Concerns raised over prevalence of diabetes in Wales

Richard Youle, local democracy reporter

The NHS in Wales spends 10% of its budget treating people with diabetes and it could rise if the current increase in patient numbers continues, health chiefs have been warned.

The expenditure works out as £2.88 million per day, going by the NHS core budget of £10.51 billion for the current financial year. And 80% of that expenditure is to treat diabetes complications such as heart attacks, strokes, kidney failure, nerve damage, blindness and amputations.

Swansea Bay University Health Board medical directors gave a presentation to the board about diabetes and asked it to support a national diabetes strategy and commission a population health needs assessment for Swansea and Neath Port Talbot.

Around 91% of people presenting with the disease have Type 2 diabetes, which health board acting executive medical director Anjula Mehta said was largely preventable.

The remainder have Type 1 diabetes, whose onset she said was largely unavoidable and usually came on at childhood.

Obesity

Ms Mehta said obesity increased the risk of developing Type 2 diabetes sevenfold, while being overweight increased it threefold. Healthy lifestyle choices could, she said, prevent or delay it. A presentation slide said one in three people aged 45 to 64 was now obese in Wales. It added that one in five children in Neath Port Talbot aged four and five were obese, compared to a lower 15% in Swansea.

Ms Mehta said family history, age and ethnicity were also contributing factors. South Asians carried a sixfold risk of developing diabetes, she said, for Afro-Caribbeans it was a threefold risk.

Around 8% per cent of the population of Wales has diabetes, and Ms Mehta said it would rise to 10% by 2036 if the current the increase in prevalence continued. “It creates a real cost burden on the NHS,” she said.

Poverty

Board members heard that “health-harming behaviours” were closely linked to poverty and social deprivation, that diabetes was 60% more common in areas of deprivation – in turn lowering life expectancy – and that obesity rates were increasing more quickly among women than men.

Ms Mehta said there needed to be a focus on prevention, better understanding of wider determinants of health, and what motivated people. A graph shown in the presentation said wider health determinants consisted of social and economic factors (40%), health behaviours (30%), physical environment (10%), clinical care (10%), and genes and biology (10%).

Ms Mehta said 5,500 people with “pre-diabetic” blood results had taken part in a study involving advice about healthy lifestyles and where to get support, and that 30% of them had “non-diabetic” blood results 12 months later, showing how early intervention made a difference.

She also said the health board had “huge room for improvement” in incidences of diabetes-related amputations, death rates, and compliance with an eight-part diabetes care standard.

Prevention

Jennifer Davies, the board’s interim public health executive director, said prevention was better than cure, and that recognising the context of people’s lives was important rather than “over-focusing” on diabetes being the fault of the individual.

The Welsh Government and Public Health Wales have set up national diabetes programmes in Wales, the latter of which – called Tackling Diabetes Together – Swansea Bay University Health Board agreed to sign up to at the meeting.

Board members asked what kind of barriers people faced in accessing support and what resources were available to tackle the link between the disease and poverty. Independent board member Anne-Louise Ferguson said councils needed to educate young people about diabetes, starting at primary school, and asked how the board could influence Welsh ministers “to think hard about the food industry”.

Ms Mehta said councils had signed up to the national programme. She added: “We should drive it as a really key priority.”