Diabetes
Theme: Health and Wellbeing Status
Background Information
Diabetes is a long-term (chronic) condition caused by too much glucose (sugar) in the blood. It is
also known as diabetes mellitus. It is thought that there are at least half a million people in the
UK who have the condition but are unaware of it. Normally, the amount of sugar in the blood is
controlled by a hormone called insulin, which is produced by the pancreas. When food is
digested and enters the bloodstream, insulin moves any glucose out of the blood and into cells,
where it is broken down to produce energy. However, in diabetes, the body is unable to break
down glucose into energy. This is because there is either not enough insulin to move the
glucose, or because the insulin that is there does not work properly.
There are two types of diabetes - diabetes type 1 and diabetes type 2. Type 1 diabetes occurs
when the body produces no insulin at all. It is often referred to as insulin-dependent diabetes. It
is also sometimes known as juvenile diabetes, or early onset diabetes, because it usually develops
before the age of 40, often in the teenage years. If you have type 1diabetes, you will need to take
insulin injections for life. You must also make sure that your blood glucose levels stay balanced
by eating a healthy diet and carrying out regular blood tests.
Type 2 diabetes occurs when there is too little insulin produced by the body to work, or when
the cells in the body do not react properly to insulin. This is called insulin resistance. In many
cases, this type of diabetes is associated with obesity. It is sometimes referred to as maturity
onset diabetes because it usually develops in people over 40 years of age. However, it is also
possible for children as young as seven to develop type 2 diabetes.
Type 2 diabetes is far more common than type 1 diabetes with type 2 diabetes accounting for
95% of all people with diabetes. Someone with type 2 diabetes may be able to control their
symptoms just by eating a healthy diet and monitoring their blood glucose levels. However, type
2 diabetes is progressive, so it is possible that they will eventually need to take insulin medication
(NHS Direct).
Data
The estimated number of excess deaths (20-79 years) attributable to diabetes in 2005 was taken
from the Diabetes Community Health Profile for Cumbria (YHPHO).
The prevalence data consist of the number of people (aged 17 years and over) on GP practice
disease registers at the end of March 2009. This data was taken from the Quality Management
and Analysis System (QMAS). QMAS is a national system which shows how well each practice is
doing, measured against national Quality and Outcomes Framework achievement targets. Since
this only includes people on GP practice registers it probably underestimates the actual number
of people classified as diabetic in the population. Prevalence refers to the number of cases
recorded over a specified period of time (in this instance 2008/09).
Modelled prevalence estimates and projections are taken from the PBS Diabetes Population
Prevalence Model Phase 3 (YHPHO) and give the number of people (all ages) with Type 1 and
Type 2 diabetes mellitus (diagnosed plus undiagnosed combined).
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Mortality
It is estimated that during 2005 in Cumbria PCT there were 300 deaths in the 20-79 years age
group that were attributable to diabetes equating to 11.2% of all deaths in this age group. This
represents the number of deaths that would have been avoided if people with diabetes had the
same mortality rate as those without the condition. Nationally, diabetes accounted for 11.6% of
all deaths in the 20-79 years age group.
Modelled and Recorded Prevalence
Figures from QOF for 2008-09 detail that 21,006 Cumbrian patients (aged 17 years and over)
were included on the Diabetes register (i.e. have been diagnosed with diabetes). This accounted
for 4.0% of the total Cumbrian GP population: a prevalence which was slightly lower than the
England average of 5.1%. Modelling by the PBS Diabetes Population Prevalence Model Phase 3
(YHPHO) suggests that there should be over 5,000 additional patients with diabetes (all ages)
that do not currently appear on the GP registers in Cumbria (i.e. undiagnosed and under 17
years).
The proportion of people on GP practice disease registers was greatest in Copeland with a
prevalence of 5.0% whilst Carlisle had the lowest with 3.7% (Table 1). No district councils had
prevalence rates above the national average of 5.1%.
Table 1 also shows the estimated 2008 prevalence of diabetes (diagnosed and undiagnosed; all
ages) in Cumbria and by district council compared to the observed prevalence from the local
2008/09 QOF register (17 years and over). The data shows that there are an estimated 5057
cases of undiagnosed diabetes in the Cumbrian population. The percentage of undiagnosed cases
is lowest in Barrow-in Furness (5%) and highest in Eden (42%).
Table 1: Recorded and expected prevalence of diabetes by district council (QMAS and YHPHO)
Allerdale
Recorded (QMAS 2008/09)
Number on
Prevalence
GP practice
disease
register
4.3%
4264
Modelled (YHPHO 2008)
Number
Prevalence
4,987
6.5%
Difference
Number
Percentage
undiagnosed
and under 17
years
723
17.0%
Barrow-in-Furness
3528
4.2%
3,715
6.5%
187
5.3%
Carlisle
4025
3.7%
5,235
6.2%
1210
30.1%
Copeland
3135
5.0%
3,581
6.3%
446
14.2%
Eden
1960
3.8%
2,790
6.5%
830
42.3%
South Lakeland
4074
3.7%
5,665
6.6%
1591
39.1%
Cumbria PCT
21006
4.0%
26,063
6.4%
5057
24.1%
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Projections
The number of people in Cumbria who are predicted to have Type 1 or Type 2 diabetes from
2008 to 2025 is shown in Figure 1. The number is projected to rise, increasing from 26,063 in
2008, to 38,773 in 2025: an increase of 48.8%.
Cumbria: People (all ages) predicted to have Type 1 or Type 2 Diabetes, projected to 2025
(Source: PBS Diabetes Population Prevalence Model Phase 3 (YHPHO))
45,000
40,000
38,773
35,000
34,781
Number
30,000
25,000
30,891
27,463
26,063
20,000
15,000
10,000
5,000
0
2008
2010
2015
2020
2025
Figure 1: 2008-25: Diabetes Projections for Cumbria
Projections by district council also show an increase in those expected to have diabetes (Figure
2). The greatest numbers are predicted to be in South Lakeland but the largest percentage
increase is expected for Eden (61.8%).
Figure 2: 2008-25: Diabetes Projections by District Council
People (all ages) predicted to have Type 1 or Type 2 Diabetes, projected to 2025 by district council
(Source: PBS Diabetes Population Prevalence Model Phase 3 (YHPHO))
10,000
9,000
8,000
7,000
Number
6,000
5,000
4,000
3,000
2,000
1,000
0
2008
2010
Allerdale
02 March 2010
Barrow-in-Furness
2015
Carlisle
2020
Copeland
Eden
2025
South Lakeland
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Inequalities in Cumbria
According to data from the primary care registers, a relationship appears to exist between
diabetes prevalence and deprivation with prevalence being higher in the more deprived GP
practices (Figure 3).
Figure 3: Diabetes prevalence by deprivation quintile
2008/09 Crude Prevalence Rate for Diabetes (age 17+) by IMD 2007 Deprivation Quintile of GP
Practice in Cumbria (Source: QOF)
5.00
Cumbria Average = 4.04%
4.50
4.00
% with diabetes
3.50
3.00
2.50
4.48
2.00
4.23
4.02
3.68
3.62
4
5 - least deprived
1.50
1.00
0.50
0.00
1 - most deprived
2
3
Deprivation Quintile of GP Practice
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