VOL: 99, ISSUE: 03, PAGE NO: 30
Mary Burden, RGN, MPH, is consultant nurse, diabetes, Heart of Birmingham Teaching Primary Care Trust
As the number of people with diabetes increases, the consequences of untreated or inadequately treated diabetes are being realised. People with diabetes are more likely to have coronary heart disease, to have a stroke, to develop renal failure and require dialysis or a renal transplant, to have visual impairment and to develop foot ulcers. They may also require amputation as a result of peripheral vascular disease or neuropathy. The cost of these complications has been estimated to be at least 8 per cent of the total cost of the NHS budget, with 80 per cent of this money being spent on treating and caring for people with these complications (King’s Fund Policy Institute, 1996). It has been shown that many of these complications are preventable (UKPDS, 1998). People who are disadvantaged socially and economically develop diabetes in greater numbers than those who are less disadvantaged, and they have worse outcomes.
There are several models of diabetes care in the community. One example is the Ladywood Project, first set up in the Ladywood area in Birmingham. This is an area of great social deprivation, with a black and ethnic population of over 50 per cent where, at one time, many single-handed GPs, with three acute trusts, struggled to provide adequate diabetes care. The initial aims of the project were to move routine diabetes care into the primary care sector, and this was done by practice nurses and GPs undertaking a nine-month course accredited by Warwick University and obtaining a certificate in diabetes care (see Useful Websites, p31).
In the past few years, several new treatments for diabetes have been developed.
The Diabetes National Service Framework: The National Service Framework on diabetes was set up by the government to try and address inequalities in health care by setting minimum standards that health care delivery systems need to put into place (DoH, 2001) (Fig 1). On publication of the standards, an implementation group was formed with a remit to ensure that the standards would be met.
There is now extensive knowledge about the causes of the complications of diabetes and the means to prevent them. All health professionals need to have the training and knowledge to support both those at risk from diabetes and those who have the disease. Nurses need to encourage self-management of diabetes, and to share the information, skills and tools with people to enable them to make healthy choices.
Department of Health (2002) Shifting the Balance of Power
Warwick Diabetes Care