As the number of people diagnosed with diabetes Type 2 grows, so does the prevalence of complications such as hypo- and hyperglycaemia, problems with the eyes, nervous system, kidneys and feet, as well as cardiovascular disease. But tackling these problems takes more than just new drugs or more money. Basic changes to the care system are required says Dr Partha Kar, consultant specialist in diabetes and endocrinology at Portsmouth Hospitals NHS Trust.

“Many of the complications of Type 2 diabetes could be better tackled if we had consistently good care across the country,” says Kar. “At present it varies from excellent in some areas to poor in others, because of inability or unwillingness to learn from good practice.”
Another barrier to better prevention and treatment of complications is ease of access to expert knowledge, says Kar.

“Where relations are good between primary care, patients and specialists, access to expert advice is easier, meaning better treatment for patients, but often these three groups rarely work together. Even now, many GPs and practice nurses do not have easy telephone or email access to specialists who can answer their questions about patient care,” says Kar.

A greater understanding of the role of primary care providers, patients and specialists in diabetes care, plus a greater willingness to learn from patients' own expertise, could also reduce the risk of complications, as would increased education for primary care staff and patients. “At present there is no guarantee that primary care staff are fully trained in diabetes care,” says Kar.

But the biggest barrier to better care is the structure of the NHS finance system, he says. “GP surgeries pay each time they ask hospital specialists for help or refer patients. This may be a deterrent to GPs, resulting in sub-optimal patient care. The system works well for acute cases but it is not for long-term conditions such as diabetes.”

As a possible approach to improving diabetes care he cites the Super Six system, now used by 80 GP practices in the Portsmouth area, which integrates hospital diabetes specialists with community diabetes care teams and states clearly the route to be taken when patients need help, so information is more easily accessible and unnecessary hospital referrals are deterred.

Other developments that could improve diabetes care include advances in medical technology and an increase in peer support and education among patients and clinicians. Dietary advice for people with diabetes may also change in future. “There is controversy about whether low-carbohydrate diets reduce the risk of developing type 2 diabetes. We are looking forward to seeing trials on this,” says Kar.

Whatever the new developments, though, he asserts: “Simply throwing more money at the problems of diabetes and its complications will not work unless existing structures are changed.”