Diabetes UK - make diabetes a priority



10 priorities to improve lives and work for a future without diabetes.

With over 2.3 million currently diagnosed and over 500,000 who have Type 2 diabetes but don't know it, Diabetes UK is asking for diabetes to be taken seriously. One person in the UK is diagnosed with diabetes every five minutes. By 2025 it is estimated that over 4 million people will have diabetes. Already people with diabetes represent a substantial interest group within a parliamentary constituency with around a third of constituencies in England having a higher number of people with diabetes than the size of the current MP's majority.

We are asking you to work with us to make diabetes a priority for government and political parties - and to make it your urgent priority. Stopping people developing the condition; identifying people who have diabetes early and making sure that each person with diabetes has high quality care outcomes and same life expectancy as someone without diabetes is crucial.

This document contains a summary of our key demands of government and political parties for to help us tackle diabetes and to improve the lives of people with diabetes. Some of these demands relate to areas devolved to local health areas but government and politicians clearly have a role in determining what is treated as a priority within the NHS and in framing the terms of legislation and the proposed NHS constitution. And individual politicians and public representatives at all levels - from the Prime Minister to an opposition backbencher and from a school governor or local councillor - have an important role in working with us and with people with diabetes to make diabetes a priority.

Diabetes is serious - that is why we are asking you to work with us to:

1. Defuse the diabetes time bomb & identify diabetes early

. By 2025 it is estimated there will be over 4 million people with diabetes (York & Humber Public Health Observatory). 57 per cent of these cases will be linked to obesity.
. GPs are currently only required to identify obese patients. The Quality & Outcomes Framework that covers GPs should include a requirement to provide weight management programmes that can help prevent people developing conditions such as diabetes.
. Up to 1,400 children have Type 2 diabetes, all of whom were obese or overweight at the time of diagnosis. Banning the marketing of junk foods high in salt, sugar and fat targeted at children would help ensure children maintain a healthy weight and help prevent them developing diabetes.
. Traffic light food labelling should be introduced. Research by the Food Standards Agency shows that traffic light labelling is more accessible to consumers and more effective than the Guideline Daily Amounts system.
. Early identification of diabetes reduces life-threatening complications such as heart disease. The welcome commitment to screening between the ages of 40-75 should be targeted to all at-risk groups in order to reduce the number of undiagnosed. Type 2 diabetes affects Black and South Asian people at a considerably younger age (from 25 yrs of age) and they are also four to five times more likely to have diabetes than the white population.
. Type 2 diabetes has also been found to be up to 5 times more common in those with a serious mental illness than in the general population and screening of people with a serious mental illness should be prioritised.

2. Ensure children with diabetes have a future

. The UK has the highest number of children with diabetes in Europe with 20,000 children below 15 diagnosed. The UK also has the lowest number of children attaining good diabetes control.
. All children and young people should have the right to receive the vital checks for good diabetes management, currently only 2.6 per cent do so (National Diabetes Audit).
. There were over 3,000 emergency admissions of children with diabetes in England in 2007. Cuts in Diabetes Specialist Nurses have been shown to lead to increase emergency admissions. Specialist support for children must be properly resourced with maximum caseload of no more than 1:70 for Paediatric Diabetes Specialist Nurses as specified by the RCN.
. Transition between paediatric and adult services should take place at the appropriate time and be negotiated with, and planned around, the needs of each individual young person.
. Children and young people with diabetes must be supported to manage their diabetes at school. No child should be excluded from any aspect of school life including extra curricular activities.
. Schools must ensure children with diabetes have a safe environment and are able to receive full access to medication and health monitoring in school. They should have trained staff to deal with emergencies and to assist with / administer insulin injections and do blood glucose tests if the child is not able to do those things for themselves. Children must also have access to food and hydration as required.
. Children with long term conditions should be explicitly included in the five outcomes of Every Child Matters (be healthy; stay safe; enjoy and achieve; make a positive contribution; and achieve economic well-being). Ofsted should be required to inspect and monitor school support to children with long term conditions as part of inspecting these five outcomes.

3. Make diabetes services world class with true accountability

. The NHS constitution should make the pledge that people with long term conditions, including diabetes, will have access to world class integrated care wherever they live in the UK.
. People with diabetes require access to a variety of healthcare professionals in order to get the care they need. All professionals must work in partnership with one another in order to deliver a joined up, integrated service, based around the needs of the individual.
. All healthcare organisations should be required to prioritise diabetes care in their local plans with ring-fenced resources ensuring investment to meet the standards set in the National Diabetes Frameworks.
. Effective diabetes networks and equivalents must be established to integrate the commissioning of high quality care. These must have patient and public involvement and representation so that people with diabetes have a stronger voice in determining how services are structured and work to ensure services are patient-centred.
. All healthcare professionals must have access to regular training & education on care for people with diabetes.
. It should be mandatory for all primary and secondary care organisations to submit data to the National Diabetes Audit - the biggest in the world.
. Those responsible for planning and delivering diabetes services should have policies that address the needs of BAME and diverse communities, extremes of age, people living in institutions and the socially excluded.

