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There are two main types of diabetes: Type 1 and Type 2. They are different conditions, caused by different things, but they are both serious and need to be treated and managed properly.

Insulin is a hormone produced by the pancreas that plays a very important role in our bodies. After we eat, we begin to digest carbohydrates, breaking them down into glucose.

The insulin released by the pancreas moves glucose into our cells, where it is used as fuel for energy. It may help to understand that insulin is often described as a key, which open the doors to the cells, allowing glucose to enter.

Type 1 diabetes

Type 1 diabetes is an autoimmune condition where the body attacks and destroys insulin-producing cells, meaning no insulin is produced. This causes glucose to quickly rise in the blood.

Nobody knows exactly why this happens, but science tells us it’s got nothing to do with diet or lifestyle.

About 10 per cent of people with diabetes have Type 1.

Type 2 diabetes

In Type 2 diabetes, the body doesn’t make enough insulin, or the insulin it makes does not work properly, meaning glucose builds up in the blood.

Type 2 diabetes is caused by a complex interplay of genetic and environmental factors. Up to 58 per cent of Type 2 diabetes cases can be delayed or prevented through a healthy lifestyle.

About 90 per cent of people with diabetes have Type 2.

Our plans for diabetes

Our plans for diabetes services focus on two areas; creating new models of care and our Bradford Beating Diabetes programme.

New model of care

Creating new models of care is an NHS England scheme. The scheme calls on health leaders to redesign care so it is sustainable and better able to meet the needs of our patient population. As diabetes is a priority area for our CCG, we have focused efforts on developing an end-to-end pathway, from the prevention of Type 2 diabetes to the improved management of people with diabetes.

Our model of care for diabetes looks at a number of different areas, covering adults and children, these include:

Bradford Beating Diabetes

NEW BBD logo 1Our Bradford Beating Diabetes programme focuses on making our population aware of the condition by highlighting the signs, symptoms and risks of Type 2 diabetes. It supports people to make lifestyle changes to reduce the risk of developing the condition and be in control and healthy. 

In our CCG there are more than 21,000 diabetic patients registered with primary care services. Every year, a person diagnosed with Type 2 diabetes will typically spend over 8,500 hours managing their own condition alongside 3 hours input from a health professional. The Bradford Beating Diabetes programme is centred on prevention and education on self-care and management of the condition so that we reduce the number of people diagnosed with the condition.

Bradford Beating Diabetes was chosen as one of the national demonstrator sites for the NHS England Healthier You: NHS diabetes prevention programme. The programme was chosen as a national demonstrator site due to it's innovative approach to delivery and the aim to get the best outcomes for patients. 

How are we doing?

The National Institute for Health and Care Excellence (NICE) produce guidelines on the care and support that should be offered to people who use health and care services. These guidelines include recommended targets for the treatment of people diagnosed with diabetes. Our data is measured against these guidelines.

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Meeting NICE recommended treatment targets

For adults, these treatment targets include HBA1c, cholesterol and high blood pressure. 

  • nationally, 39.8% of people who have been diagnosed with diabetes are meeting NICE recommended treatment targets.
  • in our CCG, 35.2% of people who have been diagnosed meet NICE recommended treatment targets,
  • this is in the lowest quartile. 

You can find information for the public on NICE treatment guidelines for adults with diabetes here

People diagnosed with diabetes under a year attending a structured education course

If you have been diagnosed with diabetes, you should be offered a place on a course to help you understand more about the condition and how to manage it, within a year of your diagnosis.

  • in West Yorkshire, the number of people attending a structured education course is 5%,
  • in our CCG, 0.4% of people who are newly diagnosed with diabetes attend a structured education course within a year,
  • this is in the lowest quartile.

Diabetes nine care processes

NICE recommends that each year all people who have been diagnosed with diabetes should receive nine key tests. These are known the diabetes nine care processes. These nine important markers help to assess whether diabetes is well controlled and are designed to prevent long-term complications.

The nine key tests include:

  1. blood glucose level measurement (HbA1c)
  2. blood pressure measurement 
  3. cholesterol level measurement
  4. retinal screening
  5. foot and leg check
  6. kidney function testing (urine)
  7. kidney function testing (blood)
  8. weight check
  9. smoking status check

Our CCG performance on the diabetes nine care process are below:

Our performance is currently as follows:

  • 9,552 people recorded on the diabetes register
  • 6,755 (71%) completed the 9 care process for diabetes
  • 9, 335 (98%) had blood glucose level measurements

What we are doing to improve management of diabetes - new model of care

The emerging new model of care for diabetes will see the providers of diabetes care across primary, secondary care and the community come together to develop a provider alliance. The scope of the work includes those at high risk of developing Type 2 diabetes, (primary prevention), therefore the work that was previously known as Bradford Beating Diabetes will continue under this umbrella. This work will encompass those who have already been diagnosed with diabetes.

