Prevention and innovation key to tackling diabetes time bomb
The UK's plan to implement a national evidence-based diabetes prevention programme comes at a critical juncture, with rising numbers of cases threatening to undermine the NHS.
The NHS clinical director for obesity and diabetes, Prof Jonathan Valabhji, said on World Diabetes Day last week that a fresh approach is needed given that there are already 3 million people with the disease in the UK, with their care accounting for 10 per cent of the total NHS budget.
The prevention programme was first unveiled in the NHS Five Year Forward View a few weeks ago, which also drew attention to the role of employers in promoting employee health, particularly around weight management that, in turn, could help reduce diabetes .
There are several other approaches that could be deployed in diabetes prevention, such as boosting food literacy and physical activity in schools, improving access to open spaces for exercise by local authorities and making more cycle-friendly routes available.
The focus on diabetes within the Forward View was a welcome boost for diabetes management in the UK, coming on the back of the termination of dedicated funding from NHS England last year. The former NHS Diabetes unit was disbanded when the Health and Social Care Act came into effect on 1 April 2013.
When the Forward View was published last month, medical charity Diabetes UK welcomed the prevention initiative as well as the recognition that the NHS needs to radically change the way that it delivers routine care.
"As the Forward View makes clear hospitals, GPs and community services must pool their support and break down the barriers that currently exist between them," said the charity's chief executive Barbara Young.
Diabetes UK estimates that another seven million people are at risk of becoming diabetic, so the NHS' current £10 billion-a-year spend on diabetes is only likely to accelerate. Around 80 per cent of cases of type 2 diabetes could be prevented or delayed through better lifestyle choices, it suggests.
"As the nation's waistline keeps piling on the pounds, we're piling on billions of pounds in future taxes just to pay for preventable illnesses," says the Forward View.
Innovation
"I was also delighted to hear during the announcement of ... Forward View that NHS England's CEO Simon Stevens plans to nurture and support innovation in the NHS," said Valabhji.
Innovation can be at the level of patient, multidisciplinary healthcare teams and at the health system scale, with integrated care backed up by improved communication channels and new technologies such as drugs, he continued.
"Innovation at the health systems level can have great reach," he added, pointing to his own experience running the multi-disciplinary foot service at Imperial College Healthcare NHS Trust, which had a dramatic impact on the incidence of major amputation.
Meanwhile, new technologies such as insulin pumps, which are already available on the NHS, continuous glucose monitoring devices that are currently being reviewed by the National Institute for Health and Care Excellence (NICE) and, potentially, closed loop systems/artificial pancreas systems "have the potential to transform peoples' lives for the better".
"We are not short of innovation in the field of diabetes," said Valabhji. "Further innovation and its effective roll-out will be a necessary contributor to both our nation's health and the sustainability of the NHS moving forward."
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