Diabetes Haringey Public Health performance update CCG Governing - - PowerPoint PPT Presentation

Diabetes

Haringey Public Health performance update CCG Governing Body meeting 29th January 2015

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Background



People with diabetes are at an increased risk of a range of further conditions and complications including cardiovascular disease, blindness, kidney disease, amputation and depression.



Without careful, continued management of the condition, a person with diabetes faces a reduced life expectancy of between 6 to 20 years.1



Around 90% of people with diabetes have Type 2 diabetes. The most important risk factor for Type 2 diabetes is overweight and

• besity. Type 1 diabetes is less common and is not linked to risk

factors that can be changed such as obesity.



Effective diabetes prevention focuses on stopping people becoming diabetic by tackling obesity, identifying people with diabetes early, and effective treatment of people who already have diabetes to prevent complications.

1 Diabetes UK: State of the Nation 2012: England

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Diabetes: Type 1 and Type 2

1in10 9in10

Source: Department of Health (2007). About diabetes; The Information Centre (2008). Health Survey for England 2006

0.00% 2.00% 4.00% 6.00% 8.00% 10.00% 12.00% 14.00% 16.00% 18.00%

16–24 25–34 35–-44 45–54 55–64 65–74 75+

Age

Prevalence of Diabetes by Age in England (2006) Men Women Adults with diabetes have Type 1 diabetes Adults with diabetes have Type 2 diabetes

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Important risk factors for type 2 diabetes

7x

higher risk for people who are

• bese

1.5X

higher risk for most deprived fifth of population Black African, Black Caribbean, South Asian and Chinese ethnic groups are at increased risk

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Being overweight or obese is the main modifiable risk factor for type 2 diabetes.

)

Over

1 in 3

Haringey children aged 10-11 are overweight or

• bese, similar to

London

(2013)

Nearly

2 in 3

Haringey adults are

• verweight or obese,

similar to London

(2013)

1kg of weight loss can reduce diabetes risk by up to 15%

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5.80% 5.80% 1.6% 2.0% 0% 1% 2% 3% 4% 5% 6% 7% 8% 9% percentage Undiagnosed Diagnosed

Prevalence of diabetes in Haringey

Diagnosed

Diagnosed + undiagnosed prevalence in Haringey totals at

16,200

Those with diabetes 49% more likely to have a heart attack

13,351

Source: NCVIN CVD Profiles 2014 – data from QOF 2012/13. * Percentages refer to proportion of the total population 17+

2,849

Haringey London

*

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Recorded prevalence of diabetes is highest in the North East Collaborative

0.0 1.0 2.0 3.0 4.0 5.0 6.0 7.0 8.0 9.0 West Central South East North East

Average recorded diabetes prevalence (%) by GP collaborative of adult population, 2013-2014 QoF

Average recorded diabetes prevalence (%), 2013-2014

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Diabetes is also prevalent amongst the under 50s in Haringey

Source: Health Intelligence Data Extract for Haringey GPs

* Note not all GP Surgeries have submitted data 200 400 600 800 1000 1200 1400 1600 1800

<35 35-40 40-44 45-49 50-54 55-59 60-64 65-70 70-74 75-79 80-84 85-89 90 and over

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Haringey’s diabetes prevalence is projected to increase above that of England by 2030

0.0% 2.0% 4.0% 6.0% 8.0% 10.0% 12.0% 2012 2013 2014 2015 2020 2025 2030

Projected Prevalence of diabetes 2012 -2030

Haringey prevalence England prevalence

Source: YHPHO Diabetes Prevalence Model: http://www.yhpho.org.uk/default.aspx?RID=154049

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Care quality outcomes for Haringey diabetic patients

