Diabetes. Immunizations. Cigarette Smoking. Alcohol Consumption 2. Age at diabetes diagnosis. Variable=agediabetes Format=agediab. Weighting Variable=wt5 …
Spotlight on
Diabetes: update
8 May 2002
Dr Christine Hine, Consultant in Public Health Medicine
If you need further copies of this document please telephone Penny Rye on
0117 900 22648
If you need this document in a different format please telephone Penny Rye
on 0117 900 2648
Contents
1 Section 1: Diabetes and the National Service Framework in Avon 1
11 What is diabetes? 1
12 Why is diabetes a priority? 1
13 Can diabetes be prevented? 1
14 What is the national policy for diabetes? 2
15 How will the National Service Framework be implemented in Avon?
2
16 Who is the lead for my area? 3
17 How are diabetes services provided in Avon? 3
2 Section 2: How Common is Diabetes? 4
21 Number of people with diabetes 4
22 Trends in numbers of People with Diabetes 5
23 Distribution of Diabetes across Avon 6
24 Risk factors for type 1 diabetes 6
25 Risks factors for type 2 diabetes 8
26 Diabetes and minority ethnic
groups 8
3 Section 3: Diabetes Complications————————————-
——————-10
31 Diabetes complications 10
32 Diabetes and lower limb complications 10
33 Prevention of Lower Limb Complications 12
34 Diabetes and Eyesight 12
35 Prevention of Eyesight Complications 13
36 Hospital Admission for diabetes coma 14
4 Section 4: Deaths due to diabetes————————————-
———————16
5 Section 5: Primary Care Prescribing Costs for Diabetes—————-
———–18
1 Section 1: Diabetes and the National Service Framework in Avon
1 What is diabetes?
Diabetes is a condition in which the body is unable to control
the amount of sugar in the blood There are 2 types of diabetes;
type 1 and type 2
Type 1 diabetes previously known as Insulin Dependent Diabetes
Mellitus [IDDM] affects children and younger adults They lack
insulin
Type 2 diabetes previously known as Non-Insulin Dependent
Diabetes Mellitus [NIDDM] tends to affect people over 40 They
may
lack insulin, or their insulin may not work properly
During pregnancy, some women develop temporary gestational
diabetes
2 Why is diabetes a priority?
Diabetes has a high cost for individuals and the NHS For
individuals, there are both health and financial costs For the
UK, the Audit Commission note an estimate of 9 of hospital
costs 19 billion attributed to diabetes, with additional
costs in primary care Provisional results of the T2ARDIS
survey estimate 20 billion NHS costs for caring for type 2
diabetes alone 47 NHS spend in 1998
Although 2-3 of the population have diabetes, people with
diabetes account for 10 of hospital admissions
People with diabetes are at higher risk of damage to nerves and
the bodys large and small blood vessels This can lead to
heart disease, stroke, loss of eyesight, foot ulceration in
some cases leading to amputation and kidney disease
3 Can diabetes be prevented?
Reducing excess weight and taking regular physical exercise are
important in preventing type 2
diabetes, and to tackle the risk
of heart disease in people who have already developed diabetes
More children and adolescents are becoming overweight Levels
of physical activity are falling Consequently, we expect the
incidence of type 2 diabetes in younger people as well as the
older adult population, to rise This is a serious problem
The longer one has diabetes, the more likely one is to develop
complications
Access to good advice and effective health care is a priority
for people who want to reduce these risks Medical care aims
to help reduce blood sugar levels and blood pressure, and to
detect and treat complications at an early stage
| |
| Better blood pressure control can reduce the risk |
|of: |
|Death from long term complications of diabetes; |
|Strokes; |
|Serious deterioration of vision |
|Better blood glucose control can reduce the risk |
|of:
