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Diabetes

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Introduction

Diabetes is a life-long health condition where the person is unable to adequately regulate their metabolism, resulting in erratic blood glucose levels, lipid levels and the potential for renal and liver damage. It is a major health concern as local and national rates are expected to increase.

There are two main types of diabetes; type 1 is an autoimmune condition resulting in 'insulin dependence' as the person's pancreas fails to produce any insulin to control blood glucose levels, and therefore requires insulin injections for life. Type 2 is known as 'insulin resistant' and is the more common type of diabetes, accounting for 90% of adults with diabetes.1 Type 2 is a progressive disease, but often in the earlier stages can be controlled by eating a healthy diet and exercise.

Long-term conditions in children provides information on childhood diabetes (type 1) in Blackpool.

Facts and Figure

Prevalence of Diabetes

For further information regarding the source of QOF prevalence data and its limitations please see Note on QOF Data.

In 2015/16 10,752 people over the age of 17 had been identified by NHS Blackpool CCG GP practices as living with diabetes.2 It is estimated that this accounts for 90% of the total population in Blackpool living with diabetes and there are likely to be approximately 1,000 people with undiagnosed diabetes.3

NHS Blackpool CGG is shown as a purple marker in Figure 1, with all other CCGs shown in blue. Figure 1 shows that 7.6% of NHS Blackpool CCG's registered population, are recorded as living with diabetes. The indicator is located outside the 3rd standard deviation meaning that Blackpool has a significantly higher prevalence of diabetes than the average of English CCGs (6.5%).

It is also important to highlight the importance of identifiying the impaired glucose state, in which a person is not diabetic but their lifestyle leaves them at high risk of developing type 2 diabetes. Contributing lifestyle factors include unhealthy diet and lack of exercise. If these lifestyle factors are changed, the onset of type 2 diabetes can be prevented.

Figure 1 - Diabetes Prevalence (17+) Funnel Plot Analysis at CCG Level (2015/16 QOF)

Source: Quality Outcomes Framework (QOF)

Figure 2 shows all the GP practices that make up NHS Blackpool CCG. There is a considerable range in recorded prevalence of diabetes at GP practices from 3.6% to 9.1%.

Figure 2 - Diabetes Prevalence (17+) Funnel Plot Analysis at GP Level (2015/16 QOF)

Source: Quality Outcomes Framework (QOF)

The GP practices highlighted in dark purple have a significantly lower prevalence of diabetes compared to the Blackpool average.

    • NEWTON DRIVE HEALTH CENTRE
    • ARNOLD MEDICAL CENTRE
    • ASHFIELD MEDICAL CENTRE

The GP practice highlighted in dark pink has a significantly higher prevalence of diabetes compared to the Blackpool average.

    • CLEVELEYS GROUP PRACTICE

National and local strategies (current best practices)

    • The National Service Framework for Diabetes (Department of Health, 2001) sets out 9 standards for the provision of high quality services, which include the identification, empowerment and care of patients with diabetes.
    • The National Diabetes Audit sets out the '9 Key Care Processes' that form a planned programme of recommended checks that all patients with diabetes are expected to receive each year. Participation in the audit is voluntary, so not all GP practices participate.
    • NICE guidance [PH38] Type 2 diabetes: prevention in people at high risk (July 2012) covers how to identify adults at high risk of type 2 diabetes. The 20 recommendations in this guideline can be used alongside the NHS Health Check programme.

    • NICE guidance [PH35] Type 2 diabetes prevention: population and community-level interventions (May 2011) covers preventing type 2 diabetes in adult populations and communities who are at high risk. It aims to promote a healthy diet and physical activity at community and population level, and recommends how to tailor services for people in ethnic communities and other groups who are particularly at risk of type 2 diabetes.

Risk Factors

Risk factors associated with developing type 2 diabetes4:

    • being overweight or obese - having a waistline greater than 94 cm (37 inches) for men or greater than 90 cm (35 inches) for men of South Asian origin. For women, having a waistline greater than 80 cm (31.5 inches)
    • being more than 40 years old or, for people of South Asian origin, more than 25 years old
    • having parents, or a brother or sister, with type 2 diabetes
    • being of Black African, Caribbean origin (3 times more likely to develop type 2 diabetes) or South Asian origin (6 times more likely to develop type 2 diabetes)
    • being a woman who has had gestational diabetes or has had a baby weighing more than 4.5kg (9.9lbs) at birth
    • being an overweight woman with a history of polycystic ovarian syndrome
    • having a history of high blood pressure, a heart attack or stroke
    • having ever experienced higher than normal blood glucose levels - impaired glucose regulation (IGR) - also known as impaired glucose tolerance, impaired fasting glucose, non-diabetic hyperglycaemia or pre-diabetes
    • having a mental health condition such as schizophrenia, bipolar illness or depression, or if someone is taking antipsychotic medication

Obesity is the most potent risk factor for type 2 diabetes. It accounts for 80-85% of the overall risk of developing type 2 diabetes. Almost two in every three people in the UK are overweight or obese.5

Individuals with diabetes also have a higher risk of retinal damage (Diabetic Retinopathy). This is when high blood sugar levels cause blood vessels in the eye to become damaged. They may become blocked, have excess fluid or leak, causing blurred visions, and in worst case, blindness. The NHS Diabetic Eye Screening Programme is therefore essential for identifying retinopathy at an early stage. Every individual over the age of 12 with diabetes should be invited for a screening once a year.


[1]Diabetes UK, State of the Nation 2012

[2]PHE, National General Practice Profiles

[3]PHE, Diabetes prevalence estimates for local populations

[4]Diabetes UK , Diabetes risk factors

[5] Hauner H. 2010, Textbook of Diabetes, Diabetes and Obesity