Diabetes

Healthy People

Physical Health Conditions

Diabetes

Stroke

Cardiovascular conditions

Cardiovascular disease

Heart attack

Heart failure

Cancer

Introduction

Diabetes is a condition that causes a person’s blood sugar level to become too high and affects about 7.3% of the adult population in England, the equivalent of 3.2million people¹. A further 850,000 people are estimated to be living with type 2 diabetes but are yet to be diagnosed².

There are 2 main types of diabetes:

Type 1 diabetes – a lifelong condition where the body’s immune system attacks and destroys the cells that produce insulin
Type 2 diabetes – where the body does not produce enough insulin, or the body’s cells do not react to insulin properly

Type 2 diabetes is far more common than type 1. In the UK, over 90% of all adults with diabetes have type 2.

High blood sugar that develops during pregnancy is known as gestational diabetes. It usually goes away after giving birth.

The amount of sugar in the blood is controlled by a hormone called insulin, which is produced by the pancreas (a gland behind the stomach).

When food is digested and enters your bloodstream, insulin moves glucose out of the blood and into cells, where it is broken down to produce energy.

However, if you have diabetes, your body is unable to break down glucose into energy. This is because there is either not enough insulin to move the glucose, or the insulin produced does not work properly.

There are no lifestyle changes you can make to lower your risk of type 1 diabetes.

You can reduce the risk of type 2 diabetes through healthy eating, regular exercise and achieving a healthy body weight.

You may be more at risk of type 2 diabetes if you:

Are living with overweight or obesity
Do not have a healthy diet
Have a family history of type 2 diabetes
Are of Asian, Black African or African Caribbean origin
Take certain medicines such as steroids for a long time
Have high blood pressure
Have had gestational diabetes during pregnancy

Why is it important to Population Health?

Leading Cause of Mortality: Both type 1 and type 2 diabetes can increase the likelihood of premature death significantly, with nearly 95,000 deaths attributed to all causes of diabetes in 2015/16³. Population health approaches to preventing people developing diabetes through timely access to lifestyle services in Derbyshire can support the reduction in risk at a population level.

Complications Related to Diabetes: Diabetes can lead to significant complications, the most common complications of diabetes which can lead to early death are strokes and cardiovascular disease. Every week in the UK, 680 people suffer a stroke as a complication of diabetes (one in five strokes is caused by diabetes), 530 people suffer a diabetes-related heart attack, and there are around 2,000 cases of diabetes-related heart failure⁴.

Other long-term complications related to diabetes include:

Eye problems (retinopathy)
Foot problems
Kidney problems (nephropathy)
Nerve damage (neuropathy)
Gum disease
Sexual problems
Increased cancer risk

Some complications can lead to long-term conditions but are brought on more suddenly:

Hypos - when your blood sugar is too low
Hypers - when your blood sugar is too high
Hyperosmolar Hyperglycemic State (HHS) - life-threatening emergency that only happens in people with type 2 diabetes. It is brought on by severe dehydration and very high blood sugars.
Diabetic ketoacidosis (DKA) – a life-threatening emergency where the lack of insulin and high blood sugars leads to a build-up of ketones.

Health Inequalities: Health inequalities are avoidable differences in health between different groups of people. Deprivation is closely linked to the risk of both obesity and type 2 diabetes. Prevalence of type 2 diabetes is 40% more common among people in the most deprived quintile compared with those in the least deprived quintile. Similarly people in the most deprived communities are more likely to have undiagnosed diabetes than those living in the least deprived communities. People from black, Asian and other minority ethnic groups are at an equivalent risk of type 2 diabetes at lower BMI levels than white European populations⁵^,⁶. Working with communities at high risk of diabetes can improve outcomes and enhance quality of life for people living in areas most affected by diabetes.

Modifiable Risk Factors: Overweight and obesity is the single biggest cause of diabetes and around 90% of adults with diabetes will be overweight or obese⁷. Likewise, lack of exercise can be a contributing factor in developing diabetes⁸. These modifiable risk factors can increase a person’s risk of developing diabetes however, population health efforts to support people to make lifestyle changes can empower people to reduce their risk of developing type 2 diabetes, improve health outcomes and reduce the long-term pressures on the NHS.

NHS/Healthcare Burden: The NHS spends around £10bn each year treating diabetes⁹. About 1 in 20 people have diabetes, yet people with diabetes account for one quarter to one third of hospital admissions for cardiovascular disease and account for a higher proportion of bed days for cardiovascular conditions than would be expected based on the general population¹⁰.