|
|Diabetic eye disease; |
|Early kidney damage |
|Loss of feeling in the feet |
|For detailed evidence on blood glucose reduction, |
|look up diabetes in the endocrine section of |
|Clinical Evidence 4 at http://wwwnelhnhsuk/ |
|There is a Diabetes UK position statement on |
|evidence from the UKPD Study and type 2 diabetes in|
|the information section under P at |
|http://wwwdiabetesorguk/ |
Delays in diagnosing a person with diabetes, which can be as
long as 12 years after the onset of diabetes, mean that between
one-third and one-half of those with diabetes already have
evidence of organ or tissue damage when diagnosed
General practitioner reports suggest that over 1 in 50 people in
Avon are known to have diabetes Research suggests that as many
again may have diabetes, but they are not aware of it
4 What is the national policy for diabetes?
In 2001 the Government published standards for the National
Service Framework for Diabetes An
Implementation Plan is due
to be published during the summer of 2002 The Department of
Health has a NSF webpage at
http://wwwdohgovuk/nsf/diabetes/
The National Institute for Clinical Excellence NICE has
published guidelines on diabetes care see
http://wwwniceorguk/
Other sources of information
Diabetes UK formerly known as the British Diabetic Association
is an important source of advice on good practice in diabetes
care For further information see
http://wwwdiabetesorguk/homehtm
5 How will the National Service Framework be implemented locally?
Diabetes lead managers in Primary Care Trusts PCTs will
convene local implementation groups, involving people with
diabetes, clinicians and health services managers, to advise on
how the NSF targets will be met
There are eight topic headings within the NSF:
type 1 diabetes;
prevention and early detection of type 2 diabetes;
management of type 2 diabetes;
diabetic
retinopathy;
diabetic nephropathy;
lower limb complications;
cardiovascular disease and other complications;
management of diabetic pregnancy
6 Who is the lead for my area?
Each primary care trust PCT has identified a lead manager for
diabetes listed in the table below
|PCT |Diabetes |e-mail address |
| |Lead Manager| |
| | | |
| |May 2002 | |
|Bath and |To be | To be appointed |
|North East |appointed | |
|Somerset PCT| | |
| | | |
|Bristol |Barbara |barbaracoleman@bristolnorth-pctnhs|
|North PCG |Coleman |uk |
|Bristol |Gill |GillVelleman@bristolswpctnhsuk |
|South and |Velleman | |
|West PCG | |
|
|North |Mike James |MikeJames@nsomerset-partnershipnhs|
|Somerset PCG| |uk |
| | | |
|South | |MaggieRogers@usermavonhealthswest|
|Gloucestersh|Maggie |nhsuk |
|ire PCT |Rogers | |
7 How are diabetes services provided?
Services are provided by general practices, specialist community
services eg podiatry, optometrists and dieticians, and
specialist nurses and doctors employed by hospital trusts
Some general practices run diabetes clinics, whilst others offer
appointments during routine surgeries Until 2000/01, 99 of
Avon practices participated in the national Chronic Disease
Management Programme for diabetes, which required that they run
chronic disease management registers, conduct audit and report
data annually on the standard of care provided However this
situation has changed subsequent to NHS reorganisation Avon
Health Authority has now ceased, most of its responsibilities
being devolved to 5 PCTs The PCTs will commission specialist
services, and develop services from their practices and
community services Also, increasing numbers of practices have
changed their contracts with the PCTs, to PMS personal
medical services This means that they will not be required to
be in the CDM programme, which means the data recording
previously used to monitor diabetes prevalence and care will
cover fewer practices This means we are in a poorer position
to compare services across Avon Hopefully this will change
when the NSF is implemented, with standard requirements to
assess and monitor standards of care
Consultant and specialist nurse diabetes services are available
at Frenchay Hospital, Southmead Hospital, Weston General
Hospital, Bristol Royal Infirmary and the Royal United Hospital,
Bath These services involve podiatrists, dieticians and
optometrists in advising and assessing people for complications
Eye,
renal, maternity vascular orthopaedic, impotence and
psychology services are involved in treating complications of
diabetes There are specialist services for children, based at
the Bristol Childrens Hospital and the Royal United Hospital,
Bath
Weston General Hospital provides information on its diabetes
services at http://wwwwestondiabetesorguk/
Section 2: How Common is Diabetes?
