Lincolnshire JSNA:
Diabetes
What do we know?
Summary
Diabetes is a long-term condition, which is affecting increasing numbers of people. There are two
main types of diabetes: Type 1 and Type 2, with Type 2 being particularly influenced by the ageing
population and overweight/obesity.
There is a wide range of interventions to address diabetes, from prevention to the ongoing
management of the condition. Diabetes is a health issue that is managed across the whole health
sector, and therefore a 'joined-up' approach to the prevention and management of this condition is
particularly vital.
The Joint Strategic Needs Assessment for Lincolnshire has a number of topics that are relevant to
diabetes, including food and nutrition, obesity and physical activity.
The Lincolnshire Health and Wellbeing Strategy has a number of themes which give priority to the
prevention and management of diabetes.
Facts and figures
Diabetes is a common life-long health condition. There are 3.2 million people who have been
diagnosed with diabetes in the UK, and an estimated 630,000 people who have the condition, but
are not aware of it.
Diabetes is a condition where the amount of glucose in the blood is too high, because the body
cannot use it properly. This is because the pancreas does not produce enough insulin, or any
insulin at all, or the insulin does not work properly.
There are two main types of diabetes:
Type 1
This accounts for about 10% of all adults with diabetes. It can develop at any age,
but usually does so before the age of 40. It is the most common type of diabetes in
childhood.
Type 2
This usually appears in people over the age of 40, although some groups have
greater risk, and in such cases it may appear earlier. It is becoming more common
in children and younger adults.
Some of the risk factors for Type 2 diabetes are age (over 40, or over 25 in the South Asian
population); close family with diabetes; overweight with large waist size; having had high blood
pressure, heart attack or stroke.
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Data is available on a wide range of issues relating to diabetes, including prevalence, management
of the condition, hospital admissions and mortality. It is not possible to provide the full range of
data in this JSNA topic briefing or on the Lincolnshire Research Observatory. However, the
briefing does identify some useful data sources, should further information be required.
The Right Care Programme have produced an NHS Atlas of Variation in Healthcare for People
with Diabetes. This provides a wide range of indicators, demonstrating variations in processes and
outcomes of care.
Public Health England has produced Clinical Commissioning Group (CCG) Diabetes Community
Health Profiles, which contain a wide range of data about diabetes in adults. Topics include
prevalence, how diabetes is managed, health conditions associated with diabetes (such as
myocardial infarction and stroke), hospital admissions and spending on prescriptions.
The National General Practice Profiles provide some information, at general practice level, on a
range of indicators included in the Quality Outcomes Framework (QOF). This provides comparator
information for the CCGs and England, showing how practices are performing against the ongoing
management indicators in the QOF.
Information from the National Diabetes Audit at CCG level is provided at the Health and Social
Care Information Centre (HSCIC). This provides information on NICE care processes and
treatment targets for each of the CCGs.
The HSCIC also provides information on hospital admissions, hospital procedures, mortality and
the QOF indicators (registers and management) in relation to diabetes.
In 2012/13, 6.96% of the adult population in Lincolnshire (42,623 people) were on GP diabetes
registers. This compares with 6.0% for England. There are variations within the county:
Lincolnshire East CCG
8.0% (16,066 people)
South Lincolnshire CCG
6.7% (11,276 people)
South West Lincolnshire CCG
6.4% (6,707 people)
Lincolnshire West CCG
6.1% (11,276 people)
Trends
Nationally and locally, the prevalence of diabetes is increasing. This is due to both the ageing
population and an increase in obesity, which is a major risk factor for Type 2 diabetes.
In 2012/13, 6.96% of the Lincolnshire population were diagnosed, and on a general practice
register for diabetes. (The figure for England was 6.00%.) This compares with a rate of 6.10% in
2009/10. (The contemporaneous rate for England was 5.4%.)
Public Health England has a Diabetes Prevalence Model for local authorities and CCGs. This
estimates the total number of people with diabetes (both diagnosed and undiagnosed). The
estimates are adjusted for age, sex, ethnic group and deprivation pattern. It was estimated that, in
2012, 7.8% of people in Lincolnshire aged 16 years and over had diabetes. It is anticipated that
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total prevalence in Lincolnshire will rise to 8.7% by 2020 (with an equivalent rate of 8.2% in
England), and 9.6% by 2030 (with an equivalent rate of 8.8% for England).
Across England, approximately one-third of the projected rise in diabetes prevalence may be
attributed to the increasing prevalence of obesity.
Targets
Various strategic frameworks have diabetes as a key, or related, component.
The NHS Outcomes Framework includes five key domains, which have a range of overarching
indicators and improvement areas. The domains specifically relating to diabetes are 'preventing
people from dying prematurely' (e.g. mortality from CVD) and 'enhancing quality of life for people
with long-term conditions' (e.g. people supported to manage their condition).
The Public Health Outcomes Framework includes four domains, each of which has associated
objectives and indicators. The domains with particular relevance for diabetes are 'health
improvement' (e.g. excess weight in adults) and 'healthcare, public health and preventing
premature mortality' (e.g. mortality from CVD).
The Quality Outcomes Framework (QOF) financially rewards general practices for the provision of
quality care, and helps to standardise improvements in the delivery of primary medical services.
Diabetes is one of the clinical domains in the Framework, and has a range of associated indicators,
including records and ongoing management.
Performance
As outlined in the 'Targets' section, there is a range of indicators which are relevant to diabetes.
The national Outcomes Frameworks have a range of indicators which are relevant to diabetes, and
these form part of the performance reporting of CCGs and local authorities.
The QOF provides information about the quality of care that is provided in general practice for
people on a diabetes register.
Various data sources provide information on how Lincolnshire compares to other geographical
areas, for example, in relation to prevalence, primary and secondary care indicators and mortality
(see 'some sources of additional information section').
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What is this telling us?
Summary
Diabetes is a key health issue in many national and local strategies. Various interventions are
commissioned and provided to address the prevention, management and care of diabetes for the
Lincolnshire population. Some of these will be included as part of Lincolnshire Health and Care
(formerly the Lincolnshire Sustainable Services Review) work.
Local views
Lincolnshire Health and Care is focussing on how health and social care will be delivered in the
county. A wide range of organisations and stakeholders are involved in designing the future
delivery model.
National and local strategies
Various national strategies and plans include diabetes as a health issue. These include:

