Diabetes- current epidemiology and measuring variables at a local level
Diabetes mellitus (DM) is not classed as single disorder as it represents a series of conditions associated with high blood sugar which are cased in turn by defects in insulin secretion or the effectiveness of insulin or both. It is usually diagnosed by evidence of hyperglycaemia in a fasting state (>7.1 mmol/l plasma glucose) or threw an oral glucose tolerance test (OGTT)( >11.1mmol/l plasma glucose). It can be diagnosed in adults who are not pregnant by a glycated haemoglobin (HbA1c) level ( 6.5% or > 48 mmol/mol) (NICE 2011).
There are a few types of Diabetes including the main two Type 1, Type 2 which we will concentrate on. Others include mature onset diabetes of the young (MODY) and gestational diabetes.
Type 1 Diabetes is when the body does not produce insulin. It is caused by Immune-mediated destruction of pancreatic β-cells resulting in insulin deficiency (Lambert et al 2006).
Type 2 diabetes is a chronic metabolic disorder and the most common type of diabetes accounting for around 90 percent of all cases. This is a condition when the body is still able to make some insulin however not enough and the insulin that is produced does not work as well as usual. This is common in patients in ages over 40, however in some ethnicity can appear earlier on. Some children are also been diagnosed with the condition and the prevalence is increasing (Barrat 2009). The main link is with being overweight or obese. I am going to concentrate and look at Type 2 Diabetes as this is the one that lifestyle changes and risk factors can be targeted to improve outcomes.
Prevalence of Type 2 Diabetes
The prevalence has been rising over past few decades. This could be due to the increase in prevalence of obesity which is directly linked to diabetes, which will be discussed in more detail later. The main concern for us as a trust and for the needs assessment is that diabetes is a major public health concern due to the related mortality, morbidity, financial costs to the health service. The prevalence and incidence will also vary in regards to place, i.e. Where about in the country as there are differences between cities and this could be multi-factorial e.g. related to living conditions, hospital facilities etc. It may vary due to an individual setting as in people who are more susceptible to diabetes living in particular areas, i.e. people from other ethnic backgrounds may be greatly located in the south. In Leeds itself there is quite a big ethnic minority community and this may have an influence on the figures.
The prevalence of diabetes globally for 2011 was 366 million and it is expected to affect 552 million people by 2030 (Diabetes UK 2011). In England in 2009-10 5.24 %(2.04 million) of the population had type 2 diabetes (Diabetes Uk2011, NHS IC 2011). This figure is only an estimate and it may be higher as this does not include people under 16. Also it is not clear if these are age standardised rates and this may have a bearing on the figures, as this could be a limitation as in older populations the prevalence will be greater as it increases with age. As a whole we are getting people living to older so over time you would expect the prevalence to go up.
When looking at type 2 diabetes. One of the main issues when it comes to prevalence is that there are some cases that will not have been diagnosed. It is also estimated that around half a million people in the UK have diabetes but have not been diagnosed yet. For Type 2 diabetes, as it is appearing in children now as well, around 1,400 children may be suffering from it (Diabetes UK 2011). Plus there is some debate about methods of diagnosing. Currently recommended to use OGTT, however there is some argument about using HB1ac test. Again there is variation in the prevalence world wide between countries. You tend to find the prevalence seems to be lowest in...
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