8 Number of people with diabetes
Until 2001/2002, Avon GPs reported on the number of people with
diabetes in their practices for the Chronic Disease Management
Scheme This data is shown in table 1 below
This data is available to practices in Avon Practice
Comparisons Practices can download this from
http://nwwavonnhsuk/imtconsortium/Info_management/practice_com
ps/defaulthtm
|Avon PCGs and PCTs , |Number of People |Total | Population with |
|1999/2000 |with diabetes |Population |diabetes |
|Bath NE Somerset |3883 |183854 |21 |
|PCT |
| | |
|Bath PCG |2044 |102213 |20 |
|Greater Wansdyke PCG |1839 |81641 |23 |
| | | | |
|Bristol North PCG |5492 |226618 |24 |
|Bristol East PCG |1682 |70400 |24 |
|Bristol Inner City |1584 |53169 |30 |
|PCG | | | |
|Bristol North West |2619 |119783 |22 |
|PCG | | | |
|Bristol South West |4088 |202737 |20 |
|PCG | | | |
|Bristol South East |1503 |66864 |22 |
|PCG | | | |
|Bristol South PCG |2032 |79023 |26 |
|Bristol West PCG |553 |56850 |10 |
|North Somerset PCG
|3901 |187922 |21 |
|Weston Super Mare PCG|1660 |81714 |20 |
| | | | |
|Woodspring PCG |2241 |106208 |21 |
|South Gloucestershire|4828 |237265 |20 |
|PCT | | | |
|Severnvale PCG |1217 |68215 |18 |
|South East |3218 |152316 |21 |
|Gloucestershire PCG | | | |
|Avon |22192 |1038396 |21 |
Table 1 - Number of registered patients with diabetes reported
by Avon in the former and current PCG/Ts Year ending
March 2000
A person can have diabetes for a number of years without
realising The numbers reported by GPs do not include these
people
Research studies designed to find out how many people have
diabetes are generally considered more
accurate than GP
registers The 1993 National Health Survey for England provided
an estimate of self reported diabetes, and investigated
undiagnosed diabetes Overall 24 of adults said they had
diabetes This was adjusted to 34 to take account of
undiagnosed cases Against these estimates for adults only, the
Avon figure for all ages is higher This could be because it is
more up to date diabetes is getting commoner, Avon GP
registers may overestimate diabetes prevalence, diabetes could
be commoner in Avon eg because of differences in the age, sex,
and ethnicity of our population
Changes in the criteria for deciding whether or not a person has
diabetes will have an effect on estimates of the population with
diabetes This will occur gradually as clinicians change to the
new diagnostic criteria produced by the World Health
Organisation in 2000
The estimated number new incident cases of diabetes in 2001
for each PCT are shown in the table 2 below Please note, these
are estimates based on
national studies and may not reflect the
actual number of new cases that occurred in 2001
|PCT |New cases |95 confidence |
| |2001 |intervals |
|BNES |267 |235-299 |
|Bristol North |324 |288-359 |
|Bristol South |251 |220-282 |
|West | | |
|North Somerset |324 |289-360 |
|South |372 |334-410 |
|Gloucestershire | | |
Table 2: Estimated new cases of diabetes in 2001
9 Trends in numbers of People with Diabetes
In 1999/2000, Avon GPs reported that over 22,000 of their
patients had diabetes Of these, nearly 75 had type 2 diabetes
In 1995, Avon GPs reported that 16 of their patients had
diabetes This percentage has grown steadily to 21 reported
in 1999/2000
The growth in the registered diabetic population in Avon over
recent years is greater than the increase in the Avon
population, and this trend is mirrored throughout the UK and
globally Graph 1 below illustrates the changes in the number
of people with diabetes in Avon
This could reflect a real increase, migration, the fact that
people with diabetes are living longer, better diagnosis,
improved recording, better statistical returns to Avon Health
Authority - or a combination of these
Most professionals feel that there is a real increase in the new
incident cases of diabetes throughout the country
Source - Avon Practice Comparisons
10 Distribution of Diabetes across Avon
Diabetes is commoner in some parts of Avon than others There is
considerable variation in the size of the local population with
diabetes, reported by GPs within the twelve former PCGs in Avon
table 1 For example in Bristol Inner City, the percentage
of the population reported to have diabetes is more than double
that for Bristol West
11 Risk factors for type 1 diabetes
New cases of type 1 diabetes arise most commonly in childhood
Graph 2 below shows the incidence of diabetes in
childhood, ie
the number of new childhood people with diabetes each year The
cause of type 1 diabetes is not known, and we do not know how to
