People with Type 2 diabetes at risk because important blood glucose targets not being met

29^th March 2006, Diabetes UK Annual Conference, Birmingham – Variations and inconsistencies in the management of Type 2 diabetes may have serious long-term implications both for patients and the National Health Service, according to new audit data presented at the Diabetes UK Annual Conference today. Many of the patients currently diagnosed with Type 2 diabetes are not achieving recommended blood glucose target levels, with huge disparities throughout the UK depending on their age and where they live.

Analysis of audit data from English, Welsh and Scottish primary care populations shows inconsistencies in care, with more Welsh patients reaching their blood glucose targets compared with those in England and Scotland . The audits also show that the blood glucose of younger patients across the UK is not being managed effectively, with average blood glucose levels found to be higher in patients aged 21-40 (mean 8.5%) vs the 61 -80 age group (mean 7.8%) - both well above recommended targets.

Dr Mark Savage, consultant diabetologist at the North Manchester General Hospital , chair of the North-East Manchester Diabetes Network and co-author, commented: “In order to attenuate the impending tidal wave of diabetic complications, we must ensure that diabetes care is consistent across the age groups and between the nations of the UK . Type 2 diabetes is a long-term chronic condition and we need to ensure in particular that our younger patients are managed effectively to minimise complications later on.”

Roopinder Brar, Care Advisor at Diabetes UK said, "We know that poor blood glucose control in Type 2 diabetes can increase the risk of complications such as heart disease, stroke and blindness in later life. Healthcare professionals are already helping patients achieve blood glucose targets, but more could be done to ensure that all people with diabetes are getting as near to the recommended targets as possible."

Despite the established benefits of lowering blood glucose, including reducing the risk of complications to the eyes, heart, kidneys and feetⁱ, and evidence that a 1.0 % reduction in HbA1c is associated with a 37% reduction in microvascular complicationsⁱⁱ, two thirds of people with diabetes in the UK are not currently achieving target blood glucose levels.ⁱⁱⁱ

• Current recommendations for blood glucose targets include:

• The National Institute for Health and Clinical Excellence (NICE)^iv which recommends a blood glucose target of 6.5 - 7.5%.

• The first ever evidence-based Global Guideline for Type 2 diabetes, developed by the International Diabetes Federation last year, recommends maintaining blood glucose levels below 6.5% to minimise the risk of complications developing.^v   

• The new GMS Contract requires annual monitoring of HbA1c levels with one of the key indicators being the percentage of patients in whom the last HbA1c level is 7.5% or less in the last fifteen months.^vi

• The Joint British Societies' guidelines on prevention of cardiovascular disease in clinical practice state that the optimal target for blood glucose levels is a HbA1c level of 6.5%. An audit standard for HbA1c of 7.5% is recommended in people who experience severe hypoglycaemic episodes.^vii 

• Diabetes is one of the greatest health challenges facing the UK today. Already, more than 2 million people in the UK have been diagnosed with the condition and deaths from diabetes are expected to rise by 25% in the next ten years.^viii

For further information, please contact Emily Brooks or Andrea Petruzella at Virgo HEALTH PR on 0844 583 8900 or emily.brooks@virgohealthpr.com / andrea.petruzella@virgohealthpr.com

Notes

About Type 2 diabetes

Over 100,000 people are diagnosed with Type 2 diabetes each year in the UK^v – approximately one person every five minutes. Type 2 diabetes is the fourth leading cause of death in most developed countries.^ix

Type 2 diabetes is a complex and currently incurable condition in which the body is unable to properly process glucose (sugar) levels in the blood due to a combination of genetic and environmental factors, particularly lack of physical activity and obesity. This leads to insulin resistance, a failure by the body to use its own insulin properly, which then results in a loss of blood glucose control and the onset of Beta Cell dysfunction.^x

Type 2 diabetes is a progressive condition that can lead to serious long-term complications, such as heart disease, stroke, blindness and kidney failure.^x

Further Information about the audits presented at the Diabetes UK

Audit data from an English and Welsh population was examined to ascertain target achievement for an under and over 60 years population. HbA1c results were available on 60,839 patients, 17,481 (29%) were below 60 years. In the total population, HbA1c 7% target achievement was lower in the younger age group (38% vs 51% England, 49% vs 56% Wales, p<0.0001). In addition, average HbA1c levels were substantially higher in the 21-40 age group (mean 8.5%) vs the 61-80 age group (mean 7.8%). This may well be due to significantly higher mortality amongst younger patients with poorly managed HbA1c. It is also possible that the older patients observed in this study represent those who have experienced better long-term control of their diabetes.

Audit data from English, Welsh and Scottish primary care populations was examined to ascertain average HbA1c levels in patients.  Data was exported in the period March – October 2005. HbA1c results were available on 57,427 English patients, 3,412 Welsh patients, and 23,694 Scottish patients. Average HbA1c levels were 7.84%, 7.44% and 7.86% respectively. 

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ⁱ UKPDS Study Group. Lancet 1998; 652: 837–853.

ⁱⁱ Stratton IM et al. BMJ 2000; 321: 405–412

ⁱⁱⁱ Ambery PD, Leaney K, Bowers R.  Are we still missing the goal with respect to glycaemic targets in 2004.  Diabetic Medicine 2005; 22 (Suppl 2):86. P120

^iv National Institute for Health and Clinical Excellence. Clinical Guideline for Type 2 diabetes. Management of Blood Glucose. September 2002 (http://www.nice.org.uk/pdf/NICE_full_blood_glucose.pdf) Last accessed February 2006

^v International Diabetes Federation, Global Guidelines for the management of Type 2 diabetes.

^vi Quality and Outcomes Framework Guidance (Updated August 2004) (http://www.dh.gov.uk/assetRoot/04/08/86/93/04088693.pdf) Last accessed February 2006.

^vii JBS 2: Joint British Societies' guidelines on prevention of cardiovascular disease in clinical practice. Prepared by: British Cardiac Society, British Hypertension Society, Diabetes UK , HEART UK , Primary Care Cardiovascular Society, The Stroke Association. Heart (2005) 91 (Suppl 5): v1-v52

^viii Diabetes: State of the Nations 2005. Progress made in delivering the national diabetes frameworks. A Report from Diabetes UK . ((http://www.diabetes.org.uk). Last accessed December 2005.

^ix Pagano E, Brunetti M, Tediosi F, Garattini L. Costs of diabetes. A methodological analysis of the literature. Pharmacoeconomics 1999; 15 (6): 583-595

^x Barnett A et al.  DEFINe Dossier – Diabetes: Evaluating Future Impact Now.  November 2004. (Sponsored by GlaxoSmithKline)

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