Tackling diabetes in England
Diabetes In The UK Professor Jonathan Valabhji, NHS England’s National Clinical Director for Obesity and Diabetes gives insight on the issue of diabetes in England.
Firstly, the outlook for people with type-1 and type-2 diabetes has improved. Over the last three years alone, the risk for any individual with diabetes developing heart failure has significantly reduced, with trends for reductions in the other major complications.
A recent study suggested that early death due to diabetes was lower in the UK than in 18 other wealthy countries. Secondly, there has been a dramatic rise in the number of people with diabetes, with 3.2 million people now living with diabetes in England. This is due to rising numbers with type-2 diabetes and relates to lifestyle; over 60 per cent of adults and one third of children at age 11 are now overweight or obese, which is the major risk factor for developing type-2 diabetes.
Although the risk of any individual with diabetes developing complications has reduced, with so many more people living with diabetes, the burden of complications that the NHS has to deal with has increased. It was estimated in 2012 that £10billion, 10 per cent of the total health budget, was spent on the care of people with diabetes, most of which, 80 per cent, was spent on dealing with complications including eye, kidney, foot, heart and stroke disease.
It has been proven that type-2 diabetes can be delayed or prevented in those known to be at high risk through lifestyle interventions that promote better nutrition, weight loss, and increased physical activity. As a result, we have recently launched the NHS Diabetes Prevention Programme. This will be implemented across England, and targeted towards high-risk individuals.
"Over 60 per cent of adults and one third of children at age 11 are now overweight or obese, which is the major risk factor for developing type-2 diabetes."
Together with the government’s anticipated childhood obesity strategy, this provides a mechanism for tackling the rising numbers with type-2 diabetes in the years to come. However, 10 per cent of those with diabetes have type-1, an autoimmune disease usually occurring in childhood and young adulthood that is not related to lifestyle factors and so cannot be prevented. People with type-1 diabetes are over-represented in complications clinics. In my own multidisciplinary foot clinic in London, 30 per cent of attendees with diabetic foot disease have type-1 diabetes, despite type-1 constituting less than 10 per cent of those with diabetes locally. So in addition to the focus on type-2 diabetes prevention, we need to also focus on better treatment and care for those that already have diabetes, particularly those with type-1.
About the author
Professor Jonathan Valabhji is National Clinical Director for Obesity and Diabetes at NHS England. He is a Consultant Diabetologist at St Mary’s Hospital, Imperial College Healthcare NHS Trust in West London and so remains highly active at the clinical coalface. The published clinical outcomes from his Multidisciplinary Diabetic Foot Service at the Trust are comparable to the best centres internationally. He is Adjunct Professor at Imperial College London, with a current research focus on diabetic foot disease, and past publications on cardiovascular disease in diabetes. He is a committee member of the Association of British Clinical Diabetologists. As National Clinical Director, he is currently providing clinical leadership around a number of national initiatives, including the National Diabetes Prevention Programme, a collaboration between NHS England, Public Health England and Diabetes UK that aims to cause England to be the first country to implement at scale a national evidence-based Type 2 diabetes prevention programme.