Professor John Wilding from the University of Liverpool charts priorities for improving patient care in the UK when it comes to the prevalent condition, Type 2 diabetes
In the last 30-40 years, we have seen a massive increase in the prevalence of diabetes. Today, more than 1 in 20 people, or 6.7% of the population, in the UK have Type 2 diabetes, increasing from just 1-2% 30 years ago.1 Type 2 diabetes is a long-term metabolic disorder where blood glucose becomes too high due to a resistance to, combined with a failure of the pancreas to make enough of, the hormone insulin.
Over a long period of time, high levels of glucose can result in tissue damage to blood vessels and nerves, leading to an increased risk of heart attacks, strokes, amputations, eye damage and kidney failure. This is a very complex disorder, which affects a large number of people across the UK and poses serious challenges for both patients and clinicians. Its impact affects people’s day to day lives and consumes approximately 10% of total NHS expenditure, with the majority of that money being spent on treating complications of the disease as opposed to the disorder itself.2
Despite its complexity, Type 2 diabetes is a manageable disease with a wide range of treatment options and effective management models within the UK. However, some key issues continue to affect the consistency with which the condition is managed. For example, the intricacy of treatment regimens can mean that people with diabetes are often taking so many different medications, at different times and for a variety of reasons, that it is incredibly difficult to ensure appropriate and consistent adherence. This can result in poor control of Type 2 diabetes risk factors, such as blood pressure and cholesterol, in addition to their blood glucose levels, leading to life-impacting complications, at a huge cost to the health system.
Education of people with diabetes about their condition and support for effective lifestyle interventions is also inconsistent, with some excellent models of care in some areas, but with patchy availability and uptake elsewhere.
Access to new medicines is another key issue for ensuring consistent care in diabetes management.
While there are exciting new medicines available and more in development that have the potential to reduce the polypharmacy associated with this disorder, as well as reducing complications, many patients don’t have access to these cutting-edge treatments. And with delays in access, we often also see a time gap between the evidence showing the efficacy of these medicines and the guidelines that recommend their use.
These challenges in managing Type 2 diabetes are long-standing, but there are ways in which we can tackle these current inconsistencies and improve care. Firstly, ensuring clinicians have the relevant education and skills to support their patients, will result in more effective diabetes management without increasing the burden on time-poor health services. Given around 4 million people currently have Type 2 diabetes, it would be impossible for all patients to have regular contact with secondary care specialists? As a result, the majority of diabetes care is delivered by GPs and practice nurses.
Providing primary care professionals with the necessary training and support to deal with Type 2 diabetes is vital, as a lack of knowledge can mean they are reluctant to start and escalate therapies, which can more adequately maintain control of blood glucose levels. These delays in switching patients to the most effective treatment can mean that people with Type 2 diabetes are at a greater risk of developing complications, therefore, decreasing their quality of life and increasing the pressure on local health services.3
Secondly, more efficient use of resources and time can result in better care and cost savings. The introduction of Regional Medicine Optimisation Committees (RMOCs) and Sustainability and Transformation Partnerships (STPs) into the NHS will be key in influencing the change in diabetes management across the UK. By using these platforms to encourage more joined-up working across health services, learnings from areas of the UK where we have already seen improvements through high-quality diabetes management can be shared and lead to a greater level of consistency in care across the country.
Finally, taking a long-term view of budget planning could have a huge impact on managing the increase in the prevalence of Type 2 diabetes. Currently, health service budgets are reviewed year on year, making it difficult to see where changes to current care practices have created efficiencies and reduced costs. Investing money now in education and support, to address the challenges we currently face, could result in greater cost savings later.
We need to prioritise simple solutions, which are easy to implement. Education and training for both patients and healthcare professionals is a key way that we can do this and will result in better management of Type 2 diabetes and ultimately, cost savings to the health system.
Firstlight Public Relations Limited through Napp Pharmaceuticals Limited has supported Professor John Wilding at the University of Liverpool to develop this article, in his role as Chair of the Improving Diabetes Steering Committee, which has been brought together by Napp Pharmaceuticals Ltd. This article has been solely put together by Prof John Wilding with medical writing support from firstlight. Napp has had no involvement in the content of the publication other than to check it for factual accuracy.
1 National Diabetes Audit 2016-17, https://digital.nhs.uk/data-and-information/ clinical-audits-and-registries/our-clinical-audits-and-registries/ national-diabetes-audit Accessed May 2018.
2 Diabetes UK, https://www.diabetes.org.uk Accessed May 2018.
3 Khunti, K. et al., 2017. Primary Care Diabetes, 11(1), pp.3-12.
Professor John Wilding (DM, FRCP)
Professor of Medicine at the University of Liverpool
Honorary Consultant in Diabetes and Endocrinology at
University Hospital Aintree, Liverpool, UK.
Tel: +44 (0)151 529 5899