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Joint Strategic Needs Assessment

People are prepared for and supported in old age – Long Term Conditions: Diabetes Last updated: March 2014

Summary / Key Points Type 1 diabetes is the least common of the two types and accounts for around 10% of all people with diabetes. In Type 1 the body cannot produce  On the Island 6.2% of people over the age of any insulin which is a hormone that helps glucose 16 registered with a GP are on the diabetes to enter the body’s cells where it is then used as register. fuel for energy. People are more at risk of Type 1  There is no statistically significant difference diabetes if a parent or sibling also has the against the 6% prevalence. condition.  It is estimated that a further 1.8% of the Island population have diabetes but are unregistered. In Type 2 diabetes often called maturity-onset  There is a statistically significantly higher diabetes, the body does not make enough insulin prevalence of diabetes in the South Wight or the amount we do produce doesn’t work locality than in the North & East Wight and the properly. This type is associated more with being West & Central Wight localities. overweight and will usually appear in people over  Mortality from diabetes increased in the 2010- the age of 40 however children are being 12 period but it remains below the England diagnosed with the condition. average with no statistically significant difference. Diabetes is set to increase nationally because of  The Island has a lower mortality rate from our ageing population and rapidly rising numbers diabetes rate than the majority of its local of overweight and obese people. People are authority comparator areas but with no more at risk of Type 2 if someone in the family statistically significant difference. also has the condition and/or if they are from South Asian or African / African-Caribbean origin. The level of population need Obesity is the strongest risk factor for Type 2 and nationally accounts for 80-85% of the overall risk Diabetes is one of the biggest health challenges of developing Type 2 diabetes. Obesity, physical facing the UK today. If we are to curb this growing inactivity, unhealthy diet, smoking and poor blood health crisis and see a reduction in the number of pressure control are higher in areas of deprivation people dying from diabetes and its complications, and all of these factors are linked to the risk of we need to increase awareness of the risks, bring diabetes. about wholesale changes in lifestyle, improve self-management among people with diabetes In 2012/13 there were 7,345 people over the age and improve access to integrated diabetes care of 16 diagnosed with Diabetes (QOF). The crude services (Diabetes UK). diabetes prevalence rate for the Island is 6.2% which is slightly higher but not statistically Diabetes is a condition in which the blood sugar significantly different to the England average. level is too high because the body cannot use it This rate is statistically significantly different when properly. If left untreated, it can lead to ill health comparing the Clinical Commissioning Group conditions such as; heart disease, stroke, (CCG) comparator areas with the Island being blindness and kidney failure. with the areas with lower rates. People are prepared for and supported in old age – Long Term Conditions: Diabetes Last updated: March 2014

Crude Diabetes prevalence - and CCG Comparators: 2012/13 It was estimated that there was a further two East thousand residents on the Island in 2012/13 that West

Great Yarmouth and Waveney have diabetes but without diagnosis and medical

South Coast help (YHPO) and that that number will increase to

East Riding of over 14 thousand in 2030. Isle of Wight

Hastings and Rother Estimated number of people 16+ who have diabetes 2012 - 2030 Herefordshire

Eastbournem Hailsham and Seaford 12% IW Number IW Rate 16,000 Hambleton, Richmondshire and… 14,000 0 1 2 3 4 5 6 7 8 9 10% Crude prevalence rate (%) 12,000 8% Estimated Sources:Quality and Outcomes Framework as at end of July 2013 accessed via NHS Information Centre Copyright © 2012, 10,000 Prevalence number The Health and Social Care Information Centre, Prescribing Support Unit. All rights reserved. 6% 8,000 Notes: These are crude rates and therefore do not take account of the underlying age structure of the population. rate of people 6,000 4% Across the Island there are no statistically 4,000 2% significant differences between the three CCG 2,000 0% 0 localities. The South Wight locality has a 6.7% 2012 2013 2014 2015 2020 2025 2030 crude rate prevalence, North and East Wight is Source: YHPHO Diabetes Prevalence Model 6.2% and West and Central Wight has a crude Slightly more men than women have been rate of 5.9%. diagnosed with diabetes. Nationally 6.3% of men

Crude Diabetes prevalence - Isle of Wight and it's localities 2012/13 have been diagnosed compared to 5.3% of

South Wight locality women.

