A world where diabetes can do no harmOur general election manifesto

We’re calling for candidates to make diabetes a priority in the next parliament.

The 2017 General Election comes at a critical time for the prevention of Type 2 diabetes, and the treatment of people already living with Type 1 and Type 2 diabetes.

Diabetes is serious

Diabetes is expensive

Over 24,000 people die prematurely every year due to diabetes in England and Wales4.

Diabetes is growing in the UK

hospital admissions for heart failure, heart attack and stroke are for people with diabetes.

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It is responsible for over 20 leg, foot or toe amputations every day1.

It is the leading cause of preventable sight loss in people of working age2.

It is the single most common cause of kidney failure3.

One person is diagnosed with diabetes every two minutes.

4.5m people are currently living with the condition5.

By 2025, it is estimated that 5.2 million people in the UK will have diabetes.

The NHS spends around £10 billion on diabetes every year – equal to 10 per cent of its budget6.

Total direct and indirect costs associated with diabetes in the UK is estimated at over £23 billion – this is predicted to rise to over £39 billion by 20357.

We’re building a world where diabetes can do no harm. We’re asking candidates to join us and make diabetes a priority. Here’s how we do it.

1. Supporting people to better manage their diabetesManaging diabetes is complicated and requires constant commitment. People with diabetes need the tools to self-manage their condition successfully and plan their care with their healthcare professionals.

Yet, three in every five people say they don’t fully understand their diabetes and 70 per cent do not feel fully in control of their condition.

Diabetes education courses (where people learn in depth about their condition) improve a range of clinical, lifestyle and psychological outcomes8. Yet, in England and Wales, less than 10 per cent of people with Type 1 and 10 per cent of people with Type 2 are attending diabetes education courses.

Test strips are a key piece of diabetes technology for many people with diabetes, allowing them to monitor and manage their condition day to day. Despite this, one in four people face restrictions accessing enough strips for their needs. Emerging technologies, can further transform the way diabetes is treated, managed and monitored, and improve outcomes. But these are not widely available on the NHS and the take up is slow9-10.

• We want everyone with diabetes to have access to diabetes education courses and a range of learning options.

• We want to see greater access to basic everyday technology like test strips, and faster access to new and emerging technologies that could transform care.

people say they don’t fully understand their diabetes

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2. Preventing life-threatening and costly diabetes complicationsDiabetes kills 65 people every day. It causes thousands of life-threatening complications, like blindness, stroke, kidney disease, heart disease and amputations each week. Complications have a huge impact on the person, their family, society, the NHS and the economy.

Everyone with diabetes should have their blood glucose (Hba1C), blood pressure, and cholesterol measured annually. In England and Wales, currently, just 18 per cent of people with Type 1 and 41 per cent of people with Type 2 are achieving all three of these NICE-recommended targets11.

People with diabetes should have their eyes screened for signs of eye disease regularly, their kidney function measured annually, and should attend an annual foot check. Too few people are having these vital checks and there are significant variations in care12. Along with the devastating impact on the person with diabetes, the cost of foot ulcers and amputations in people with diabetes in England is estimated at £1billion a year. But with the right care in place, four out of five amputations could be prevented13.

• We want everyone to have timely access to specialist services, including specialist foot teams, to prevent the development of complications or the progression of any existing complications. Everyone should receive high quality and effective care.

• In England, we want the NHS to continue its initial transformation funding of £40m a year for the next three years, to make sure changes are embedded.

3. Improving diabetes care in hospitalOne in six hospital inpatient beds is occupied by someone living with diabetes15. While often not admitted for their diabetes, an unacceptable number of inpatients suffer diabetes complications, like hypos and diabetes ketoacidosis, whilst in hospital16.

This is distressing for people with diabetes and wasteful for the NHS. The systemic acceptance of poor outcomes must be challenged.

Diabetes inpatient Specialist Nurses are integral to achieving good, cost-effective patient care and outcomes. Likewise, speedy access to a multidisciplinary footcare team has been shown to considerably lower the risk of amputation. And yet many people with diabetes don’t have access to these teams.

• We want all clinical staff to be able to recognise patients at risk of hypos and to provide appropriate support. Specialist diabetes staff are essential to support generalist staff and care for patients with more complex needs.

• Where appropriate, we want all people in hospital to be supported to manage their diabetes.

• We want all people with diabetes in hospital to have their feet checked on admission and to have access to a multidisciplinary footcare team.

hospital inpatient beds is occupied by someone living with diabetes.

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4. Ensure children with diabetes are safe in schoolThere are over 1 million children with long-term medical conditions in the UK, including 31,500 children with diabetes17.

With the right management, there is nothing stopping a child with diabetes from living a full and healthy life. But when proper support is not given, studies have shown it can have an impact on development, academic achievement and long-term health18.

In England, the Children and Families Act 2014 introduced a duty on schools to make sure they make arrangements to support children with medical conditions. Improvements have been made, but a 2017 investigation showed that 89.5 per cent of schools asked were not complying with the duty and all its statutory requirements19. Many schools were not aware the duty existed or that it is statutory.

• We want all children with diabetes across the UK to be safe in school.

• In England, we want medical conditions policies to be checked as part of routine Ofsted inspections.

• In England, we want the government to make sure all schools are aware of the duty and what is required so that they comply with the law.

of schools asked were not complying with the duty and all its statutory requirements.

89.5%

5. Reducing obesity and preventing Type 2 diabetesBeing overweight and obese is a major risk factor for developing Type 2 diabetes. It can make it more difficult to manage diabetes effectively, and lead complications.

