DIABETES


Treatments costs for diabetes account for ten per cent of current local healthcare expenditure – this could rise to 17 per cent by 2035


> partners is to ensure continuous improvement in disease management for those living with type 2 diabetes. this can help patients avoid unnecessary complications, thereby minimising patient suffering, maximising life expectancy, easing pressure on the health and social care system and reducing treatment costs. Patient education is crucial in assisting self management of type 2 diabetes


Self management is the cornerstone of type 2 diabetes care, since patients will spend the vast majority of their time away from the direct influence of the healthcare system. however, many people with type 2 diabetes do not control their condition well. It is therefore important that people receive the right education and skills training to be able to self-manage their condition.


One success story While the report is critical of the lack of implementation of initiatives, it does highlight the contribution of one local initiative used by the northern trust in recent years to try and improve self management of type 2 diabetes.


diabetes Education and Self- Management for ongoing and newly diagnosed (dESMond) is a structured education programme for type 2 diabetes patients aiming to provide education and support to 1,000 patients annually within the northern health and Social care trust area. the programme aims to educate 500 of the 800 newly diagnosed patients within the area annually, as well as a further 500 patients with established type 2 diabetes with high risk complications. Programme delivery is


16 - PharMacY In focUS


by registered healthcare professionals who have been formally trained within dESMond, who have a working knowledge of diabetes, and an interest in, and experience of, working with diabetes patients.


referrals to the programme are received from gPs, diabetic Specialist nurses, practice nurses and secondary care professionals. Priority is given to newly diagnosed patients and to people with diabetes management problems that could result in long term complications or hospital admissions.


One possible solution? one potentially viable solution suggested by the report in terms of tackling type 2 diabetes is bariatric surgery.


In instances where a dietary approach has been unsuccessful in controlling obesity and type 2 diabetes, the report says, bariatric surgery may be an effective option for helping to minimise patient complications. Bariatric surgery involves modifying the gastrointestinal tract to reduce the intake and/or absorption of food, most commonly using a gastric band or gastric bypassing.


In 2008, the department endorsed nIcE clinical guidelines which recommended bariatric surgery as a treatment option for patients with morbid obesity and type 2 diabetes. disappointingly, however, the report highlights that responsibility for implementing these guidelines lies with the hSc Board and the Pha, and, to date, the guidelines have not been adopted locally.


although the local trusts have estimated that more than 50,000 people in northern Ireland may meet the nIcE criteria for bariatric surgery, nIcE considers that only between two and four per cent of these would actually seek surgery. the department has estimated that treating two per cent of those eligible would cost approximately £20 million.


the absence of a comprehensive local bariatric surgery service has meant that more than 120 local patients have been referred for the procedure to specialist units in England. In the 2018-19 financial year, £1.5 million has been set aside for such referrals.


at £5,000 to £15,000, the initial cost of bariatric surgery is high. Whilst


research demonstrates that the benefits delivered may make the process cost-effective over a patient’s lifetime, current budget restrictions and the significant up-front costs may limit more widespread local adoption of the procedure for type 2 diabetes patients. another practical limitation to providing the surgery is a possible imbalance between patient demand and workforce supply. the department highlighted that bariatric surgery may only have a peripheral impact on the overall local scale of obesity and type 2 diabetes. however, it also acknowledges that the issue remains to be resolved in terms of regional commissioning, including the development of appropriate care pathways for those who may be assessed as suitable for this treatment.


Conclusion While the report offers positive suggestions to deal with the rising challenge of type 2 diabetes, Mr donnelly ended on a note of negativity.


‘the current strategy offers potential to secure real improvements,’ he said. ‘however, for too long, the prevalence of the condition, the serious healthcare outcomes for people living with it, and the costs associated with treating it have been increasing unchecked. I can only conclude that, to date, value for money has not been achieved in delivering type 2 diabetes services.’


A clear opportunity to improve care for people living with Type 2 diabetes was missed according to a report issued recently by the Northern Ireland Audit Office (NIAO)


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