Isle of Wight Nationally gestational diabetes affects around 5% North and East Wight locality of pregnancies with women who are overweight

West and Central Wight or obese in pregnancy at higher risk. There is a Locality

0 1 2 3 4 5 6 7 8 7% lifetime risk of contracting Type 2 diabetes if Rate

Sources: Quality and Outcomes Framework as at end of July 2010 accessed via NHS Information Centre Copyright © 2010, The Health and you developed gestational diabetes during Social Care Information Centre, Prescribing Support Unit. All rights reserved. Notes: These are crude rates and therefore do not take account of the underlying age structure of the population. People on the diabetes registers are aged 17+. pregnancy. On the Island, 4% of mothers who Diabetes has increased significantly over the last gave birth in 2012/13 had gestational diabetes few years and it is estimated that five million (PIDS). people in the UK will be diagnosed by 2025 with 13,250 on the Island. If poorly managed diabetes can cause damage to; nerves, muscles, sweat glands and circulation of Diabetes has increased by 20% on the Island, a the feet and legs, all of which can lead to statistically significant increase from 2008. amputations.

Crude Diabetes prevalence - Isle of Wight and England trend: 2008/09 to 2012/13 There were 385 episodes of care for diabetic foot 7 Isle of Wight England disease between 2009 and 2012 which accounted 6 5 for 4,340 nights in hospital. There were no 4 statistically significant differences between the 3 Island and the national average for episodes of Crude Prevalence Rate (%) Rate PrevalenceCrude 2 care for amputations. 1

0 2008-09 2009-10 2010-11 2011-12 2012-13

Sources: Quality and Outcomes Framework accessed via NHS Information Centre Copyright © 2012, The Health and Social Care Information Centre, Prescribing Support Unit. All rights reserved. Notes: These are crude rates and therefore do not take account of the underlying age structure of the population. People on the diabetes registers are aged 17+ against the 17+ population.

2 Produced by IWC Public Health Team

People are prepared for and supported in old age – Long Term Conditions: Diabetes Last updated: March 2014

Annual amputations per 1,000 adults with diabetes People with diabetes are twice more likely to be 3.2 2009-2012 admitted to hospital and spend longer in hospital

3 than those without. During 2012/13 7% of all

2.8 Island admissions to hospital (excluding

2.6 maternities and gestational diabetes) had diabetes as an underlying condition (PIDS). 2.4

2.2 Similar CCG Group NHS Isle Of Wight CCG All CCGs in England References

Source: YPHO diabetes foot profiles Diabetes UK www.diabetes.org.uk/About_us/What-we- Diabetes is the fifth most common cause of say/Statistics/Diabetes-in-the-UK-2012/ deaths in the world and accounts for an estimated 16% of deaths in England. Life expectancy on PIDS Performance Information Decision Support the Island is 79.1 years for males and 83.6 for – IOW NHS Trust females. For those with Type 1 diabetes life QOF http://qof.hscic.gov.uk/ expectancy is reduced by up to 20 years and up to ten years for those with Type 2 diabetes. Health and Social Care Information Centre Mortality rates from diabetes on the Island are www.hscic.gov.uk/ lower but not statistically significantly different to YPHO Foot disease profiles the England average and the majority of our www.yhpho.org.uk/diabetesprofilesfoot/ccg_pdfs/10L_Diabetes_Foot care_Profile_201112.pdf comparator areas. Mortality rates from Diabetes YPHO www.yhpho.org.uk/resource/view.aspx?RID=154049 pooled 2010-12 PERSONS Allerdale CD Waveney CD UA UA Great Yarmouth CD UA Scarborough CD Dover CD Thanet CD UA ENGLAND CC Isle of Wight UA Shepway CD Carlisle CD Weymouth and Portland CD 0 2 4 6 8 10 12 Rate per 100,000 Sources: Health and Social Care Information Centre. © Crown Copyright. Notes: Data are based on the latest revisions of ONS population estimates for the respective years. Data are based on the original underlying cause of death. Mortality rates from diabetes have decreased since 2003/05 but there have been no statistically significant differences across the ten year period.

Mortality from Diabetes: Persons, All Ages

10 England South East Isle of Wight

8

mortality 6 rates per 4 100,000 population 2

0 2003-05 2004-06 2005-07 2006-08 2007-09 2008-10 2009-11 2010-12

Sources: Health and Social Care Information Centre. © Crown Copyright. Notes: Data are based on the latest revisions of ONS population estimates for the respective years. Data are based on the original underlying cause of death.

3 Produced by IWC Public Health Team