Diabetes: a ‘ticking time bomb’ for the NHS

This article was taken from: https://www.theguardian.com/society/2018/oct/24/diabetes-ticking-time-bomb-nhs

By Sarah Johnson at the Guardian

Lack of specialist support and rising numbers of people living with the condition will create huge complications, say experts

Rising numbers of people with diabetes and a lack of specialist staff and adequate training are creating a ticking time bomb, experts and medical professionals have warned.

The combination of an increase of people with type 2 diabetes over the past 20 years, cuts to NHS spending on continuing professional development and insufficient specialist support and expertise for people with type 1 diabetes will result in “huge complications” over the next two decades, according to experts at a Guardian roundtable event . Clinicians, academics, policy advisers and people with personal experience of diabetes discussed how to improve care in the UK.

“We have a huge problem in ensuring people with type 1 diabetes get the right support,” said Dr Emma Wilmot, a consultant diabetologist at Derby teaching hospitals NHS foundation trust, adding that the number of people with type 2 diabetes is also going up. There’s a recognition that GPs should be primarily responsible for caring for people with diabetes, she said, “but GPs are under incredible pressure with their workload. There are huge challenges.”

Professor Roger Gadsby, an honorary associate clinical professor at Warwick medical school who has been involved in training GPs and practice nurses, agreed. Over the past five to eight years, he said, there had been a significant reduction in spend on the continuing professional development of NHS staff. “In times of austerity, it’s a soft budget that is easy to cut,” he commented, adding that the NHS would “head into a black hole” if it didn’t support staff professional development.

All the panellists acknowledged the need to do better in terms of care for people with diabetes. Nikki Joule, policy manager for Diabetes UK, said adults with diabetes are not getting the right care. “Diabetes specialist nurses play a huge role in providing appropriate care but there aren’t enough,” she added. Wilmot acknowledged that clinicians are “not able to see people with type 1 diabetes as much as we’d like to.” Lesley Robertson, programme director at north west London collaboration of clinical commissioning groups, also said that adult services for people with diabetes “can and need to do better”.

Lydia Parkhurst, a blogger and public speaker who lives with type 1 diabetes, said she had noticed a difference between the care she received as a child and as an adult. “You get so much support in a children’s clinic and then when you’re in an adult clinic it stops,” she pointed out. “You get an appointment about once a year.”

Gadsby and Wilmot explained that this is because trusts get paid for treating children with diabetes, which does not continue for adults.

Another aspect missing from diabetes care is adequate psychological support, said Professor Khalida Ismail, professor of psychiatry and medicine at King’s College London and an honorary consultant liaison psychiatrist at King’s College hospital NHS foundation trust. “We have to move away from thinking of diabetes as a medical condition,” she said. “It’s a biopsychosocial condition.”

Panellists lamented the lack of up-to-date and robust guidelines in terms of diet recommendations for those living with diabetes, especially over carbohydrates. Some said reducing them could be very effective while others said there was no compelling evidence either way. Dr Shivani Misra, a consultant diabetologist and researcher at Imperial College healthcare NHS trust, acknowledged that there is still not enough research in this area. Regardless of studies and official guidelines, clinicians should treat the “individual in front of them” and adapt treatment accordingly, she said.

Everyone agreed, however, that the stigma and messaging surrounding diabetes was unhelpful and potentially harmful, particularly the suggestion that people were to blame for having the condition because of poor diet choices. Diabetes nurse consultant Ruth Miller likened the punitive approach to diabetes as similar to racism. “The blame game is corrosive and unhelpful … and damaging for people to hear,” she said. Type 1 and 2 diabetes are different conditions, noted Miller, but they are both on a spectrum. “Somewhere there’s a merging of conditions. It’s not about being fat and inactive.”

There is no cure for diabetes, and panellists agreed that it is essential to empower people to manage and live with the condition successfully. Diabetes UK has spoken to 9,000 people with diabetes, explained Joule. Their priorities are better access to healthcare professionals and emotional support, as well as access to technology and treatments.

“I have patients using apps and they have got the best control [of their diabetes] that I have ever seen,” said Wilmot. “The next five years are going to be fascinating. We need to get apps approved [by the NHS] because they are transformative for people. They are the future.”

At the table

Richard Vize (chair)
Public policy commentator

Prof Roger Gadsby 
Honorary associate clinical professor, Warwick medical school, University of Warwick

Prof Khalida Ismail
Professor of psychiatry and medicine, honorary consultant liaison psychiatrist, King’s College London, King’s College hospital NHS foundation trust

Nikki Joule
Policy manager, Diabetes UK

Dr Ian Lake
GP, medical officer, Low Carb Program

Ruth Miller
Diabetes nurse consultant, north west London collaboration of clinical commissioning groups

Dr Shivani Misra
Consultant diabetologist and researcher, Imperial College healthcare NHS trust

Lesley Robertson
Programme director, north west London collaboration of clinical commissioning groups

Lydia Parkhurst
Blogger and type 1 diabetes public speaker

Lis Warren
Co-chair, NHS London diabetes patient experience group

Dr Emma Wilmot
Consultant diabetologist, Derby teaching hospitals NHS foundation trust

This discussion was supported and initiated by Sanofi