prevent it Incident cases of type 1 diabetes are getting
commoner The reason for this in unknown
Source - appendix 3 of Health care needs assessment Diabetes
Williams R, Farrar H Oxford 2000 See http://hcnaradcliffe-
onlinecom/diabeteshtm
At the end of 2000, specialist paediatricians at the Bristol
Childrens Hospital and Royal United Hospital estimated that
they had caseloads of just over 300 and 43 children and young
people under 20 who live throughout Avon, respectively It is
likely that these figures include almost all children with
diabetes, but in late adolescence, people with diabetes start to
transfer to adult services Hence this caseload is not a
reliable indicator of the number of children and teenagers with
diabetes
Graph 3 below provides annual incidence rates of type 1 diabetes
per 100,000 population in children
and adults, as estimated by
the University of Southampton Diabetic Retinopathy Screening
Project using studies by Green and Gale 1993, Green et al
1992 and Cudworth 1978 The data is published at
http://wwwsotonacuk/scb/datahtm
12 Risks factors for type 2 diabetes
Graph 4 shows that new cases of type 2 diabetes arise more
frequently in older age groups New cases are commoner in non-
white populations, for all age groups New cases are slightly
commoner amongst men than women New cases of type 2 diabetes
are now arising amongst young people, associated with being
overweight and less physically active
Source - University of Southampton Diabetic Retinopathy
Screening Project at http://wwwsotonacuk/scb/datahtm,using
a USA study Lipton et al, 1994 Estimates in Health care
needs assessment: Diabetes Williams R, Farrar H Oxford 2000
at http://hcnaradcliffe-onlinecom/diabeteshtm are higher, and
the authors question their value given that diagnosis tends to
be late in
type 2 diabetes
The people most at risk of developing Type 2 diabetes are:
People with a family history of diabetes
People aged between 40 and 75
People of South-Asian or Black Caribbean origin
People who are overweight
Women who have had a baby weighing more than 4kg 8lb 8oz
13 Diabetes and minority ethnic groups
The 1999 national survey of Health of Minority Ethnic Groups
found that South Asian men and women had the highest rates of
diabetes, with Pakistanis and Bangladeshis of both sexes being 5
times more likely to develop diabetes compared with the general
population Indian men and women were 3 times more likely, and
Black Caribbean men and women were 25 times and 4 times more
likely to have diabetes, respectively
Rates amongst Chinese and Irish people were not significantly
raised above the general population level
With the exception of Black Caribbean people, all groups were
achieving physical activity levels below the general
population
Central obesity excess weight particularly around the waist is
associated with higher risk of diabetes South Asian men were
more likely to have central obesity than the general population
Central obesity in women was commoner than in the general
population for all minority ethnic groups at higher risk of
diabetes
The full national survey report is available via
http://wwwofficial-
documentscouk/document/doh/survey99/hse99htm
A Bristol Black and ethnic minority health survey 10 years
earlier found that 8 of respondents aged 18-64yrs said they had
diabetes Two out of 3 of this group did not experience
difficulty attending the surgery for care A subsequent audit
by 4 local general practices found that patients from different
backgrounds received the same level of routine diabetes
examinations However further survey analysis highlighted the
particular barriers faced by South Asian women with respect to
achieving higher levels of physical activity
Source: National survey of Health of Minority Ethnic Groups,
1999 Published at http://wwwofficial-
documentscouk/document/doh/survey99/hse99htm
2 Section 3: Diabetes Complications
1 Diabetes complications
Diabetes can lead to a number of complications, including
problems with eye sight, blood supply to lower limbs, and
increased risk of kidney failure and cardiovascular disease
Clinical Evidence 4 2001 noted that:
Mortality rates from coronary heart disease are up to 3
times higher in people with diabetes compared to their
peers
About 45 of middle aged and older men with diabetes have
evidence of coronary heart disease compared with 25 of
people of the same age group and population
The Clinical Evidence website at
http://wwwclinicalevidencenhsuk/
provides a regularly updated review of effective interventions
that can reduce cardiovascular risks in people with diabetes