2012/13 2013/14 Haringey (% of patients) Haringey (% of patients) Direction

• f change

Good sugar control (HbA1c is <=59mmol/mol) 56.0 CI (55.8 -57.5) 60.4 CI (59.6-61.3) Good Blood Pressure Control (BP is <=140/80 mmHg) 63.0 CI (62.2-63.8) 68.9 CI (68.1-69.7) Good Cholesterol Control (Total cholesterol <=5mmol/l) 72.4 CI (71.6-73.1) 70.7 CI (69.9-71.5) Eye Screening in last 12 months 80.0 CI (79.3-80.7) 80.6 CI (80.0-81.3) Micro-albuminuria test last 12 months 82.98 CI (82.34-83.61) 78.59 CI (77.90-79.27)

Source: QOF

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BP and cholesterol control in Haringey diabetics significantly lower than North London average

0.0 20.0 40.0 60.0 80.0 100.0 Percentage of diabetes patients England Area Team (NE & C.London) Haringey Eye Screening uptake Good blood pressure control Good cholesterol control Good blood sugar control

Haringey significantly worse than N London

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The proportion of diabetics with good blood sugar control varies across Haringey Practices

Source: QOF 2013/14

Haringey mean = 60.4%

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The proportion of diabetics with good blood pressure control varies across Haringey practices

Source: QOF 2013/14

Haringey mean = 68.9%

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Hospital admissions for diabetic ketoacidosis have decreased in Haringey

Source : Hospital Episodes Statistics (HES) and National Statistics

5 10 15 20 25 30 35 40 2007/8 2008/9 2009/10 2010/11 2011/12

DSR per 100,000

Year

Emergency hospital admissions: diabetic ketoacidosis and coma 2007/8 to 2011/12

England Haringey

London

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People with diabetes in Haringey are at increased risk of complications compared to people without diabetes

124%

Additional risk of major amputation for diabetics*

Major Amputation

84%

Additional risk of renal replacement therapy for diabetics *

Renal Replacement Therapy (RRT)

403%

Additional risk of minor amputation for diabetics*

Minor Amputation

Source : National Diabetes Audit 2010/11 and 2011/12

*Risk of these complications in

Haringey is not significantly different from the national average

Diabetics are at also increased risk of: Heart attack, stroke, blindness, heart failure, ulcers

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The cost of diabetes prescribing in Haringey is comparatively low, but is rising

5th

lowest cost out of 211

CCG’s for diabetes prescribing

£3,052,406

Total prescribing spend for Haringey CCG (2012/13) Monthly cost of non-insulin, anti-diabetic meds

from April 2012 to October 2014

Apr 2012 Oct 2014 £163k £113k

£228.63

Annual cost of prescribing per person with diabetes

Source: Data from NCVIN diabetes profile and Haringey medicines management

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10 20 30 40 50 60 70 80 90 Percentage of patients achieing HbA1c Target

High Cost high achievement Low cost high achievement High cost low achievement High Cost high achievement Low cost high achievement High cost low achievement High Cost high achievement Low cost high achievement Low cost low achievement High cost low achievement

Percentage Achieving HbA1c of 59mmol/mol(7.5%) or more

Practices can achieve good diabetic control even with low prescribing spend

% of patients with good blood sugar control Increasing prescribing spend per patient

Plot of Haringey GP practices: Achievement of glucose control vs medication spend per patient

From Haringey Medicines Management: Adjusted for practice deprivation

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Reducing the impact of diabetes: Local interventions



Promoting healthy lifestyles



Active for Life, Community Health Champions, Health Trainers, Weight Management



Early identification of people at risk of Type 2 diabetes



NHS Health Checks and Community Health Checks (east of the borough)



Improved care

 Moving towards value based commissioning for diabetes with

providers working together to improve diabetes outcomes.

 Increasing capacity of the intermediate diabetes service



Access to specialist nurses to initiate insulin therapy



Education programme to improve care for GPs.

 Care planning for diabetes (pilot)  Medicines management: BP toolkit for diabetes patients

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

Contribute to the multi-agency approach to tackling obesity in adults and children.



Promote benefits of healthy lifestyles through NHS health checks and improve referral to lifestyle behavioural programmes.



Further develop ways of improving the quality of primary care for people with diabetes.



Improve access to self-management programmes for people with diabetes, including those with multiple long-term conditions.

What else can the CCG do about diabetes?