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DIABETES . Dr Rowan Hillson, MBE National Clinical Director for Diabetes. I strongly believe that…. Everyone with diabetes deserves the highest standards of personalised diabetes care, no matter where, when or by whom it is delivered.

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Diabetes l.jpg

DIABETES

Dr Rowan Hillson, MBE

National Clinical Director for Diabetes


I strongly believe that l.jpg
I strongly believe that…

  • Everyone with diabetes deserves the highest standards of personalised diabetes care, no matter where, when or by whom it is delivered.

  • People providing diabetes care must be trained in diabetes and must know the boundaries of their knowledge.

  • They must have opportunities to extend these boundaries and to keep up-to-date.

  • People with diabetes and professionals must have ready access to specialist diabetes expertise.


Nhs diabetes national diabetes support team l.jpg
NHS Diabetes(National Diabetes Support Team)

  • Within NHS Diabetes and Kidney Care

  • Promoting service improvement

  • Knowledge

  • Communication

  • Leadership and development

  • Director (Anna Morton) plus support team

  • 10 Regional Programme Managers

    www.diabetes.nhs.uk



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New Diagnoses

About 320,000 new cases a year

One or two people every 2 minutes

National Diabetes Audit 06/07


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Diabetes prevalence

YHPHO 2005

T1 DM 0.3%, T2 DM 4.1%

Men 3.8%

Women 5.1%.

White 4.3%

Black 6.0%

Asian 6.9%


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Diabetes attributable deaths

  • 2005 20 – 79 yrs old

    Diabetes accounts for 26,300 of deaths (11.6% of all deaths)

    3 deaths an hour

  • Varies considerably between PCTs

    9% (Bucks) – 17% (Newham)


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Vascular risk checks

  • Everyone aged 40 – 74 yrs not known to have cardiovascular disease or DM

  • Risk assessment including smoking, BMI, BP, sugar measure, renal measure as relevant

  • Healthy living advice for all

  • Targeted advice for high risk

  • Treatment for new diabetes, hypertension etc




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Life expectancy

  • Man, non-smoker, aged 45

  • No family or personal history of CV disease

  • Type 2 diabetes newly diagnosed

  • HbA1c, Cholesterol + BP within QoF targets

  • Life expectancy 62 vs 79 yrs all men

  • Reduced by 17 years

  • Woman – similar health

  • Life expectancy reduced by 20 yrs

    Source YHPHO


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Diabetes in hospital

  • 10 – 20+% hospital beds occupied by people with diabetes

  • People with diabetes twice as likely to be admitted as non-diabetics

  • Longer stay

  • 165,000 diabetes discharges / yr

  • 1.34 million bed days / yr

  • £465 million / yr


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Diabetes inpatient specialist team

  • Every acute hospital should have a diabetes inpatient specialist team with

    • dedicated inpatient sessions

    • access to all diabetic inpatients on all units

  • Diabetic inpatient specialist nurses reduce A&E admissions, reduce clinical incidents, shorten length of stay, and improve patient experience.

    www.diabetes.nhs.uk/news-1/Inpatient%20care.pdfwww.institute.nhs.uk


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Diabetes and pregnancy

Women with established diabetes have:

  • 5 x more stillbirths

  • 3 x more neonatal deaths

  • 2 x congenital malformations

    Compared with non-diabetic women

    Major national project to improve outcomes of pregnancy in women with pre-existing and gestational diabetes

    www.cemach.org.uk


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Children and Young people

  • Audit of the numbers of children and young people with diabetes in England

  • Royal College of Paediatrics and Child Health

  • Sponsored by NHS Diabetes


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Education & care planning

Healthcare Commission 2006:

  • Only 10.5% patients had had education

    (range 1 – 52%)

  • Care plan:

    almost always 47%, sometimes 23%

    DAFNE DESMOND Local courses

    Year of Care project www.diabetes.nhs.uk


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Retinopathy screening

  • Free to everyone with diabetes

  • Has been offered to 93% all patients

  • 76% of those offered photos had them

  • In total 72% have had eye photos

  • We must all encourage everyone with diabetes to have their eye photos


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Where are we now?

  • We know more about diabetes in England than we did in 2001

  • There have been improvements in diabetes care

  • We must improve glucose and BP control

  • We must improve diabetes care in hospital

  • We must improve the outcomes of pregnancy

  • We must improve information and education

  • We must improve uptake of retinopathy screening

  • We must always ensure that we work closely with people who have diabetes



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