Diabetes education adds up to human and economic sense

Can industry do more to help people with diabetes learn more about their condition, save lives and save the NHS some of its most crippling and unnecessary costs?

An education course took the guesswork out of diabetes, says Stewart, a patient who’s advocating for the Diabetes UK campaign to learn more about the condition.

The more you know, the better you live, the charity is arguing in its Taking Control campaign, pointing out that most people with diabetes only spend around three hours a year with their doctor, nurse or consultant. For the other 8,757 hours they must manage their diabetes themselves.

Diabetes is a difficult condition to understand and manage. You have to learn how to monitor it, count carbohydrates, adjust the insulin you need according to your blood glucose levels. You have to understand your diet, how cooking affects your food and why it’s important to be active.

If you don’t, you face complications – amputation, heart attack or stroke, raising the bar of your condition considerably and even risking your life. In 2012/13 there were nearly 200,000 cases where individuals suffered complications because of diabetes.

Globally, 5m people died from diabetes in 2015 – that’s more than from HIV/AIDS, TB and malaria combined.

Leonie Watson (http://www.bbc.co.uk/news/disability-34847776) told the BBC she became blind because she ignored being diabetic, and, as a result, developed advanced diabetic retinopathy. As her experiences graphically show, complications have a dreadful impact on individuals who have jobs, families and lives that are irrevocably altered.

£25,000 a minute

But they also drain an enormous amount of money from the health service. Diabetes costs 10% of the whole NHS budget – more than £25,000 a minute – and complications account for £8bn.

Per patient, per year, complications cost between £1,800 and £2,500. Set these against annual outpatient costs of £300-£370 a year per patient and it’s easy to see how a substantial proportion of that £8 billion can be prevented.

Barbara Young, Diabetes UK Chief Executive, has called the huge number of diabetes complications “a tragedy” that could be prevented with better care and support. Complications are fuelling the high death rate of people with diabetes and burdening the NHS with unnecessary costs.

Earlier this year she identified education as the key and urged the NHS to get better at educating people, saying: “With the numbers of people with diabetes rising at an alarming rate, it is vital that the Government and the NHS act urgently to end the postcode lottery of diabetes care and ensure that all people living with diabetes get the support and care they need to live long healthy lives.

“Unless this happens, thousands more people a year will be condemned to entirely avoidable debilitating complications and early death, and the future sustainability of the health service will be at great risk.”

Education for people at risk

That education should extend to people at risk, as well as those already diagnosed, and, according to the charity, could save the NHS around £57m over four years, rising to £176m over a 15 years and pay for itself after 20 years.

But at the moment it’s not working. Education’s patchy and the support patients receive depends on where they live. Sound familiar? When the InDependent Diabetes Trust (IDDT) surveyed more than 15,000 people, it found 37% weren’t given the right advice and information about diet and exercise when they were told they had diabetes.

The Trust estimates 2.5m people, therefore, have not received the education they need. Its report, “Diabetes 2015: Care in Crisis” reveals a shocking 32% did not feel their GP or practice nurse knew enough about diabetes either.

So, like Diabetes UK, it is calling for proper patient education because, despite NICE calling it an integral part of diabetes care, it is simply not being provided.

The Trust’s demands each Clinical Commissioning Group (CCG) fund “convenient and high-quality structured education courses and top up courses’” for anyone who wants them. Other learning opportunities, such as peer support group learning and online courses, should also be on offer and CCGS should provide printed information about diet, exercise and medication in non-medical language to people who are newly diagnosed or not in an education programme.

Global epidemic

The consequences of getting to grips with education are enormous, not least because diabetes is a global epidemic with China, India and USA taking the first three places in the world chart of adults with the condition.

The IDF Diabetes Atlas shows 12% of health spending globally goes on diabetes treatment and complications. This will only rise because the number of people affected by the condition is set to keep going up.

The Atlas says one in seven births is characterised by high blood glucose in pregnancy and Type 1 diabetes in children is going up by 3% a year. A total of 415m adults have diabetes and 318m have impaired glucose tolerance, meaning they are at risk. There will be an estimated 642m sufferers by 2040.

All those people are or will be connected to the pharma industry through their existing and future products. So, if the NHS is unable to provide the education people need, maybe industry should be stepping in to help fill the gap? It is not beyond our scope, surely, to develop tools to help men and women in every country in the world use their products correctly?

And that is an opportunity to do something great that will prevent some of the most horrific and preventable complications of this global epidemic.

Published on: December 18, 2015