Diabetes is a serious health condition where your blood glucose level is too high. This can happen when your body doesn't produce enough insulin, the insulin it does produces isn't effective, or the body can't produce any insulin at all (Diabetes UK). There are two main types of diabetes: Type 1 and Type 2. Of those diagnosed with diabetes, 8% have Type 1, 90% have Type 2 and the remaining 2% have rarer forms of the disease.
Type 1 diabetes is an autoimmune condition. This means your body has attacked and destroyed the cells that make a hormone called insulin, that regulates the glucose level in your blood.
Type 2 diabetes develops when the body is not able to produce enough insulin or when the insulin produced does not work properly.
Unlike Type 1 diabetes, Type 2 diabetes is often linked to:
- Being overweight, particularly being bigger around the waist than hips
- Doing little physical activity
- Those with a family history of diabetes
- Certain ethnic backgrounds (Asian, African or Caribbean)
- Developing gestational diabetes during pregnancy
Currently, this condition mainly affects older adults but is increasingly affecting young adults and teenagers, due to increases in obesity levels.
Diabetes UK describes prediabetes as; 'blood sugars that are higher than usual, but not high enough for a diagnosis of type 2 diabetes'. It also means that an individual could be at high risk of developing type 2 diabetes.
Prediabetes is also sometimes called borderline diabetes. Higher than normal blood sugars can be detected via blood tests.
These tests are a mix of fasting or non-fasting and they all help healthcare teams to understand the risk of developing type 2 diabetes. If left untreated, diabetes will get progressively worse, making early detection vital. By making changes to diet, increasing physical activity and losing weight, about half of type 2 diabetes cases can be prevented or delayed in some people.
In 2020/21, 6.1% of GP patients in Southampton were diagnosed with diabetes, less than both the South East region (6.5%) and the national average (7.1%). This is probably explained by Southampton having a relatively young population. However, much diabetes is undiagnosed, and modelled estimates in 2017 estimated the true underlying prevalence in Southampton to be 1.3x higher than the recorded rate. Despite a steady, but consistent increase since 2012/13, the rate of increase in Southampton is below both that of the South East and national rates.
In Southampton the typical profile of a Type 1 diabetes patient is:
- Male (56.3% of Type 1 patients)
- Under 40 years old (53.2% of Type 1 patients, the percentage of Type 1 diabetes patients decreases with age)
- From a White ethnic origin (87.4% of Type 1 patients)
The typical profile of a Type 2 diabetes patient in Southampton is:
- Male (55.9% of Type 2 patients)
- Aged 40 to 64 years old (46.0% of Type 2 patients)
- From a White ethnic origin (71.7% of Type 2 patients)
People with diabetes are at greater risk of developing other health issues and conditions. The ratio of diabetic patients in the Southampton CCG who experienced complications, has been steadily increasing since 2011/12. In 2018/19, the ratio of complications in people with diabetes was 127.2 in Southampton, significantly higher than the national average of 100.0, and making Southampton the highest amongst its comparator Clinical Commissioning Groups (CCGs).
Two of the most common complications are eye and feet related complications:
- Eye conditions - 4.2 per 100,000 people, aged over 12, were provided with a New Certification of Visual Impairment (CIV) due to diabetic eye diseases
- Foot conditions - 176.2 per 10,000 people, aged over 17, were hospitalised, for an average of 10.5 days, for diabetic foot disease. Additionally, 37.1 minor and 9.4 major, diabetic lower-limb amputation procedures, directly standardised per 10,000 people aged over 17, were carried out between 2017/18 and 2019/20
To improve long-term care of patients with diabetes, NICE (National Institute for Health and Care Excellence) recommends 8 key care processes, in addition to retinal (eye) screening.
These care processes are:
- Glycated haemoglobin (HbA1c) measurement, with a suggested target of 59 mmol/mol.
- Blood pressure (BP) measurement, with a suggested target of 140/80 mm Hg.
- Cholesterol level measurement, with a suggested target for total cholesterol (TC) of 5 mmol/L.
- Foot checks
- Urinary albumin testing
- Serum creatinine testing
- Weight check
- Smoking status check
In 2018/19, 43% of people with Type 1 diabetes in Southampton received all 8 care processes, statistically similar to England at 40.8%. The proportion of people, with both Type 1 and Type 2 diabetes, who received all 8 care processes has decreased since 2014/15 in Southampton, however this has decreased more rapidly for those with Type 2 diabetes. Consequently, Southampton now has statistically less individuals receiving all 8 care processes (49.6%) when compared nationally (54.3%), the first time over the five-year period between 2014/15 and 2018/19.
Looking at the care processes individually, across both types of diabetes, smoking status recording is the most carried out process (91.9% of Type 1 patients and 95.0% of Type 2 patients) and urinary albumin tests are the least carried out process (50.9% of Type 1 patients and 54.4% of Type 2 patients). This mirrors national observations.
Southampton proportionately carries out more than the national average for 6 out of the 8 care processes, for Type 1 patients, but only 1 out of 8 for Type 2 patients (recording smoking status). Over the last five years positive progress has been made in 6 out of 8 care processes, seeing an increase in completion rates for Type 1 patients but only 2 out of 8 for Type 2 patients.
At a GP practice level, the proportion of patients receiving all 8 care processes ranges from 16.7% to 100% for Type 1 patients. In addition, when looking at each care process at an individual level each one had a minimum completion of 55.6%, except for the urinary albumin test. For Type 2 patients, the proportion of patients receiving all 8 care processes was lower, ranging from 8.7% to 93.8% with all processes carried out at a minimum of 73.9%, except for the urinary albumin test.
Three targets, Hba1c (glucose control), blood pressure and serum cholesterol, have been recognised as key evidence-based measures to evaluate whether diabetic patients are being supported to successfully manage their condition.
In Southampton in 2019/20, only 22.5% of Type 1 diabetics achieved all three targets and 39.0% of Type 2 diabetics, with little change witnessed for either group of patients since 2014/15. Despite the lower success in achieving these targets amongst Type 1 diabetics, Southampton is performing statistically similar against the English average (19.8%), whilst achieving statistically lower levels for Type 2 diabetics, the national average is 40.3%.
Structured education courses for diabetes patients, as recommended by NICE can be a successful tool for empowering patients to self-manage their condition, and reduce the onset of complications, whilst improving key outcomes and reducing treatment costs. In 2018/19 the structured education programme was offered to 62.5% of Type 1 patients and 76.6% of Type 2 patients, within 12 months of diagnosis, yet uptake remained low at 12.5% and 13.0% respectively.
The diabetes dashboard presents a wide range of data regarding diabetes, to provide intelligence to help drive strategic decision making. Analysis includes benchmarking against statistical neighbours and trends over time.
OHID - Fingertips - Diabetes profile
NICE - NICE impact diabetes
NHS Digital - National Diabetes Audit
NHS Digital - Compendium – Mortality from diabetes
NHS Digital - Complications associated with diabetes
Gov.uk - Diabetes: develop treatments in the UK
Solent NHS Trust - Diabetes Services
NHS - Diabetic retinopathy
Healthier You - preventing diabetes