetes in the UK has more than doubled over the past two decades, with more than 3.8 million people currently affected. Around 10% of them have Type 1 diabetes, which is caused by loss of insulin production, while the remaining 90% have Type 2 diabetes, associated with loss of responsiveness to insulin. A further seven million people are at high risk of developing Type 2 diabetes, reflecting an ageing and increasingly inactive, overweight and obese population.
Individuals living with diabetes face an increased risk of heart disease, stroke, lower limb amputation, kidney disease and blindness. This has a negative impact on social and economic independence and reduces life expectancy by up to 14 years.
In Scotland, more than a quarter of a million people have diabetes. This is just below 5% of the population, which is slightly better than the 6% in the UK as a whole, but it appears to be getting worse more quickly, with incidences having doubled in the past ten years alone. It is worth stressing the need to be careful with these numbers: to some extent they may reflect advances in being able to diagnose the disease. But saying that, there seems little doubt that the problem is getting worse.
Diabetes costs the NHS in Scotland more than £1 billion a year, 80% of which is spent on managing avoidable complications associated with the disease. People with diabetes account for around one-fifth of hospital in-patients at any point in time and spend nearly three days longer in hospital than patients without diabetes.
Direction of travel
Cases of both Type 1 and Type 2 diabetes are increasing in number. Scotland has the third-highest incidence of childhood Type 1 diabetes in the world (after Finland and Sardinia), and levels of Type 2 diabetes are also increasing in young individuals.
Type 1 diabetes is an auto-immune disease and has nothing to do with lifestyle choices. The high and growing prevalence is not well understood. On the other hand, with Type 2 diabetes, the evidence shows that about three-quarters of sufferers are either overweight or obese (with most of the remainder either explained by tendencies within families or ethnicity, with south Asians and Afro-Caribbeans most at risk). So this increase goes hand in hand with the fact that Scottish people are increasingly likely to be overweight.
Significantly, 13.8% of very young Scottish children were reported to be obese in 2010, and only 65% of school children were of a healthy weight. Overall, one in five people either has or is at high risk of diabetes.
So – an uphill battle indeed. In a bid to turn it around, eight years ago the Scottish government set up the Scottish Diabetes Research Network (SDRN), which was developed a National Research Register for patients wishing to take part in research with the aim of improving the quality and quantity of diabetes research in Scotland. It is an impressive initiative, which doesn’t exist elsewhere in the UK for example.
New treatments are now emerging or being tested in large-scale clinical trials. Research is ongoing into islet cell transplantation with a view to developing a vaccine for Type 1 diabetes.
In 2010 the government published a route map towards healthy weight. It outlined plans for reducing Scotland’s energy consumption, encouraging more exercise, and instilling good habits during early years with a view to improving the proportion of children within the healthy weight range.
The government published a report in 2013 that looked at how this strategy had been progressing. It showed early signs that obesity had reduced slightly, while acknowledging there was still a long way to go. This is an encouraging sign, though it has not yet produced any decline in the diabetes numbers.
Since the early 2000s, the authorities have also monitored the quality of diabetes care across Scotland by the Scottish Diabetes Survey. The survey provides key information to help NHS boards identify what is needed to improve care or outcomes for diabetic individuals.
For example, one priority is to ensure that individuals with Type 1 diabetes achieve optimal control of their blood glucose: four out of five individuals, particularly 15-25 year olds do not achieve target levels, increasing their risk of life-threatening ketoacidosis and other serious complications in the future.
Does this add up to a good package? The truth is that it will be years before we know for sure. It will be vital that we keep monitoring our progress against the route map and make changes if we seem to be heading in the wrong direction.
The other side of the coin is that individuals need to take responsibility for their own health, whether or not they already have diabetes. There tends to be a lot of emphasis on confronting people with their failures to make the right choices, which in my view is more likely to lead them to give up rather than change their behaviour.
Instead it is worth emphasising the positive steps that people can take on their own. Those living with diabetes can register to access their own clinical information on an interactive diabetes website. It helps people who have diabetes, with their carers, to self-manage their disease.
Good self-management involves carrying out nine key healthcare checks each year. These include measuring blood glucose, blood pressure and cholesterol; retinal screening, a foot and leg check, assessing kidney function (urine and blood), and checking their weight and smoking status. Diabetes UK also recommends care planning, emotional and psychological support, inpatient diabetes support, advice during pregnancy, access to insulin pumps, education and self-management.
For individuals who do not have diabetes, it is vital that they understand their future risk of diabetes, for example by using the online Diabetes UK risk assessment tool. Those considered more at risk can then take preventive measures such as reducing their weight and doing more physical activity. With education and encouragement, the hope is that we can start to turn the corner.