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What can be done to improve diabetes care in the UK?

Diabetes care in England has been deemed inadequate, according to the findings of a report by the charity Diabetes UK. Here, Rod Tucker digs into the evidence.

Diabetes is a common condition. In a 2023 report, the charity Diabetes UK estimated there are 4.3 million people in the UK living with diabetes, 850,000 of whom are living with undiagnosed diabetes. Uncontrolled diabetes leads to severe micro- and macrovascular complications.

In the UK, the Quality and Outcomes Framework incentivises primary care practitioners to provide better care to patients with diabetes. In addition, the National Diabetes Audit (NDA), introduced in 2003, sought to link attainment of clinical indicators with outcomes. The NDA has a set of nine care processes representing markers of best long-term care.

But to what extent does diabetes care in the UK meet these standards?

Diabetes care in practice

Data from the 2019/20 NDA on complications and mortality, published on 11 May 2023, revealed that diabetes accounts for 25-30% of hospital admissions for cardiovascular disease, despite only 7% of the adult population having diabetes.

Failure to achieve the diabetic care standards detailed in the nine processes increases the risk of death. For instance, attaining only five or fewer standards, increased mortality risk by 32% in people with type 2 diabetes. In contrast, satisfactory control of HbA1c, cholesterol and blood pressure, reduces hospital admission rates in people with type 2 diabetes.

Despite these obvious benefits from reaching at least some of the care processes, there is still much to be done. For instance, a 2019 study found disparities in glycaemic control, diabetes-related monitoring the and prescription of newer therapies for people with type 2 diabetes.

A stark reminder

The latest report from Diabetes UK provides a stark reminder of how the provision of diabetes care in England is suboptimal. The online survey of 11,304 individuals reveals how nearly half (48%) experienced difficulties managing their condition. The primary reason, cited by 50% of those having difficulties, was access to their care team. In fact, 38% said that they found it difficult to make an appointment with their care team.

The report also highlights the problems of social inequality. For example, one in three living in the most deprived areas found it difficult to contact their diabetes team. In contrast, only one in four of those in the least derived areas experienced these difficulties.

Over 20 years since the introduction of the NDA, questions remain over how effective diabetes care is today. The Diabetes UK report incorporates data from the latest NDA (2021/22). This reveals how across England, only 47% of people with diabetes received all the relevant care processes. In fact, across the country, this figure ranged from 25-62%.

Achievement of the full diabetic care processes in England is currently substandard and driven in part by social inequality. Nevertheless, tackling inequalities in healthcare was a stated aim of the Health and Social Care Act in 2012. It could therefore be argued that the persistence of health inequality represents a breach of that act.

Poor control of diabetes and the ensuing complications have a hugely negative impact on patient’s quality-of-life. Such complications also increase healthcare expenditure, which provides a powerful case for greater investment in diabetes care. The title of the Diabetes UK report asks ‘is diabetes care fair enough?’, to which the current answer is a resounding no.

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