Diabetes Haringey Public Health performance update CCG Governing Body meeting 29 th January 2015
Background People with diabetes are at an increased risk of a range of further conditions and complications including cardiovascular disease, blindness, kidney disease, amputation and depression. Without careful, continued management of the condition, a person with diabetes faces a reduced life expectancy of between 6 to 20 years. 1 Around 90% of people with diabetes have Type 2 diabetes. The most important risk factor for Type 2 diabetes is overweight and obesity. Type 1 diabetes is less common and is not linked to risk factors that can be changed such as obesity. Effective diabetes prevention focuses on stopping people becoming diabetic by tackling obesity, identifying people with diabetes early, and effective treatment of people who already have diabetes to prevent complications. 2 1 Diabetes UK: State of the Nation 2012: England
Diabetes: Type 1 and Type 2 1 in 10 Adults with diabetes have Type 1 diabetes 9 in 10 Adults with diabetes have Prevalence of Diabetes by Age in England (2006) Type 2 diabetes 18.00% 16.00% Men Women 14.00% 12.00% 10.00% 8.00% 6.00% 4.00% 2.00% 0.00% 16 – 24 25 – 34 35 – -44 45 – 54 55 – 64 65 – 74 75+ 3 Age Source: Department of Health (2007). About diabetes; The Information Centre (2008). Health Survey for England 2006
Important risk factors for type 2 diabetes 1.5 X higher risk for most deprived fifth of Black African, Black Caribbean, population South Asian and Chinese ethnic groups are at increased risk 7x higher risk for people 4 who are obese
Being overweight or obese is the main modifiable risk factor for type 2 diabetes. ) Nearly Over 2 in 3 1 in 3 Haringey adults are Haringey children aged 10-11 are overweight or overweight or obese, obese, similar to similar to London (2013) London (2013) 5 1kg of weight loss can reduce diabetes risk by up to 15%
Prevalence of diabetes in Haringey Those with diabetes 49% more likely to have a heart attack 9% London Haringey 8% 7% 2,849 2.0% 1.6% Undiagnosed Diagnosed + undiagnosed 6% * prevalence in Haringey 5.80% 5.80% 5% percentage totals at 4% 16,200 3% Diagnosed Diagnosed 13,351 2% 1% 0% Source: NCVIN CVD Profiles 2014 – data from QOF 2012/13. 6 * Percentages refer to proportion of the total population 17+
Recorded prevalence of diabetes is highest in the North East Collaborative Average recorded diabetes prevalence (%), 2013-2014 North East South East Central West 0.0 1.0 2.0 3.0 4.0 5.0 6.0 7.0 8.0 9.0 Average recorded diabetes prevalence (%) by GP collaborative of adult population, 2013-2014 QoF 7
Diabetes is also prevalent amongst the under 50s in Haringey 1800 1600 1400 1200 1000 800 600 400 200 0 <35 35-40 40-44 45-49 50-54 55-59 60-64 65-70 70-74 75-79 80-84 85-89 90 and over Source: Health Intelligence Data Extract for Haringey GPs 8 * Note not all GP Surgeries have submitted data
Haringey’s diabetes prevalence is projected to increase above that of England by 2030 Projected Prevalence of diabetes 2012 -2030 12.0% Haringey prevalence England prevalence 10.0% 8.0% 6.0% 4.0% 2.0% 0.0% 2012 2013 2014 2015 2020 2025 2030 9 Source: YHPHO Diabetes Prevalence Model: http://www.yhpho.org.uk/default.aspx?RID=154049
Care quality outcomes for Haringey diabetic patients 2012/13 2013/14 Haringey (% of Haringey (% of Direction patients) patients) of change Good sugar control 56.0 60.4 (HbA1c is <=59mmol/mol) CI (55.8 -57.5) CI (59.6-61.3) Good Blood Pressure Control (BP is <=140/80 63.0 68.9 mmHg) CI (62.2-63.8) CI (68.1-69.7) Good Cholesterol Control (Total cholesterol 72.4 70.7 <=5mmol/l) CI (71.6-73.1) CI (69.9-71.5) Eye Screening in last 12 80.0 CI 80.6 months (79.3-80.7) CI (80.0-81.3) Micro-albuminuria test 82.98 78.59 last 12 months CI (82.34-83.61) CI (77.90-79.27) 10 Source: QOF