As diabetes affects large blood vessels, the risk of stroke is
also increased
1999 data from the UK Renal Registry reports diabetes as the
commonest single cause of end stage renal kidney failure
amongst adults starting on renal replacement therapy accounting
for 16 of the total
2 Diabetes and lower limb complications
Poor blood supply peripheral vascular disease or PVD and
damage to the nerve supply neuropathy of the lower limbs are
relatively common complications of diabetes An estimated 20
men and 25 women with type 2 diabetes have PVD, estimates for
people with type 1 diabetes are lower Peripheral neuropathy
becomes commoner with age, rising from 5 of 20-29 year old, to
60 of 80-89 year old people with diabetes
These changes to blood and nerve supply mean that diabetic feet
are more susceptible to damage and infection Ulcers can be
serious and difficult to heal A minority of cases lead to
substantial damage to the foot, and in some cases, amputation to
prevent further damage
From GP reports we estimate that at least 22,000 Avon residents
have diabetes Between 1999/00 and 2001/02, there were
approximately:
290 hospital admissions each year because of lower limb
ulcers in people with diabetes;
89 hospital operations for amputations involving people
with diabetes, each year graph 6
on average, each year over 2063 bed days were used for
these admissions
Graph 6 shows the number of hospital operations for amputation
affecting lower limbs in people with diabetes
Source: Admitted Patient Care Data, Avon IMT Consortium
Note: Main operation codes Lower Limb Amputations ICD10 X09,
X10, X11 with any diagnosis diabetes code ICD10 E10-14
National data allows us to compare the rate of amputation in
people with diabetes in Avon with similar health districts, and
the rest of England graph7
In each of the three years between 1997/98 and 1999/00, the Avon
rates were not significantly different from the average for the
South West or England Note that this data counts the
number of
operations only in those people where diabetes is noted as a
primary diagnosis This gives a lower total than in graph 6,
where all admissions mentioning diabetes have been included
Source: Compendium of Clinical Indicators
3 Prevention of Lower Limb Complications
The risk of diabetes complications can be reduced by good
control of blood pressure and blood sugar, and regular
examination for early signs of complications can ensure that
early preventive treatment and advice are given
For prevention of lower limb complications in particular,
people are advised to inspect their feet regularly and wear well-
fitting shoes to reduce the risk of developing a foot ulcer, and
it is essential to take care and seek early treatment for foot
problems Evidence on prevention of lower limb complications has
been published in Clinical Evidence - see the endocrine
section at http://wwwclinicalevidencenhsuk/
4 Diabetes and Eyesight
Diabetic complications in the blood vessels of the retina
diabetic retinopathy can lead to visual impairment and
blindness
We do not have a formal diabetes eye screening programme
covering all of Avon There are retinal photography screening
services in Weston and Bath In Bristol, doctors and
optometrists commonly use ophthalmoscopes to examine the eyes
fundoscopy
GPs reported that 57 of people with diabetes underwent
fundoscopy in 1999/2000 Table 3 The percentages of the PCT
diabetic populations receiving eye tests vary, and it appears
that for a substantial proportion of these populations, there is
no record of an annual eye screening test This is so even if
we assume there is no overlap between those receiving fundoscopy
and retinal photography - the minimum estimate is 25 people
with diabetes have no record of either a retinal photograph or
fundoscopy in 1999/2000 Visual acuity checks are currently
recommended as an annual check for all people with diabetes, but
only half of patients had a record of this check for 1999/2000
In
1999/2000, 864 laser procedures aimed at preventing visual
impairment were performed on Avon residents with diabetes, for
an estimated 607 people
A survey of 40 practices in Avon and Somerset has shown that the
risk of developing diabetes eye disease is related to socio-
economic factors Lower levels of education and income are
associated with higher risks of eye and heart disease Less
advantaged individuals have more ill health but appear to use
specialist care less
| | Fundoscopy | Visual Acuity | Retinal |
| | | |Photography |
|BANES PCT |72 |68 |48 |
|Greater Wansdyke |64 |62 |39 |
|Bath |80 |73 |57 |
