Non-insulin dependent diabetes needs more attention

BMJ 1996; 313 doi: (Published 31 August 1996) Cite this as: BMJ 1996;313:510

The financial, medical, and personal impact of non-insulin dependent diabetes has been greatly underestimated, says a London based health policy group, the King's Fund.

The fund estimates that the cost of treating the complications, which affect 85% of all people with diabetes and over a million people in Britain, is at least double previous estimates and may be as high as £2bn ($3.5bn) a year. Its report found that by 2011 expenditure on diabetes could total 10% of NHS revenue.

The World Health Organisation has already warned of a worldwide epidemic of non-insulin dependent diabetes, while in Britain longevity, together with obesity and physical inactivity, is likely to result in a pronounced increase in people with diabetes. Yet the British Diabetic Association estimates that for every patient diagnosed, another patient with non-insulin dependent diabetes is undetected.

The report calls for an end to the neglect of non-insulin dependent diabetes compared with insulin dependent diabetes and other major causes of mortality. It highlights the need for greater public and professional awareness of the health threat posed by the disease, while calling for a broader appreciation of the effectiveness of preventive measures and early treatment. The public should be more aware of the link between obesity and physical inactivity and the risk of developing non-insulin dependent diabetes.

“Given the weight of evidence now available, there is no excuse for professional inactivity, whether by government or healthcare professionals,” said the report's author, Linda Marks, visiting fellow at the King's Fund Policy Unit. “While they may have been clouded in people's minds in the past, the links between lifestyle and non-insulin dependent diabetes need to be clarified and incorporated prominently into health promotion.”

There should be an annual health check of all people in whom diabetes is diagnosed to ensure early detection of retinopathy, neuropathy, renal damage, peripheral vascular disease, and coronary heart disease, and regular specialist and local follow up with priority access to key services. The report recommends the development of flexible programmes of shared care between general practitioners and local specialist diabetes teams, including adequate provision of dieticians, chiropodists, and health educators.

The report cites recent British research by Dr John Peters and Craig Currie at the University of Cardiff showing that the medical records of 40% of patients with diabetes fail to record the fact that they have diabetes, contributing to previous underestimates of treatment costs. Typical health district treatment for inpatient care for a patient with diabetes was £1979 compared with £310 for a patient without diabetes.

“Our gut feeling is that preventive measures will cut the cost of diabetics care, but we now need a new study to provide the economic data to support that view,” said Craig Currie, research officer in the department of medicine, University Hospital of Wales.

According to Professor Harry Keen, chairman of the British Diabetic Association, which commissioned the report: “People are still going blind, still losing limbs, and still going into renal failure unnecessarily, since in so many cases these devastating complications are preventable. The personal, financial, and medical impact of non-insulin dependent diabetes has only now been recognised and quantified.”—ALISON BOULTON, freelance journalist, London


Some people with diabetes are not getting a good deal

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