BP and cholesterol control in Haringey diabetics significantly lower than North London average Eye Screening uptake Good blood sugar control Good cholesterol Haringey significantly control worse than N London Good blood pressure control 0.0 20.0 40.0 60.0 80.0 100.0 Percentage of diabetes patients England Area Team (NE & C.London) Haringey 11
The proportion of diabetics with good blood sugar control varies across Haringey Practices Haringey mean = 60.4% Source: QOF 2013/14 12
The proportion of diabetics with good blood pressure control varies across Haringey practices Haringey mean = 68.9% Source: QOF 2013/14 13
Hospital admissions for diabetic ketoacidosis have decreased in Haringey Emergency hospital admissions: diabetic ketoacidosis and coma 2007/8 to 2011/12 40 London England Haringey 35 30 DSR per 100,000 25 20 15 10 5 0 2007/8 2008/9 2009/10 2010/11 2011/12 Year 14 Source : Hospital Episodes Statistics (HES) and National Statistics
People with diabetes in Haringey are at increased risk of complications compared to people without diabetes Renal Replacement Therapy (RRT) 84% Major Amputation Minor Amputation Additional risk of 124% renal replacement therapy for diabetics * Additional risk of major amputation for 403% diabetics* Additional risk of minor amputation for diabetics* Diabetics are at also increased risk of: * Risk of these complications in Haringey is not significantly different Heart attack, stroke, blindness, heart failure, ulcers from the national average 15 Source : National Diabetes Audit 2010/11 and 2011/12
The cost of diabetes prescribing in Haringey is comparatively low, but is rising Monthly cost of non-insulin, anti-diabetic meds from April 2012 to October 2014 70,000 £163k 60,000 50,000 5 th 40,000 lowest cost out of 211 30,000 CCG’s for diabetes prescribing 20,000 10,000 £113k 00,000 0,000 £228.63 0,000 Apr 2012 Oct 2014 Annual cost of prescribing per person with diabetes £3,052,406 Total prescribing spend for Haringey CCG (2012/13) 16 Source: Data from NCVIN diabetes profile and Haringey medicines management
Practices can achieve good diabetic control even with low prescribing spend % of patients with good blood sugar control Plot of Haringey GP practices: Achievement of glucose control vs medication spend per patient 90 High Cost high High Cost high High Cost high 80 achievement achievement achievement Low cost high Low cost high Low cost high 70 achievement achievement achievement Percentage of patients achieing HbA1c Target 60 50 Percentage Achieving HbA1c of 40 59mmol/mol(7.5%) or more 30 20 Low cost low High cost low High cost low High cost low 10 achievement achievement achievement achievement 0 Increasing prescribing spend per patient 17 From Haringey Medicines Management: Adjusted for practice deprivation
Reducing the impact of diabetes: Local interventions Promoting healthy lifestyles Active for Life, Community Health Champions, Health Trainers, Weight Management Early identification of people at risk of Type 2 diabetes NHS Health Checks and Community Health Checks (east of the borough) Improved care Moving towards value based commissioning for diabetes with providers working together to improve diabetes outcomes. Increasing capacity of the intermediate diabetes service Access to specialist nurses to initiate insulin therapy Education programme to improve care for GPs. Care planning for diabetes (pilot) Medicines management: BP toolkit for diabetes patients 18
What else can the CCG do about diabetes? Contribute to the multi-agency approach to tackling obesity in adults and children. Promote benefits of healthy lifestyles through NHS health checks and improve referral to lifestyle behavioural programmes. Further develop ways of improving the quality of primary care for people with diabetes. Improve access to self-management programmes for people with diabetes, including those with multiple long-term conditions. 19
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