Diabetes

Diabetes

Diabetes is a lifelong health condition that causes a person’s blood sugar level to become too high. 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
• Ageing

Currently, this condition mainly affects older adults but is increasingly affecting young adults and teenagers, due to increases in obesity levels.

More information can be found in the diabetes dashboard below and in the resources section.

Prediabetes

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. 

More information can be found in the diabetes dashboard below and in the resources section.

Prevalence

In 2021/22, 6.2% of GP patients in Southampton were diagnosed with diabetes, less than both the South East region (6.7%) and the England average (7.3%). This is probably explained by Southampton having a relatively young population. However, many cases of diabetes go 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 year on year increase since 2012/13, the prevalence of diabetes in Southampton remains below the South East and England rates.

NHS Health checks can identify help hypertension and early signs of type 2 diabetes, stroke, kidney disease, heart disease or dementia. The pandemic affected Health Checks and in Southampton, 2.8% of the targeted 20% eligible population (14.0%) had an NHS Health Check in 2021/22.

More information can be found in the diabetes dashboard below and in the resources section.

Other complications

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 England average of 100.0. Southampton’s ratio of diabetic complications, rates of diabetic eye conditions and rates of minor diabetic lower limb amputations are all higher than the England average and are the highest amongst Southampton’s comparative CCGs.

Two of the most common complications are eye and feet related complications:

• Eye conditions – 2 per 100,000 people, aged over 12, were provided with a new certification of visual Impairment due to diabetic eye diseases in Southampton during 2021/22. This rate is higher than the England average and all other comparators.
  
  
• Feet conditions - 176.2 per 10,000 people aged over 17 were hospitalised, for an average of 10.5 days, for diabetic foot disease. Additionally, 5 minor and 9.6 major, diabetic lower-limb amputation procedures, directly standardised per 10,000 people, aged over 17, were carried out between 2017/18 and 2019/20.

More information can be found in the diabetes dashboard below and in the resources section.

Care

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

Due to coding issues, the 2019/20 total for serum creatinine testing (and therefore the total number of people receiving all 8 care processes) is artificially low in Southampton.

In 2020/21, 26.3% of people with Type 1 diabetes in Southampton received all 8 care processes, statistically similar to England at 27.4%. 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 fewer individuals with Type 2 diabetes receiving all 8 care processes (25.4%) when compared to England (36.9%). This has been significantly worse than England for 3 consecutive years.

Looking at the care processes individually in 2020/21, Smoking status recording is the most carried out process for both Types of diabetes (89.1% of Type 2 patients and 84.0% of Type 1 patients). The least carried out process for Type 1 diabetes in Southampton is the urinary albumin test (47.6%), however this is significantly better than the England average of 42.5%. The least carried out Type 2 process is the serum creatine test (48.7%), this is significantly worse than England’s average of 85.7%.

Southampton carries out a significantly higher proportion than England for 2 out of 8 Type 1 processes (BMI recording and the urinary albumin test), and a significantly lower proportion for 1 of the processes (serum creatine test). For Type 2 processes, Southampton is significantly better than England in 3 out of 8 processes (BMI recording, urinary albumin test and blood pressure check), and significantly worse in 3 processes (blood test, serum creatine test and annual foot check).

At a GP practice level, the proportion of patients receiving all 8 care processes ranges from 0% to 70% for Type 1 patients. For Type 2 patients, the proportion of patients receiving all 8 care processes was higher, ranging from 0% to 82.4%.

More information can be found in the diabetes dashboard below and in the resources section.

Treatment

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 2020/21, only 23.5% of Type 1 diabetics achieved all three targets and 29.0% 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 (20.8%), whilst achieving statistically lower levels for Type 2 diabetics, the national average is 35.5%.

More information can be found in the diabetes dashboard below and in the resources section.

Education

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 2019/20 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.

More information can be found in the resources section.