4. Prevent life threatening complications and support self management

. Diabetes increases the risk of life threatening complications and makes people four times as likely to develop heart disease and three times as likely to develop kidney failure.
. 95 per cent of diabetes care is self care. People with diabetes and their carers must be supported to self manage, by having access to at least an annual review and being actively involved in planning their own 'Year of Care' reflecting their personal needs and priorities.
. All people with diabetes should have access to appropriate emotional and psychological support structured and ongoing education and information to effectively self-manage their condition.
. Co-ordinated and timely access to specialist services as part of locally integrated care according to individual need is essential including specialist foot teams to prevent further progression of complications.
. Transfer for specialist to primary care services must be based on individual assessment. The choice of the person with diabetes must be respected and changes undertaken in a sensitive and timely manner, with particular consideration to the importance that people attach to continuity of care.
. Retinal screening services must be accessible to all people with diabetes, meeting national retinal screening targets and ensuring follow up appointments and treatment.

5. Improve emergency & inpatient care

. Around 100,000 emergency '999' calls are made to ambulance services each year by people with diabetes. Ambulance Trusts should develop policies for managing diabetic emergencies and be involved in local diabetes networks.
. General ward staff must have regular training and support from the diabetes specialist team to support them in caring for people with diabetes as inpatients. This will assist in ensuring that medication and food timings are appropriately co-ordinated, and that diabetes related emergencies are effectively handled.
. People with diabetes should have an assessment of their individual needs, including cultural and religious issues, during their hospital stay including whether they are able to and wish to self manage during their stay.

6. Ensure equal access to insulin pumps and other innovations

. Take up of insulin pumps in the UK is 'dramatically lower than in most other countries of comparable economic standing and level of healthcare provision' (Insulin Pump Report) and there is considerable variation on access to insulin pumps between different parts of the country.
. Availability should be based solely on clinical need, choice and suitability - not on the basis of a postcode lottery. People with diabetes, including children and young people, should have access to insulin pumps and other technological innovations to help them manage their condition on a day to day basis.
. A commitment to a modern and personalised health service means that the NHS must offer technological advances, such as continuous blood glucose monitoring, to give people the power to control their own diabetes.

7. Protect the health of pregnant women & their unborn babies

. Women with diabetes and their unborn babies require high quality, specialist support during pregnancy to help prevent the particular risks to mother and baby and achieve good outcomes for both.
. Women with diabetes experience more complications than those without the condition. This includes increased incidence of premature delivery and increased rates of Caesarean section with a 67 per cent Caesarean rate compared to 22 per cent in the general maternity population. Women with diabetes should be supported to plan their pregnancies through the provision of appropriate pre-conception care, to ensure optimal diabetes control and physical and emotional wellbeing.

8. End discrimination at work

. Currently around 800,000 people in the UK are on insulin, all of whom are likely to experience unfair and unnecessary discrimination throughout their lives - many in ways that affect their livelihood and quality of life. Examples of this include a man who has been stopped from driving his taxi, and a young army recruit who will never be allowed to complete training to join the front line.
The Disability Discrimination Act requires employers to make reasonable adjustments for the individual with insulin treated diabetes to continue working.
. No employer should operate a blanket ban preventing people on insulin from continuing in their occupation. Each case should be taken on its merits. To make an informed decision an employer must carry out an individual risk assessment to determine how well the diabetes is controlled.

9. Improve care for older people

. One in four people in care homes have diabetes (Sinclair et al 2001) Residents with diabetes living within institutional settings are a highly vulnerable and often neglected group.
. Care deficiencies include a lack of care planning, poor case management, inadequate access to nutritional information or food at appropriate times; insufficient treatment review and blood glucose monitoring; poor understanding of medication and inadequate access to preventative screening services such as foot care and retinal screening.
. The quality of care and support provided for those with diabetes living in residential care and nursing homes should be assessed within inspection and regulatory frameworks.

10. Prioritise diabetes research

. Diabetes costs the NHS £9 billion a year which equates to 10 per cent of NHS resources annually. Without investment in to research this will only rise in the future and opportunities to tackle diabetes and improve the lives of people affected by diabetes will be missed.
. Investment is needed to encourage researchers in to diabetes research and to retain the best researchers in the field throughout their careers.
. Emphasis should be placed on funding research in areas that will make a difference to the lives of people with diabetes their parents and carers, in the short-, medium- and longer term. An immediate priority area is the improvement of the day to day management of all aspects of diabetes. Of particular importance is research to investigate new technologies, for example non-invasive blood glucose monitoring and insulin delivery. Diabetes UK would also welcome further research into achieving good blood glucose control while avoiding the risk of hypoglycaemia.
. Diabetes UK is working for a future without diabetes and we call on the government to work with us in prioritising diabetes research that will lead to the prevention of Type 2 diabetes and long term behaviour change and join us in supporting the long term vision of identifying cures for both Type 1 and Type 2 diabetes.

About Diabetes UK - the charity that cares for people with diabetes

Diabetes UK is the largest organisation in the UK working for people with diabetes, funding research, campaigning and helping people live with the condition. We have over 170,000 members and are one of the largest patient organisations in Europe. We work for people with diabetes, their carers, family and friends. We represent the interests of people with diabetes by campaigning for better standards of care and the best quality of life. We provide practical support and information and safety-net services to help people manage their diabetes.

Diabetes is the largest funder in the UK of research into diabetes to improve the treatment of diabetes and search for a cure. Our mission is to improve the lives of people with diabetes, to work for prevention of diabetes and ultimately to work towards a future without diabetes.

We think tackling and treating diabetes effectively should be a priority. For further information on any of our demands or ways in which you can work with us in making diabetes your priority please contact: 020 7424 1000 or campaigns@diabetes.org.uk.

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