|N SOMERSET PCG |39 |44 |17 |
|Woodspring |60 |51 |3 |
|Weston Super Mare |17 |36 |32 |
|BRISTOL NORTH
PCG |57 |36 |11 |
| | | | |
|Bristol East |36 |24 |12 |
|Bristol Inner City|65 |19 |3 |
|Bristol North West|65 |53 |16 |
|BRISTOL S W PCG |60 |52 |2 |
| | | | |
|Bristol South |68 |58 |3 |
|Bristol South East|39 |34 |2 |
|Bristol West |82 |82 |0 |
|SOUTH |62 |51 |16 |
|GLOUCESTERSHIRE | | | |
|PCT | | | |
|South East |62 |48 |16 |
|Gloucestershire | | | |
|Severnvale |60 |57
|14 |
|AVON HEALTH |57 |49 |18 |
|AUTHORITY | | | |
Source: Avon Practice Comparisons
Table 3: Percentage of people with diabetes with eye checks
recorded as part of a diabetes annual review Avon
General Practices, 1999/2000
5 Prevention of Eyesight Complications
The risk of complications for diabetes can be reduced by good
control of blood pressure and blood sugar Regular screening
tests for early signs of complications can help ensure that
early preventive treatment and advice are given
There is no information system recording how many people in Avon
have lost their sight due to diabetes We have used research
data to estimate the scale of this complication of diabetes By
implementing a programme using the preferred screening test
retinal photography, we estimate:
At least 18,000 people with diabetes would attend for
screening each year
The benefits of preventive treatment would emerge over
time: within a year of treatment, between 16 and 48 people
would have had blindness prevented
Within 10 years, up to 300 people would have had blindness
prevented
Despite screening and treatment, a small number of people
would still lose their sight, as this cannot be prevented
in 100 of cases
For national recommendations on screening for diabetic
retinopathy, look at the National Screening Committees advice
at http://wwwdiabetic-retinopathyscreeningnhsuk/ NICE
http://wwwniceorguk/ has issued a guideline on early
management of diabetic retinopathy Further advice on screening
is expected in the Diabetes NSF Implementation Plan due summer
2002
The proposal for a diabetic retinopathy screening programme in
the Bristol and South Gloucestershire areas can be accessed at
http://nwwavonnhsuk/phnet/Publications/retinopathy_screeningd
oc
6 Hospital Admission for diabetes coma
Lack or loss of control of diabetes can lead to sudden and
severe rises in blood sugar, and changes in body chemistry This
can lead to coma and death Ketoacidosis is a term describing
the production of ketones, which can be a serious feature of
acute loss of control of diabetes Coma can also be described
as hyperosmolar where ketones are not produced, but there are
other potentially life threatening changes in body chemistry
Treatment of diabetes can be complicated by a different type of
coma, if blood sugar falls to a dangerously low level
hypoglycaemic coma
Hospital episodes for both types of coma are monitored
nationally, and results for the Avon area are presented in graph
8 This shows that in the three years between 1997/98 and
1999/00, the overall rate for Avon was higher than the average
for the South West region and England In one of these years
1998/99, the hospital episode rate was significantly higher in
Avon compared to England and the South West region Within
Avon, the rates
for Bath and North East Somerset and North
Somerset unitary authority populations were particularly high
Source: Compendium of Clinical Indicators
These high rates could be due to differences in the way that
episodes of care are counted An episode refers to a period of
time when a patient is recorded as being under the care of a
particular consultant If the patient was transferred to a
different consultant during a single hospital admission, then
this would count as two episodes
Local data has been analysed in more detail ie for the 12 former
PCG areas within Avon, and over a three year period April 1997-
March 2000 to provide a larger and more reliable dataset
Hospital admissions have been estimated to overcome the problem
of counting episodes described above table 4 This suggests
that the highest ratios compared to the Avon standard of 100
were for the Bath and Weston-Super-Mare populations The ratios
were significantly lower than Avon in Bristol East, Bristol
West, Severnvale and
South East Gloucestershire
| |Hospital |Indirectly |95 Confidence |
| |Admissions, |Standardised |Limits for |
| |April 1997 - |Hospital Admission|standardised |
| |March 2000 |Ratios |admission ratios |
|Bath |98 |127 |110-164 |
|Bristol East |24 |50 |30-70 |
|Bristol Inner |43 |125 |80-162 |
|City | | | |
