Diabetes: 3.2 million reasons to focus on patient care

On Monday this week you may have seen in the news that the number of people diagnosed with diabetes in the UK has soared by 60%1 in the past decade. It was also mentioned that the spending on diabetes drugs has increased during that time and we can all appreciate that the financial resources available for paying for drugs in the UK are not limitless. It is important that money is spent on pharmaceutical clinical trials to assess safety, efficacy and more importantly the complications of diabetes which can be associated with substantial costs.

Barbara Young, the chief executive of Diabetes UK, said the government needed1 to act to prevent new cases and improve treatment for those already affected. She said: “Diabetes already costs the NHS nearly £10bn a year, and 80% of this is spent on managing avoidable complications.  So there is huge potential to save money and reduce pressure on NHS hospitals and services through providing better care to prevent people with diabetes from developing devastating and costly complications,” she added.

So the focus cannot be simply on the laboratory blood glucose values for a patient with diabetes but should be on providing treatments that reduce the risk of diabetes related complications.

In addition, pharmaceutical management should be on clinical guidelines that support an individualized approach to diabetes care.

The facts

Since 1996, the number of people living with diabetes in England has more than doubled to 3.2 million2 It is estimated that 2.7 million people are currently diagnosed with diabetes3 and a further 500,000 people have the disease but do not know it.2 If trends continue, this number will rise to 4 million people by 2025.2 Type 2 diabetes accounts for 90 per cent of all cases of diabetes.

Poorly managed diabetes is the cause of 20,000 early deaths per year.4 Diabetes accounts for around 10 per cent of the annual NHS budget, or about £10 billion a year2.

If ignored, type 1 and type 2 diabetes will cost society £39.8 billion by 2035/36.5

Guideline development

The National Institute for Health and Care Excellence (NICE) are currently updating the clinical guideline on the management of type 2 diabetes. We acknowledge there have been many welcome improvements to the draft guideline during the consultation period. However, we still believe this guideline does not support an individualised approach to prescribing in diabetes.

It appears to be heavily focused on short-term cost efficiencies and fails to acknowledge the longer-term impact of the effective use of medicines in reducing avoidable complications associated with type 2 diabetes, which are responsible for an estimated £8 billion per annum of NHS spend.4

It is inconsistent with the principles of medicines optimisation and the shift in focus from looking solely at prescribing cost to getting the best value from medicine use by putting the patient at the centre of the prescribing decision.6

It may mean that people diagnosed with diabetes may not receive the treatment they need.

What should be done?

Diabetes has been recognised as a national priority for prevention through the National NHS Diabetes Prevention Programme7 but it is essential that improving care for the 3.2 million2 people already living with diabetes is also a Government priority.

All relevant diabetes guidelines need to adopt an individualised approach to patient care that enables patient-centred prescribing in line with the principles of medicine optimisation.7 This will ensure medicines are tailored to the individuals needs and circumstances, taking into account their personal preferences to achieve the best value and outcomes from medicine use for people with diabetes and the NHS.

References:

  1. BBC website http://www.bbc.com/news/health-33932930 last accessed August 2015
  2. Diabetes State of the Nation 2014 – Diabetes UK, published January 2015
  3. Quality and Outcomes Framework (QOF) 2012–13
  4. HSCIC (2012). National Diabetes Audit 2011–2012. Report 2: Complications and Mortality
  5. Hex, N. et al (2012). Estimating the current and future costs of Type 1 and Type 2 diabetes in the United Kingdom. Diabetic Medicine 29 (7) 855–862
  6. National Diabetes Prevention Programme. NHS England website (accessed June 2015)
  7. Medicines Optimisation: Helping patients to make the most of medicines. RPS. May 2013