Sue Marshall blogs about diabetes for Desang

Britain’s Diabetic experts add their voice to growing medical concerns over soaring levels of obesity | March 31, 2010

Much more needs to be done to reduce the number of people putting themselves at risk of diabetes because they are overweight, say The Association of British Clinical Diabetologists (ABCD) –  which represents 650 consultant physicians and senior registrars.

It also highlighted the ongoing disparities in specialist diabetes care and staffing in different parts of the NHS, at a time when its prevalence is accelerating – and budgets being squeezed.

ABCD was responding to the publication of a Department of Health report chronicling the progress made by the National Service Framework (NSF) for diabetes since its launch six years ago.

It welcomed the progress being made in many areas of diabetes treatment which, it said, had created “one of the most comprehensive care systems in the world”, as well as recognition of the pivotal role played by specialists in diabetes.  But it warned that it was important to keep building on this platform.

The aim of the original NSF was to outline the structures which needed to be put in place to underpin the provision and standards of care for people with diabetes in England. These standards were based on scientific data and best practice. This new document highlights the progress in achieving these goals.

“There is no doubt that the NSF for diabetes has delivered progress towards this though the national diabetes audit and the national diabetes information service,” said Dr Ian Gallen, Honorary Secretary of ABCD, and a consultant physician and endocrinologist at Buckinghamshire Hospitals NHS Trust,
“We now have a good idea of the numbers of people with diagnosed diabetes and how those people are being treated. The efforts in primary care seem to show that the numbers of people with undiagnosed diabetes has fallen.

“Unfortunately, another aim – to reduce the numbers of people who are at risk from developing diabetes – seems to have been made very little progress. It is of particular concern to ABCD that the numbers of adults who are becoming obese, and hence who are at risk of developing diabetes, are increasing.”

ABCD said it was also disappointed that while the NSF envisaged patient empowerment of adults with both types 1 or 2 diabetes through improved educational programmes, relatively few people in England had benefited from this initiative.

The NSF set out standards of care which people with diabetes should expect. Whilst ABCD said is was true that the organisation of diabetes care in primary care has improved – thanks to the targeting of blood pressure, glucose and cholesterol control – much remained to be done to reduce the numbers of people who will develop the disabling complications of diabetes disabling complications such as amputation, kidney failure and blindness.

There now remained the added challenge of reducing these risk factors for the complications of diabetes in the climate of reduced health expenditure.

One significant highlight had been the marked improvement in screening for changes which may lead to blindness for people with diabetes, with the majority of people now being examined.

However, ABCD remains concerned that the patient’s specialist may not have rapid access of retinal images, so that whole system care and access to timely intervention for specialist diabetes and opthalmological care follows the detection of retinopathy.
ABCD carried out a joint survey (with Diabetes UK) of specialist services which showed an increase in consultant numbers between 2001 and 2006 – but continued regional disparities in staffing and services  throughout England, at a timing of major increases in diabetes incidence.

Recent recommendations call for a minimum of three WTE (whole time equivalent) consultants per 250,000 population to provide core specialist services to support all aspects of NSF. This is not currently commissioned and provided in many areas. A further pressure is that consultants in diabetes have had to provide more time supporting emergency medical care at the expense of diabetes service.

Dr Gallen added: “Six years ago, the NSF for diabetes was received with caution by specialists in diabetes who felt that it somewhat sidelined their important role. This update report makes it clear that the specialists have a crucial role in providing care.

“Diabetologists are crucial in increasing provision of insulin infusion pumps, in providing care for children and young people with diabetes and for women who have pregnancy complicated by diabetes.  We will want to work with primary care teams to improve the networks of care for people with diabetes, and to provide care for those with the advanced complications of diabetes.

“ABCD therefore welcomes NSF six years on, but there remains significant challenges yet to be overcome, particularly in terms of equity of care throughout England.”

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