|Bristol North |83 |100 |78-121 |
|West | | | |
|Bristol South |57 |109 |81-137 |
|Bristol South |37 |82 |56-108 |
|East | | | |
|Bristol West |24 |63 |38-88 |
|Greater Wansdyke |62 |118 |89-147 |
|Severnvale |24 |57
|34-80 |
|S E |74 |75 |58-92 |
|Gloucestershire | | | |
|Weston Super Mare|93 |159 |127-192 |
|Woodspring |67 |92 |70-114 |
|Avon HA |697 |100 |93-107 |
Source: Avon Practice Comparisons package, AHA Information Department
Table 4: Hospital admissions for ketoacidosis and hypoglycaemic coma,
former PCGs in Avon, April 1997 - March 2000
Standardised admission ratio is the ratio of observed to
expected admissions in an area multiplied by 100 Age specific
admission rates for Avon HA are used as the standard for
deriving expected admissions
As this indicator combines hospital admissions for different
types of coma, further analysis is needed to find out what the
underlying pattern is However in all cases, the major issues
to address are quality of control and timely diagnosis of
diabetes Clinical audit is needed to monitor quality of
control
3 Section 4: Deaths due to diabetes
Between 1998 and 2000, 253 deaths due to diabetes were recorded
amongst Avon residents Almost 90 of these deaths were in people
aged over 65yrs Diabetes contributes to further deaths, but may not
be registered as the main cause Graph 9 below includes those deaths
where diabetes is stated as the main cause so they represent a minimum
estimate of the impact of diabetes in terms of deaths
About half of all deaths in people with diabetes are due to heart
disease, for which diabetes is a risk factor Diabetes shortens life
expectancy, but improving heart disease risk factors being physically
active, stopping smoking and reducing blood pressure and lipids can
improve survival Evidence on treating heart disease in diabetes has
been reviewed - see the endocrine section at
http://wwwclinicalevidencenhsuk/ The remainder of deaths are due
to other complications of diabetes, including kidney failure and
infection
Source: Compendium of Clinical Indicators 2001
Mortality rates from diabetes are higher in areas of
deprivation By dividing Avon into five equal parts quintiles
according to deprivation scores, it can be seen that mortality
rates in the two most deprived quintiles were significantly
higher than rates of the two affluent deprived quintiles between
1995 and 1999 graph 10
Source: ONS mortality files; 1991 census for calculation of Townsend
scores
4 Section 5: Primary Care Prescribing Costs for Diabetes
Table 5 gives the primary care prescribing costs for diabetic
medication and monitoring agents for 1999/2000 The figures in
represent payments per 1000 STAR PUs Specific Therapeutic Age-Sex
Related Prescribing Units for the PCG STAR PUs have been developed
to allow for the differences in the age and sex of patients for whom
drugs in a specific therapeutic groups are usually prescribed The
STAR PUs used here are for endocrine drugs for which there is a
particularly large difference between prescribing costs for men and
women between 35 to 64
The costs of endocrine drugs prescribed for women aged 45 to 54 is 13
times that for males These figures
therefore account for differences
in the age and sex distribution of the PCGs, but not for the ethnic,
social or economic variations between the PCGs and PCTs - or the local
prevalence of diabetes
|Former PCGs |Prescribing costs in per 1000 STAR PUs |Total |
|in Avon | |Prescribing|
| | |costs |
| |Insulin |Oral anti |Screening |Total cost | |
| | |Diabetics |and |per STAR PU| |
| | | |Monitoring | | |
| | | |Agents | | |
|Bath |293 |107 |211 |617 |392,888 |
|Bristol East |250 |133 |178 |565 |250,052 |
|Bristol Inner|356 |254 |221 |835 |250,794 |
|City | | | | | |
|Bristol North|290 |141 |170 |605 |460,217 |
|West | | | | |
|
|Bristol South|294 |142 |152 |592 |254,165 |
|East | | | | | |
|Bristol South|364 |181 |171 |721 |345,618 |
|Bristol West |222 |67 |136 |430 |120,762 |
|Greater |286 |134 |199 |628 |351,193 |
|Wansdyke | | | | | |
|Severnvale |318 |106 |199 |633 |262,076 |
|SE |258 |119 |166 |547 |542,006 |
|Gloucestershi| | | | | |
|re | | | | | |
|Weston Super |391 |175 |211 |782 |434,494 |
|Mare | | | | | |
|Woodspring |273 |109 |183 |572 |431,309 |
|Avon |296 |135 |183 |620 |4,095,576 |
|Range |222-391 |67-254 |136-221 |430-835 |120,762-542|
| | | | |
|,006 |
Table 5: Prescribing costs for former PCGs in Avon Health
Authority, 1999/2000 : diabetes medications and
monitoring agents
Source Prescribing And Cost Database PACT
Note: Includes treatment of hypoglycaemia
———————–
May 2002
Source:nyc.gov
