Assessing needs of people living with diabetes to provide the best care available
Series of measures to promote better care for all types of diabetes and prevention for people at risk of developing type 2 diabetes.
Preventing type 2 diabetes, and managing both type 1 and type 2, requires life-long commitment, but the potential health gains are huge. Placing people at the heart of services can improve their engagement, health outcomes and experiences.
To address this the National Institute for Health and Care Research (NIHR) have published a briefing that aims to put people at the heart of diabetes services by paying close attention to their needs.
Diabetes is a serious, life-changing condition in which people have too much sugar in their blood. Long-term complications may include sight loss, kidney disease, amputations, heart disease and stroke. Type 1 diabetes cannot be prevented, but type 2 diabetes often can: a healthy weight and lifestyle greatly reduce a person’s risk.
Diabetes is estimated to cost the NHS around £10 billion a year. It is a national priority and a focus of the NHS Long Term Plan. There are guidelines on diabetes management and NHS policy highlights the need for more person-centred care. This includes supporting people, and giving them the tools they need to manage their own health. However, there are large inequalities in access to services across the country.
The briefing said: “Diabetes is one of the fastest-growing health challenges of the 21st century. It requires constant self-management and regular contact with healthcare services throughout life. Effective ways to prevent type 2 diabetes, and to manage type 1 and type 2, are available. However, more needs to be done to understand how to engage people with services, and how to target care to those who need it most.
“This collection provides examples of how taking account of individuals’ needs, differences and wishes, can help. Offering prevention services at lower BMIs (body mass index) for people from certain ethnic groups could prevent type 2 diabetes in some. People would be more likely to stay in prevention programmes if course materials were engaging and group sizes below 15.
“Young people would be more likely to engage with diabetes services if their life priorities were given as much attention as their blood sugar levels. Increasing access to personal health records could help people self-manage their blood sugar levels. Using personal risk scores to identify people at high risk of complications or worsening health could help provide targeted care.
“Diabetes care is complex. It requires personal commitment and NHS resources. This Collection provides examples of NIHR research that demonstrate the efforts being made to improve the services on offer. Above all, it highlights that ‘one size does not fit all’. Every individual should be kept at the very centre of their own care.”
The briefing added that many people are at risk of or are living with diabetes. The numbers are increasing rapidly, with latest figures showing that diagnoses have doubled in the last 15 years.
In 2021, 4.1 million people in the UK had a diagnosis of diabetes; 90% had type 2. This is an increase of more than 150,000 since 2020. A further 1 million people have no diagnosis but could also have type 2 diabetes. An estimated 13.6 million people are at risk of developing type 2 diabetes. However, up to half of these people could prevent or delay diabetes through lifestyle changes such as sustained weight loss and physical activity.
This NIHR Collection brings together messages from research highlighted in accessible summaries and illustrates how taking account of individuals’ needs, differences and wishes could improve diabetes services.
In addition, the report looked at ways to increase participation in type 2 diabetes prevention programmes.
Diabetes prevention programmes can reduce the risk of developing the condition, but engaging people is challenging – as reports show that many people never start the course, or do not complete it.
Programmes are for people with prediabetes. This means their blood sugar is above target range, but not at the threshold for a diagnosis of type 2 diabetes. The aim of the programmes is to promote healthy eating, a physically active lifestyle and weight loss.
The NIHR is carrying out an independent assessment of the NHS Diabetes Prevention Programme for England, ‘Healthier You’. Signs were encouraging that people who completed the programme reduced the amount of sugar in their blood and lose weight.
Also examined is how diabetes prevention could be guided by people’s ethnic group.
For example, body weight is closely linked to the chances of developing type 2 diabetes, but has different effects on different groups of people. However, while NICE guidance currently recommends action to prevent type 2 diabetes for people with a body mass index (BMI) of 30, in Black African, African-Caribbean, South Asian and Chinese groups, prevention should start at a BMI of 27.5.
The NIHR briefing concluded: “We hope it provides useful information both for those commissioning and delivering services, and for members of the public.”
Read the National Institute for Health and Care Research briefing
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