Diabetes

Health intelligence

Jon Walker

Advanced public health analyst

Surrey County Council

Jon.walker@surreycc.gov.uk

020 8541 7827

Outline

• Prevalence• Prevalence gap• Risk factors• Complications• Care processes

Prevalence diabetes estimated and diagnosed

Current diabetes prevalence

Estimated percentage diagnosed

Prevalence gap

Risk factors

• Age• Deprivation• Ethnic background• Weight/BMI• Waist circumference• Diet• Family history• High blood pressure or history of cardiovascular disease• Polycystic ovary syndrome or who have a history of gestational

diabetes• Mental health conditions or learning disabilities

• Fasting plasma glucose of 5.5–6.9 mmol/l or an HbA1c level of 42–47 mmol/mol [6.0–6.4%]

Guildford and Waverley CCG population

Deprivation

Ethnicity

11

Trend in excess weight among adults

Patterns and trends in adult obesity

Adult (aged 16+) overweight including obese: BMI ≥ 25kg/m2

Source: PHE NOO

12

Trend in obesity prevalence among adults

Patterns and trends in adult obesity

Adult (aged 16+) obesity: BMI ≥ 30kg/m2

Source: PHE NOO

Percentage of adults classified as overweight or obese (2012)

Guildford

Epsom and Ewell

Elmbridge

Waverley

Woking

Mole Valley

Runnymede

Tandridge

Spelthorne

England

Reigate and Banstead

Surrey Heath

0 10 20 30 40 50 60 70 80

National Child Measurement Programme

2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 2013/140%

5%

10%

15%

20%

25%

30%

35%

40%

Percentage excess weight in year 6 (10-11)

England Surrey NHS Guildford and Waverley

Percentage children aged 10-11 having excess weight

Non-diabetic hyperglycaemia

• NCVIN estimates for Surrey CC suggest a prevalence of 11.3% or 106,000 adults (16+) with non-diabetic hyperglycaemia (HbA1c 6.0% - 6.4%)

• Around 19,000 in Guildford and Waverley CCG• 5-10% of people per year with prediabetes will

progress to diabetes, with the same proportion converting back to normoglycaemia (Tabak et al)

Diabetes projections

2015 2020 2025 20300

2000

4000

6000

8000

10000

12000

14000

16000

Crude estimate of number of people projected to have diabetes in Guildford and Waverley CCG

Obesity continues to rise at current rate 2010 obesity levels maintained

Diabetes: the fastest growing health issue

• There are more than 5m people in England at risk of Type 2 diabetes

• Diabetes accounts for 10% of the NHS budget

• Strong international evidence for effectiveness of lifestyle interventions to lower risk

Additional risk of complications

Diabetic retinopathy complications

Aug

ust

Sep

tem

ber

Oct

ober

Nov

embe

r

Dec

embe

r

Janu

ary

Feb

ruar

y

Mar

ch

Apr

il

May

June

July

Aug

ust

Nov

embe

r

Dec

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r

Janu

ary

Feb

ruar

y

Mar

ch

Apr

il

June

July

2012/2013 2013/2014 2014/2015

0

1

2

3

4

5

6

7

£0.00

£500.00

£1,000.00

£1,500.00

£2,000.00

£2,500.00

£3,000.00

£3,500.00

£4,000.00

Admitted Patients (April 2012 - July 2014)

Patients - Diabetic retinopathy Cost - Diabetic retinopathy

Pat

ien

ts

Nights in hospital for diabetic foot disease per 1,000 diabetics

Nine NICE annual care processes

• HbA1c• Blood pressure• Cholesterol• Serum creatinine• Urine albumin• Foot surveillance• BMI• Smoking• Eye screening (NHS retinopathy screening)

Percentage patients receiving the eight care processes (2012-13)

Percentage patients receivingcare processes

HbA1c (2013-14)

H81022

H81044

H81031

H81053

H81064

H81647

H81085

H81077

H81006

H81132

H81010

H81035

H81084

H81052

H81062

H81021

H81043

H81029

H81026

H81090

H81076

CCG

0 10 20 30 40 50 60 70 80 90 100

DM007: Last HbA1c is <=59mmol/mol in last 12mths (den. incl. exc.) Last HbA1c is >59mmol/mol in last 12mths (den. incl. exc.)

Diabetes education programmes

Further information• Diabetes community health profile (2013):

http://www.yhpho.org.uk/resource/view.aspx?RID=8470• GP practice profile: http://fingertips.phe.org.uk/profile/general-practice• NCVIN CVD profile – diabetes (2015):

http://www.yhpho.org.uk/default.aspx?RID=203617• Footcare activity profile: http://www.yhpho.org.uk/default.aspx?RID=116836• CVD intelligence pack (2015):

http://www.yhpho.org.uk/ncvinintellpacks/pdfs/09N_SlidePack.pdf• NICE guidance:

– https://www.nice.org.uk/guidance/cg87– https://www.nice.org.uk/guidance/ng17– https://www.nice.org.uk/guidance/ng18– https://www.nice.org.uk/guidance/ph38

• NDA CCG profiles – Report 1 Care processes and treatment targets:

http://www.hscic.gov.uk/catalogue/PUB14970– Report 2 Complications and Mortality:

http://www.hscic.gov.uk/catalogue/PUB16496