Population health approaches aim to help prevent people developing type 2 diabetes and if they do to manage their condition effectively can help ease the pressure on the NHS.

Economic Impact: The impact of diabetes can be felt in the wider economy. The cost of sickness absence from work, early retirement and social benefits costing nearly £15.5bn annually¹¹. Preventative action to tackle the causes of diabetes can help manage the economic burden diabetes has on the economy.

The Derbyshire Population Health Approach

The Derbyshire Population Health Approach focuses on prevention, population health, evidence-informed practices, causes, and collaboration. It emphasises proactive measures to prevent health issues, tailors interventions to specific populations, incorporates evidence-informed practices, addresses underlying causes, and promotes collaboration for effective action.

When considering the topic of diabetes within The Derbyshire Population Health Approach:

Preventative action to tackle diabetes is important to support the wellbeing of people in Derbyshire whilst protecting the future sustainability of the NHS. Supporting access to weight management services such as Live Life Better Derbyshire and encouraging uptake of physical activity, especially in at-risk groups can help people manage their individual risk of developing diabetes.

Differences in the risk of developing diabetes and experiencing negative consequences of diabetes vary significantly across the county depending on where a person lives. Additionally, different ethnic groups are at higher risk of developing diabetes compared to people of white British origin. Targeted interventions to support communities who experience high levels of CVD can be developed to support the specific needs of those communities.

We have a good understanding of the evidence behind why people develop diabetes and the disproportionate impact it has on NHS services. The NHS in its Long-Term Plan¹² sets out a commitment to support people to manage their own health in order to prevent people from developing diabetes. Population health practitioners work closely with NHS and other partners to implement evidence-informed activity to prevent people developing diabetes.

Understanding the underlying causes of developing diabetes and those communities most at risk of developing diabetes allows population health to target cost effective and evidence-informed approaches to where they will have the greatest impact. Population health approaches to collaboratively delivering preventative services such as weight management activity through Live Life Better Derbyshire or supporting people to become more physically active can improve health outcomes whilst reducing the pressure on the NHS.

Working with our colleagues across NHS, local authority and community, voluntary and independent sector is essential to embed a population health approach to diabetes prevention. Our partners are essential in supporting the development and implementation of strategies, plans and services to manage diabetes within at-risk communities whilst ensuring the wider health needs of communities are also supported.

Latest Derbyshire Data

Trend Data

Prevalence Maps of Derbyshire

The maps below illustrate Lower Super Output Areas (LSOAs) and Middle Super Output Areas (MSOAs) for Derbyshire. LSOAs and MSOAs are geographical divisions used for statistical purposes, allowing for more detailed analysis of local data. In these maps, you can explore various health indicators and data for Derbyshire, providing valuable insights into the area’s health and wellbeing.

LSOA
MSOA

In the top right of the map, you’ll find the ‘Layer Control’ icon. This is an easy way to customise what you see on the map visualisation. Click the ‘Layer Control’ to choose which information is displayed on the map. Pick the indicator that interests you the most, and the map will transform accordingly.

Slope Index

This chart illustrates the differences in health and lifestyle factors across areas in Derbyshire, from the most deprived (decile 1, red) to the least deprived (decile 10, green). As you move from left to right on the chart (from more deprived to less deprived areas), the line shows whether these factors are becoming more or less common. Essentially, it’s a way to see how living in wealthier or poorer areas affects the prevalence of these factors.

Further Analysis & Assessments

Derbyshire Joint Strategic Needs Assessment (JSNA) involves a thorough examination of a specific health problem, exploring its causes, consequences, and underlying factors. It combines various data sources, collaboration with stakeholders, and rigorous analysis to generate insights for evidence-informed interventions and policy changes.

Coming soon…

More Information & Resources

Here is a list of useful resources and information with regard to diabetes. These materials are meant to provide individuals, healthcare professionals, and communities with the knowledge and tools they need as part of efforts to address diabetes as a population health topic.

NHS Health Check - Live Life Better Derbyshire - You are eligible for a free NHS Health Check every five years if you are aged between 40 and 74 and not already being treated for certain long term conditions.
Live Life Better Derbyshire - This service provides free help and advice to increase physical activity, quit smoking, and lose weight.
Derbyshire Sport - Active Derbyshire supports people to increase their activity levels in a way that works for them.

Contributors

Ben Cooper, Advanced Public Health Practitioner, Healthcare Public Health