There are 11.9 million people in the UK at increased risk of Type 2 diabetes - that’s 1 in 4 of the adult population 20. Up to 58 per cent of cases of Type 2 diabetes could be prevented or delayed.

The NHS Diabetes Prevention Programme is helping people reduce their risk of developing Type 2 diabetes. We welcome commitments made in the Childhood Obesity Plan, including the Soft Drinks Industry Levy and a sugar reduction programme. But, with one third of children and two thirds of adults considered overweight or obese, we need to take further action urgently if we’re going to tackle the diabetes crisis.

• We want to see a strengthened Childhood Obesity Plan, including:

• An extended sugar reduction programme to include salt, saturated fat and calories, backed by meaningful sanctions.

• Restrictions on junk food marketing to children.

• Mandatory traffic light front-of-pack food labelling.

• Full implementation and evaluation of the Soft Drinks Industry Levy.

• Smaller portion sizes and more price promotions on fruit and vegetables.

• We want to see a continued commitment to support, and fund the roll out and evaluation of the NHS Diabetes Prevention Programme across England and the NHS Health Check.

• We want to see commitments to develop evidence-based programmes to identify and support those at risk of Type 2 diabetes in Wales, Scotland and Northern Ireland.

adults are considered overweight or obese.

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1. Public Health England (2016). Diabetes Footcare Activity Profiles. Using the average annual number of amputations per year from 2012-15

2. Liew, G et al. (2014) A comparison of the causes of blindness certifications in England and Wales in working age adults (16–64 years), 1999–2000 with 2009–2010. BMJ Open 2014;4:e004015 doi:10.1136/bmjop-en-2013-004015

3. UK Renal Registry 16th Annual Report:2013 https://www.renalreg.org/wp-content/uploads/2014/09/Report2013.pdf

4. Office for National Statistics Statistical Bulletin: Births in England and Wales 2013 https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmar-riages/livebirths/bulletins/birthsummarytablesenglan-dandwales/2014-07-16 General Register Office for Scotland: 2013 Births, Deaths and Other Vital Events – Preliminary Annual Figures https://www.nrscotland.gov.uk/statistics-and-data/statistics/statistics-by-theme/vital-events/general-publications/births-deaths-and-oth-er-vital-events-preliminary-annual-figures/2013 Northern Ireland Statistics and Research Agency: Statistical Bulle-tin: Births in Northern Ireland 2013 https://www.diabetes.org.uk/Documents/Position%20statements/DiabetesUK_Facts_Stats_Oct16.pdf This data is based on number of live births, minus the relevant number of multiple births (twins and triplets) but including the number of still births to give the total number of maternities: Total numbers E&W 690,820; Scotland 55,403; NI 24,000

5. Quality and Outcomes Framework (2014/15), Diabetes Prevalence Model 2016 (Public Health England) and 2012 APHO Diabetes Prevalence Model.

6. Taylor R & Davison JM (2007). Type 1 diabetes and preg-nancy, BMJ 334 (7596); 742–745

7. Hex, N et al (2012). Estimating the current and future costs of Type 1 and Type 2 diabetes in the United King-dom, including direct health costs and indirect societal and productivity costs. Diabetic Medicine. 29 (7); 855-862

8. https://www.diabetes.org.uk/self-management-education

9. https://www.diabetes.org.uk/Documents/campaign-ing/1092_Testing%20times_test%20strips%20and%20meters%20report%20WEB%20final.pdf

10. https://www.diabetes.org.uk/Get_involved/Campaigning/Our-work-in-Parliament/APPG-2016-report-launch/

11. https://www.diabetes.org.uk/Documents/Position%20statements/Diabetes%20UK%20State%20of%20the%20Nation%202016.pdf

12. https://www.diabetes.org.uk/Get_involved/Campaigning/Our-work-in-Parliament/APPG-2016-report-launch/

13. https://www.diabetes.org.uk/Upload/Shared%20practice/Improving%20footcare%20economic%20study%20(Jan-uary%202017).pdf

14. https://www.diabetes.org.uk/About_us/News/Twen-ty-devastating-amputations-every-day/

15. https://www.diabetes.org.uk/Global/Homepage/News/nati-diab-inp-audi-15-nat-rep.pdf

16. https://www.diabetes.org.uk/Global/Homepage/News/nati-diab-inp-audi-15-nat-rep.pdf

17. https://www.diabetes.org.uk/Documents/Position%20statements/DiabetesUK_Facts_Stats_Oct16.pdf

18. Gaudieri, P.A., Chen, R., Greer, T.F. and Holmes, C.S. (2008) Cognitive function in children with type 1 diabetes: A meta-analysis. Diabetes Care, 31(9), 1892-1897.

19. Heallth Conditions in Schools Alliance. (n.d.). Statistics from our 2017 investigation. Retrieved from: http://medi-calconditionsatschool.org.uk

20. Based on the latest 2014 dataset for the UK population (Office for National Statistics. Population Estimates for UK, England and Wales, Scotland and Northern Ireland - Mid-2014): 25,183,266 adult men and 26,504,311 adult women are recorded. 22% of the men is 5,540,319 and 24% of the women is 6,361,035 - which is a total of 11,901,354

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References

We want to see a world where diabetes can do no harm. We want everyone to receive the best possible care and treatment for their diabetes, and to prevent Type 2 diabetes.

This is why we’re asking you in the next Parliament, together with Diabetes UK, to fight for better diabetes care in your local area and to make diabetes a priority in parliament. To start this we’re asking you to:

1. Sign the Diabetes Manifesto here: www.diabetes.org.uk/manifesto

We’ll be in touch after the election with more tailored information about your constituency such as local events, visits and opportunities to meet with constituents.

2. Join the Diabetes APPG following the election.