Diabetes

Background and Policy Context 

Diabetes
About 150,000 people in Wales have diabetes, it affects all age groups. The complications can significantly impair quality of life and their consequences can be fatal. There is good evidence that early detection and effective treatment can delay or even prevent progression of complications associated with diabetes. (Source: All Wales Diabetes Advisory Group 23 March 2009) 
 
The Welsh Assembly Government has put in place a number of policies and a Diabetes National Service Framework for NHS Wales to tackle the increasing prevalence of the condition, improve services and maximise outcomes for those patients diagnosed with diabetes.
 

What are we doing to minimise the impact of diabetes?

Prevention, early detection and management of the condition are key elements in minimising the impact that diabetes can have.

Prevention

Providing education and advice to individuals so that they can make informed choices about lifestyle improvements to help prevent them developing the condition in the first place.
In particular health promotion initiatives centred around reducing weight, healthy eating and increasing physical activity are aimed at helping to prevent the onset of diabetes.
 
National initiatives include:
 
Health Challenge Wales offers simple advice to individuals and organisations on improving health and well-being.
 

The Networks below are for all individuals, organisations and sectors with a role to play in improving nutrition and levels of physical activity in Wales. They support members by providing and improving access to information and by providing a forum for sharing knowledge and good practice.

Local initiatives:

Local Public Health Teams work with Local Health Boards ito mprove health and well being and reduce health inequalities in their areas: 

Early Detection

Much of the management and monitoring of people with diabetes (particularly those with type 2 diabetes) is undertaken by General Practitioners and the Primary Care Team which may include nurses, dieticians, health visitors and pharmacists among others.
 
The Quality and Outcomes Framework is a voluntary annual reward and incentive programme for GPs through which GP practices submit data on a wide range of key indicators including diabetes data. Practices score points against the indicators and the levels of services offered. It is about encouraging good practice and making it easier to monitor long term conditions like diabetes.
Practices may undertake screening for those at high risk of developing type 2 diabetes to identify those who may not know they have the condition.
 

Management

An essential role of diabetes services is to encourage and support patients to self-manage their diabetes. Patient centred care and partnership working between generalist and specialist cllinicians, allied health care professionals, social care support staff and the patient living with diabetes differs from the traditional professional model of consulting.

Once a patient has been diagnosed with diabetes there is still a need for preventive intervention to limit the impact of  diabetic complications and other associated pathology.

Patient Education
Structured and on-going programmes of patient education mean that people are better equipped to care for themselves, assess their risk of developing complications and know how to change their behaviour to reduce their risk.

The Expert Patients Programme Wales (EPP) provides a range of self-management courses and workshops for people living with long-term health conditions or for those who care for someone with a long term condition

Regular Reviews to screen for complications and to arrange appropriate treatment and referral
Primary health care teams will conduct regular reviews to assess patient lifestyles, knowledge, skills and feelings about diagnosis.  These reviews along with regular tests of blood, urine, blood pressure, checks of eyes and feet and on-going dietary management advice are aimed at keeping blood glucose levels within normal range and at reducing the impact of complications.

The Diabetic Retinopathy Screening Service for Wales (DRSSW) is an all Wales service designed to detect sight threatening diabetic retinopathy at an early stage before visual loss occurs 

Indications for referral to hospital specialist care may include the detection of, or  worsening complications, Type 2 diabetics failing on oral therapy and who may need insulin, diabetic women planning pregnancy, foot problems and control problems for those with shift patterns.

Diabetes Statistics and Resources

 

The Cardiff Diabetes Handbook is a resource developed to help primary care clinicians develop services for patients with diabetes. It is based on national and international evidence-based guidelines and authoritative advice on what is considered to be current best practice.