Steve How and Oli Hudson, of Wilmington Healthcare, assess the scale of the diabetes crisis and how coronavirus might impact on it
On March 28, Stephen Powis, National Medical Director of NHS England, said that the UK would have done “very well” if there were fewer than 20,000 coronavirus deaths.
However, figures show that nearly 33,000 people died as a result of diabetes in England and Wales alone in 2017* and death rates among diabetes patients might rise even higher than currently predicted, as covid-19 can pose serious risks to them.
The diabetes crisis
Facts and statistics cited in a report compiled by Diabetes UK show that by 2025, more than 5 million people are likely to have diabetes in the UK. Currently, 4.7m people have the disease – that’s one in 15. Around one million of these people are estimated to be living with undiagnosed type 2 diabetes, a condition that causes the level of sugar (glucose) in the blood to become too high.
The number of people diagnosed with diabetes in the UK has more than doubled in 20 years; a figure that is largely attributed to the increase in type 2 diabetes, which now accounts for about 90 percent of cases.
Co-morbidities are common among diabetes patients. For example, according to the Diabetes UK report, people with type 2 diabetes are nearly two and a half times more likely to have a heart attack and twice as likely to have a stroke than people who do not have the condition. This, combined with the vast number of people affected by the disease, mean that it places a huge strain on NHS resources.
Diabetes and covid-19
Illnesses and infections, including covid-19, make it particularly hard to control blood sugar levels as they naturally rise to try to tackle with the problem. This means that people with diabetes are at greater risk of experiencing serious blood sugar highs and lows, as well as longer-term problems with their eyes, feet and other areas of the body.
For those with type 1 diabetes, a condition called Diabetic Ketoacidosis (DKA), is a particular risk if the body starts to run out of insulin. It causes harmful substances called ketones to build up in the body which can be life-threatening if not spotted and dealt with quickly.
The co-morbidities associated with diabetes are also of concern with regards to coronavirus because generally it is believed that the more health conditions a person has, the higher their risk of serious complications from covid-19.
UK covid-19 strategy
A key element of the Government’s strategy to tackle covid-19 has involved social distancing to avoid contracting the virus, with shielding in place for certain sectors of the population. While some diabetes patients might be self-isolating or shielding, the majority will be following the measures which require everyone to stay at home during lockdown and go out only for very limited purposes.
Essentially, people with diabetes will remain at extreme risk, until a coronavirus vaccine becomes available and although estimates vary, this is not expected to happen until the middle of next year at the earliest.
NHS strategy and diabetes
The covid-19 pandemic has been forcing the pace of some of the transformational change envisaged in the NHS Long-term Plan, particularly with regards to providing more services remotely and adopting population health management techniques.
In the weeks leading up to the coronavirus lockdown, many GP surgeries began advising patients not to attend booked appointments at surgeries to lower the risk of infection. Instead, a GP or nurse contacted the patient to arrange a telephone triage as near to the appointment as possible and this practice has now become widespread.
Before the covid-19 pandemic began, the NHS had already moved away from routine face to face check-ups for diabetes patients who have the disease well under control. Diabetes patients who need to keep in regular contact are expected to engage with healthcare professionals over the telephone or via digital means during the covid-19 pandemic, unless they have a specific problem that requires a follow-up appointment.
Covid-19 presents an unprecedented challenge to the NHS and the fight against it is touching all of us in some way; yet the huge number of people who die from diabetes each year in the UK and the immense strain that this disease places on NHS resources goes unnoticed by most people.
However, diabetes is another a global pandemic and one that is likely to insidiously gather pace in the UK, which faces a diabetes time bomb. Dietary and lifestyle changes are key to averting a crisis with regards to type 2 diabetes. However, with immense pressure now being placed on the NHS by covid-19, it remains to be seen how far it will be able to go this year in implementing its vision to prevent type 2 diabetes and even achieve remission for some patients.
*National Diabetes Audit, 2017-18 Report 2a: Complications and Mortality (complications of diabetes) England and Wales