1960 to now: the big differences in diabetes care
Care & Medication Four decades ago, UK patients with diabetes received very different — and extremely limited — treatment. We shouldn't forget how things used to be, says one leading clinician.
Type 2 diabetes has quadrupled since 1960's
When Professor Roger Gadsby began his medical career around 40 years ago, the care and treatment for type 2 diabetes was very different. But then, far fewer people had been diagnosed with the disease.
“At that time, approximately 1%-1.5% of the country had a type 2 diabetes diagnosis, so it was a relatively rare condition,” says Gadsby, Honorary Associate Clinical Professor, Warwick Medical School, University of Warwick. “Today, those numbers have quadrupled. I'm afraid the prevalence of type 2 diabetes mirrors people's increasing obesity and sedentary nature.”
Increased personalisation options for treatment
“The increase of type 2 diabetes mirrors increasingly sedentary lifestyles.”
In the 1960s and 1970s, most diabetes care took place in hospital. Now, around 90% of people with type 2 diabetes are able to receive care in the community, which causes less disruption to their lives.
Forms of treatment were less varied then, too. “By the mid-1980s, patients had just three types of treatment options: insulin and two kinds of glucose-lowering tablets,” notes Professor Gadsby. “That meant it was difficult to personalise care or reduce complications if they arose.” Now, it's a different story: there are more than six kinds of medication available in tablet and injectable form.
Driving up standards in diabetes care
Another change has been the medical profession's view of the disease. “Clinicians used to look at diabetes in a strictly medical way,” remembers Professor Gadsby. “Now, there's an attempt to motivate people to make dramatic changes to their lifestyles that will either prevent diabetes — or, if they already have it, send it into remission.”
Initiatives such as the National Diabetes Audit — which measures the quality of diabetes care in England and Wales — and the Quality and Outcomes Framework (QOF), have undoubtedly helped improve patient care. Education has also developed to meet the needs of clinicians. “The tools are there to enable practices to run good diabetes care,” says Professor Gadsby. “I'm optimistic that patient treatment will improve further, but only if financial and human resources continue to be made available.”