31 March 2014
There are an estimated 360,450 people in the West Midlands with diabetes, when adjustments are made for age, sex, ethnic group and deprivation. This is 8.1% of the adult population, higher than the average prevalence for diabetes for England of 7.4%. By 2030, levels of diabetes in the West Midlands are expected to rise to 488,711 people or 10% of the adult population, compared with 8.8% for England as a whole. However, 80% of all cases of Type 2 diabetes are preventable.
Diabetes has a huge impact on life expectancy, with Type 1 diabetes reducing an individual’s life expectancy by at least 20 years and Type 2 diabetes by up to 10 years. Both patients and the NHS bear the brunt of this disease, with an estimated £10 billion treating diabetes. The indirect costs of diabetes (such as increased mortality and morbidity, work loss and the need for informal care) are currently estimated to be £13.9 billion per year, rising to £22.9 billion in 2035/6. Deaths from diabetes in 2010/11 are estimated to have resulted in over 325,000 lost working years.
The programme aims to make a difference by bringing together a community of like-minded people to share and spread ideas to improve the lives of people in the West Midlands with diabetes. The programme, which is supported by WMAHSN and Health Education England, also benefits from joint working with Daiichi Sankyo UK Ltd, Eli Lilly and Company Ltd and Novo Nordisk Ltd.
The programme launched in December 2014, when the first cohort of people gathered to undertake the inaugural two day workshop. Attendees learned new ways of thinking about how to make a difference and planned how to work together to engage 500 people to make 1,000 differences to people with diabetes.
Seventeen trailblazers came to the first ever event, bringing passion and an open mind, ideas and a desire to make a difference. In a very short time, the group had come up with more than 170 ideas, large and small, which have the potential to make a real change to the lives of people with diabetes. These ideas ranged from national directives such as a tax on sugar, to local initiatives such as healthy food boxes, support networks and exercise classes, to very personal changes – “help my mother-in-law reduce her weight and therefore the need for medication”.
Participants are supported with a comprehensive support package, comprising:
Microalbuminuria is a prognostic marker for diabetes, as well as chronic kidney disease, cardiovascular disease, hypertension, venous thromboembolism and all-cause mortality. At risk patients are identified by their albumin:creatinine ratio (ACR). ACR screening for diabetes patients has been removed as a QOF indicator, and awareness was raised that it was not being done consistently. As part of the Making a difference programme one of the participants, Walsall GP Dr Andrew Askey, set out to increase the number of his patients who had ACR screens.
EMIS prompts and protocols were written, and 178 patients who were screened in 2015 who were missed in the previous year. This has also formed part of a local improvement scheme for practices in Walsall, with the potential that up to 6,000 patients who missed screening last year will be screened this year.
Dr Askey then looked at the eight National Diabetes Audit care processes for diabetes patients, to see where improvements could be made, including targeting cholesterol of 4mmol/l or less (QOF targets 5 or less), increasing the number of patients having the eight care processes done, reaching targets for HbA1c, cholesterol and blood pressure, changing statins in line with NICE guidelines and using newer diabetes drugs appropriately.
2014: 406 ACR screens done (36 per month on average), 89 patients coded for microalbuminuria
2015: 385 ACR screens done in just seven months (55 per month on average), 134 patients coded for microalbuminuria
There was also an increase across all eight National Diabetes Audit care processes for diabetes patients, including treatment targets for Hba1c, blood pressure and cholesterol. While the initial aim of the programme was to recruit “500 difference makers to make 1000 differences in 2015”, the practice can demonstrate a minimum of 753 changes made which will have a significant impact on long term outcomes. Note this does not include improvements in Hba1c or blood pressure, weight loss or quality of life indicators as separate measures, nor have the number of differences made for newly diagnosed patients been quantified.
t: 0121 371 8061