For those that have diabetes, is there a consistent quality of diagnosis and care across the NHS?
More people would be diagnosed if the government’s health checks for people between the ages of 40 and 74 were carried out more consistently. For people diagnosed, the care and treatment of people with diabetes varies across the country, as shown by last National Diabetes Audit 2012-13.
The nine key checks recommended annually for people with diabetes are not being received by many people under the age of 40, with only 29.1% with Type 1 diabetes and 46.3% with Type 2 diabetes receiving eight of the nine NICE recommended checks. By comparison, people aged 65 to 79 received the highest rate of eight checks at 59.9% with Type 1 and 66.7% with Type 2 diabetes.
So, there is only one conclusion to be drawn - younger people with diabetes are receiving significantly worse care and treatment than older people, yet younger people will live longer with diabetes putting them at greater risk of developing complications that will affect their health and possibility their mortality. Systems for the care and treatment of people with both types of diabetes must be improved.
What is the history of IDDT? When was it founded, and what are its aims?
IDDT formed 20 years ago with the aim of trying to ensure that natural animal insulin remains available for the people with diabetes who had, and still have, adverse reactions to the genetically engineered so-called human insulin introduced in 1982. After many years of lobbying, the then Minister of Health, Jane Kennedy, stated that animal insulin must continue to be available for the people who need it. Since then, IDDT’s aims are to ensure that people with diabetes have an informed choice of treatment and to ensure that people with both Type 1 and Type 2 diabetes receive the information they need to manage their condition.
There has been a lot of discussion recently about the concept of ‘pre-diabetes’ diagnosis. What is your view on that?
People who are at risk of developing Type 2 diabetes are now being classed as having ‘pre-diabetes’ which is not a medical condition but is being defined as when blood glucose levels are on the high side of normal but not high enough to be classed as diabetes. By this definition, a third of adults in England fitting into this category. They have no symptoms of ill health but they are being labelled as having a medical condition of ‘pre-diabetes’ and this brings with it a new set of problems including anxiety about future health problems (which may never occur), issues associated with self-image, insurance and employment.
The term ’pre-diabetes’ is not recognised by the World Health Organisation and the National Institute for Health and Care Excellence (NICE) has stated to BBC News that it does not believe there should be a separate category of ‘pre-diabetes’.
There have always been people who are at risk of developing Type 2 diabetes and those at risk have been advised to change their lifestyle – a healthy diet and plenty of exercise, which can either slow down or prevent the development to Type 2 diabetes. It is important that this advice continues to be given to those at risk without unnecessary medicalisation by using the term pre-diabetes, especially when the risk of developing Type 2 diabetes is probably 10 to 20% over 10 years.
‘Pre-diagnosis’ is one response to what has been called an ‘epidemic’ of diabetes. What is your view on what steps should be taken to reduce the numbers of people becoming diabetic?
It is important to remember that there are two types of diabetes, Type 1 and Type 2 and it is only Type 2 diabetes that is being classed as reaching ‘epidemic’ numbers. This is associated with the increase in overweight and obesity and reduced physical activity in the general population.
This is a public health issue and the development of effective public health strategies should be treated as a matter of urgency nationally. Food labelling of foods and drinks with high sugar content should warn about this content. There should be a complete review of the evidence of the recommended dietary advice for the general population with consideration given to reducing the recommended level of carbohydrates.
How do you judge the quality of information out there, and how does that affect diabetic people’s ability to manage the condition?
The demand for our information booklets and leaflets suggests to us that people do not receive sufficient information, especially dietary information. Without essential information about diabetes and its treatment, people with diabetes will not be able to manage their condition and risk the development of complications associated with diabetes and a reduced quality of life, not to mention increased costs to the NHS.
World Diabetes Day is a good opportunity to highlight IDDT’s campaigns – what will be your focus this year?
Our focus for World Diabetes Day is on healthy eating and health lifestyle and we are publicising our latest book, ‘Diabetes – Food, Meds and More’, which is a recipe book with a difference because it covers what to eat in everyday life – including when carrying out sports, when ill, when travelling and for parties.
How effective can diet be for people with Type 2 diabetes in managing the condition?
The treatment of both Type 1 and Type 2 diabetes is medication, whether insulin or tablets, diet and exercise and they are all vital to manage the conditions.