The NHS Outcomes Framework

The Public Health Outcomes Framework

Putting Patients First – the NHS England Plan
Also available is a wide range of NICE guidance that addresses both the prevention and
management of diabetes.
Locally, diabetes is an intrinsic part of various strategies, including:

Lincolnshire Joint Strategic Needs Assessment

Joint Health and Wellbeing Strategy for Lincolnshire

CCG Commissioning Plans
Current activity and services
Diabetes prevention and care is provided across the whole healthcare system.
A range of preventative interventions are commissioned and provided by local authorities. For
example, Lincolnshire County Council commissions weight management and other lifestyle
services.
General practices maintain a register of people with diabetes, and provide ongoing support for
patients to manage their condition.
Lincolnshire Community Health Services provide specialist diabetes services for patients with
complex and intermediate diabetic problems.
United Lincolnshire Hospitals NHS Trust and other secondary care providers also contribute to the
provision of care for diabetic patients.
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Key inequalities
There is a range of health inequalities relating to diabetes.

Inequalities are evident in some of the risk factors for Type 2 diabetes. For example,
overweight and obesity are more prevalent in deprived communities.

People with diabetes have an increased risk of certain conditions, such as angina, heart
failure, stroke and amputation.

People with diabetes also have a reduced life expectancy.
Key gaps in knowledge and services
There is a wide range of information about diabetes, including the extent to which it is affecting the
population, evidence about groups at increased risk of developing the condition, and evidence
about interventions for managing the condition.
Lincolnshire Health and Care (formerly the LSSR) is planning for the future delivery of health and
social care in Lincolnshire across four areas: proactive, urgent, elective and women's/children's.
Risks of not doing something
Diabetes is a long-term condition that is becoming increasingly prevalent.
Some of the known risk factors for diabetes can be addressed through preventative measures.
Therefore, for example, effective interventions to address obesity in both children and adults are of
vital importance.
Diabetes can lead to serious health complications if the condition is not managed well.
Consequently, it is essential to promote self-care across the health and social care system.
What is coming on the horizon?
Lincolnshire Health and Care (formerly the LSSR) will bring significant changes to the way that
both health care and social care are provided across Lincolnshire.
What should we be doing next?
We should continue taking action to implement the Lincolnshire Joint Health and Wellbeing
Strategy, particularly Theme 1 (Promoting healthier lifestyles) and Theme 3 (Care for the major
causes of ill health and disability).
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Some sources of additional information
Right Care Programme Atlas of Variation - http://www.rightcare.nhs.uk/index.php/atlas/diabetes/
Diabetes CCG Profiles - http://www.yhpho.org.uk/default.aspx?RID=8470
General Practice Profiles - http://fingertips.phe.org.uk/profile/general-practice
National Diabetes Audit – http://www.hscic.gov.uk/nda
NICE guidance - http://www.nice.org.uk/
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