DIABETES


Type 2 diabetes: where do we go from here?


StatIStIcS rElatIng to tYPE 2 dIaBEtES MakE for dEPrESSIng rEadIng. at PrESEnt, thE dISEaSE affEctS alMoSt SIx PEr cEnt of thE adUlt PoPUlatIon In northErn IrEland, WIth thE nUMBErS dIagnoSEd IncrEaSIng BY MorE than 70 PEr cEnt SIncE 2004-05, and ProJEctEd to rEach 100,000 BY 2020.


I


n northern Ireland, available statistics indicate that 88,000 people, or around 5.7 per cent of


the population, have been diagnosed with diabetes, and that around 90 per of these are type 2 cases. the number of local people living with diabetes is increasing annually – and has risen by 71 per cent between 2004-05 and 2015-16. type 2 diabetes can have a major impact on the physical and psychological well- being of individuals and their families.


despite the fact that action is obviously needed – and urgently – to tackle this growing problem, this latest report from nIao is critical of the lack of implementation of initiatives to meet the challenge.


‘the projected growth of type 2 diabetes creates a real risk that the current model of care provision will become unsustainable,’ said kieran donnelly, the comptroller and auditor general at nIao.


‘a review of diabetes care in 2003 pointed the way towards adopting many areas of best practice. Whilst a number of initiatives aimed at enhancing diabetes care were subsequently introduced, I was disappointed to note that there was limited implementation of the 2003 review and that the department did not introduce a comprehensive strategy until late 2016. this was clearly a missed opportunity to slow the growing prevalence of the disease, and to reduce the numbers of serious complications which can


14 - PharMacY In focUS


arise, including blindness and lower limb amputations.’


The cost to NI healthcare Mr donnelly is particularly concerned about the treatment costs of type 2 diabetes.


‘type 2 diabetes is a matter of concern, both in terms of its impact on human life and its cost to the public purse,’ he said. ‘already it is estimated that treating diabetes costs northern Ireland £400 million annually. this is ten per cent of the local healthcare budget and forecasts indicate this may rise to 17 per cent of health spending by 2035.


‘the department has limited data on the local costs of treating complications, but it did estimate the costs of treating diabetes in an acute hospital setting in 2010-11 at £68.6 million (£57.9 million of which related to type 2 diabetes).


‘however, such costs are almost certainly significantly higher, as this analysis excluded a wide range of relevant expenditure. In addition, there are between 150 and 200 lower limb amputations due to diabetes annually. Estimates suggest that these cost between £9,400 and £13,500 each, with individual hospital emergency admissions for-diabetes related hypoglycaemic or hyperglycaemic events costing between £816 and £3,570.’


Mr donnelly’s concerns over the cost of the disease are supported by


statistics from diabetes Uk, which suggested recently that, if 75 per cent of local diabetes patients were treated in accordance with best practice, health and social care could save £75.5 million by 2030.


So, what can be done? according to the report, if the substantial human and cost burden of type 2 diabetes is to be minimised, effective strategies to reduce incidence and patient complications must be implemented. the new diabetes Strategic framework recognises that community-based services play a vital role in providing people with care and support, including support to care for themselves.


for people with type 2 diabetes, ‘self- care’, says the report, is about dealing with the impact of the condition on their daily lives. a growing body of


evidence demonstrates that supporting people with long-term conditions to self manage offers improved clinical and `quality of life’ outcomes. It can also minimise increases in healthcare costs.


the current diabetes Strategic framework has set the direction for local diabetes care until 2027. Based on current estimates, the local healthcare system is expected to incur expenditure of at least £4 billion in this period on treating diabetes. however, if the implementation of the framework does not succeed in securing meaningful advances in preventing type 2 diabetes and in minimising patient complications, the future cost burden on the healthcare system will almost certainly be significantly greater.


the starting point, according to the report, for the department and its >


Number of people aged 17 or over diagnosed with diabetes (Types 1 and 2) in Northern Ireland 2004-05 to 2015-16


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