DIABETES
The Age of Diabetes W
e are all familiar with recognising history as periods or ‘ages’ in an
attempt to understand it. We know that each ‘age’ brings with it positive change as well as new turmoil. The Industrial Age brought innovation and production but it also introduced overcrowding and slum housing. Often we can’t see the ‘age’ we are in until there is some distance to refl ect and analyse.
According to the Scottish ‘State of the Nation’ Report 2015, we are in the ‘Age of Diabetes’.
There currently exists the ability to respond because we have the science, data analytics and voices of people affected by diabetes and healthcare professionals pushing forward with ways to manage it. No longer is there the need to wait to refl ect back and say that hindsight is a wonderful thing – it can be seen now. The challenge is: what will we do about it?
The number of people living with Type 1 and Type 2 diabetes is increasing. There have not been signifi cant inroads to bring this number down although we are starting to see evidence in Scotland that the rise in numbers is affected by an ageing population and people surviving longer with diabetes.
These numbers, although sometimes disputed, have not been signifi cantly challenged or changed in recent years. There is a commitment to develop a framework to address this. Scotland has the worst record of HbA1c control in the western world. While action to tackle this has begun in last few years, this is in its early stages and will need commitment, resource and focus to achieve strong outcomes.
NHS Scotland spends almost £1bn annually, or £100,000 every hour, on diabetes. 80% goes on managing avoidable complications.
It is known that people with all types 16 - SCOTTISH PHARMACIST
of diabetes are more likely to live in areas of deprivation, more likely to smoke, more likely to experience depression and other mental health issues. This access to information gives pharmacists and allied healthcare professional’s power. However, information only matters if you use it to inform positive change and better health outcomes.
Unlike Type 1 diabetes, which is not preventable, up to 80% of cases of Type 2 diabetes can be delayed or prevented. This can be done by:
• Developing and implementing an appropriate framework for assessing risk of Type 2 diabetes and identifying those who are currently undiagnosed.
• Helping people to maintain a healthy weight through whole population-level interventions.
Being overweight or obese is the most signifi cant risk factor for Type 2 diabetes, and accounts for 80 to 85% of the risk of developing this condition. The most effective way of preventing Type 2 diabetes is by maintaining a healthy weight, eating a balanced diet, being more active and living in an environment where this is supported.
Community pharmacists and their teams must support all parts of the population to make healthier choices.
15 HEALTHCARE ESSENTIALS Every person with diabetes needs the recommended treatment and services, regardless of their age, ethnicity, where they live or whether they have Type 1 or Type 2 diabetes. This includes the nine care processes outlined by SIGN. Scottish Government data says this is not happening for signifi cant numbers of people particularly those with Type 1 diabetes, people in certain geographical areas and people living in areas of deprivation.
Diabetes UK 15 Healthcare Essentials
set out the care that all people with diabetes should expect to receive from their healthcare team every year. They include the nine care process checks recommended by SIGN, and provide a starting point for ensuring everyone gets high quality and effective care.
1. Blood glucose levels (HbA1c) should be measured at least once every year. This will measure overall blood glucose control and help sufferers and you as the healthcare provider, set a target.
2. Blood pressure should be measured and recorded at least once a year, and set a personal target that is right for the patient.
3. Blood fats, such as cholesterol, should be measured every year. Patients should have a target that is realistic and achievable.
4. Eyes should be screened for signs of retinopathy every year.
5. Advise on having feet checked. The skin, circulation and nerve supply of the feet should be examined annually. Patients should then be told if they have any risk of foot problems and how serious they are.
6. Kidney function should be monitored annually. This should involve two tests: a urine test for protein and a blood test to measure kidney function.
7. Weight must be checked and waist measured to see if patients need to lose weight.
8. Offer support to smokers, including advice and support on how to quit.
9. Engage in care planning discussions with to talk about the patient’s individual needs and set targets.
10. Advise on attendance to education courses in your local
area to help understanding and self-management of diabetes.
11. Advise and refer on specialist paediatric team care for children or young people.
12. Advise on need to receive high- quality care if admitted to hospital from specialist diabetes healthcare professionals, regardless of whether or not they have been admitted due to their diabetes.
13. Provide information and specialist care advice to those planning to have a baby as their diabetes control has to be a lot tighter and monitored very closely. Patients should expect care and support from specialists at every stage, from preconception to postnatal care.
14. Offer referrals advice to specialist diabetes healthcare professionals to help further manage their diabetes, such as podiatrists, ophthalmologists and dietitians.
15. Offer advice on importance of emotional and psychological support. Being diagnosed with diabetes and living with a long- term condition can be diffi cult.
THE URGENCY
Diabetes is the fastest growing health threat of our time and a critical public health matter.1
• The number of people living with diabetes is rising each year and since 2008 there has been a 25% increase in the number of Scots with the condition.
• Over 276,000 people in Scotland now have diabetes:
·· 276,430 people – or 5.2% of the population – have been diagnosed with diabetes. There is a signifi cant difference across Health Boards ranging from 4.2% to 5.8%
·· a further 45,500 people are >
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