The aim is to reduce the numbers of people who develop Type 2 diabetes and ensure that those who do develop the condition or already have diabetes receive appropriate care and education when and where they need it. By delivering against this aim, we expect to see a reduction in the serious complications associated with diabetes.

What you tell us about diabetes services

We make sure that we are listening, engaging and involving patients in the planning and design of their local NHS.

To do this, each programme of work has the infrastructure to engage and collect information from people through:

Diabetes service experienceThe insight and feedback you give us makes sure that we don't just collect information, but that we have the means and ability to use it to inform our commissioning activity and improve quality. All the insight and feedback is pulled together in a system we call grass roots.

Grass roots

Grass roots pulls together information reported through NHS Choices, Patient Opinion, Healthwatch, complaints, local groups and direct patient, family and community feedback so that we can understand experiences of local NHS services. This information helps us inform our CCG planning and decision making. 

What you report through grassroots

Your feedback on the Bradford Beating Diabetes prevention programme

BBD programme feedback

Patient stories

 

What have we done in 2016/17?

Our efforts during 2015/16 focused on our Bradford Beating Diabetes programme. The programme looks to make our population aware, active, healthy and in control of Type 2 diabetes. 

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Bradford Beating Diabetes

NEW BBD logo 1The Bradford Beating Diabetes programme is delivered in conjunction with NHS England, Public Health England and Diabetes UK. It aims to identify people who are at high risk of developing Type 2 diabetes and offer support in making lifestyle changes. As a a result of being identified by the programme, it is expected that people will reduce their risk, preventing or postponing the onset of Type 2 diabetes. 

There are two phases to Bradford Beating Diabetes programme:

  • Phase one - looks at people who, as a result of a previous blood test, show they are at risk of developing Type 2 diabetes. If shown to be at risk, they will be invited to attend an appointment for a further blood test to assess their level of risk. If someone is at high risk, they will be referred to the local diabetes prevention programme groups where they will be given lifestyle advice and support on how to reduce the risk of developing Type 2 diabetes.
  • Phase two - involves all patients who are above the age of 40 or between the ages of 25-39 (if from a South Asian, Chinese or African-Caribbean background). People who are identified to be at risk in these groups are invited to attend an appointment for a blood test to assess their level of risk. If someone is identified to be at high risk of developing Type 2 diabetes, they are referred to the local diabetes prevention programme. 

Our CCG has completed phase one of the Bradford Beating Diabetes programme and started phase two. 

Intervention - Bradford's diabetes prevention programme

To identify people who might be at risk of developing Type 2 diabetes, we are proactively case finding in GP practices. From doing proactive case finding, we know that there are over 54,000 people in Bradford who are at risk of developing Type 2 diabetes. So far, we have seen over 21,000 people who have been given advice on how to reduce their risk.

However, only a small percentage of people wanted to be referred to our diabetes prevention programme groups. We know that this needs to improve, which is why we are working on offering more choice in our interventions so that people can choose how they want to make changes to prevent the risk of developing Type 2 diabetes. 

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Activity and results

Overall, our evaluation shows that our prevention programme is having great results. Our data shows statistically significant changes to BMI, waist circumference, increased activity levels and improved general understanding of how to reduce the risk of developing Type 2 diabetes.

BC BBD activityAcross our CCG and Bradford Districts CCG, 442 patients have been added to the diabetic register since 1st October 2015. in total, over 1,500 new patients have been added to the register. Without proactive targeting of high risk individuals through the Bradford Beating Diabetes programme, it is likely that these people would have remained undiagnosed.

These figures demonstrate that the Bradford Beating Diabetes programme raises awareness and also identifies people with diabetes at an early stage, reducing the risk of complications.

What we are doing over the next two years

Bradford Beating Diabetes (BBD) has focussed its attention supporting people who are at high risk of developing Type 2 diabetes to delay or prevent the onset of the disease. Awareness raising, identification of those who are at high risk and referral into a robust structured education programme have all been the key elements to the success of the work. Going forward, the Bradford Beating Diabetes work will continue but will be part of an integrated new model of care.

Our plans for the next five years 

All providers of diabetic care will work collaboratively to ensure diabetes care is delivered when and where it is deemed appropriate.

We will ensure staff and our local population are skilled to manage diabetes care either clinically or using self-care. A ten year contract will be awarded to the new Bradford Provider Alliance which will allow providers to deliver a new model of care to the people of Bradford.

This means that our population will have a single, simple, joined up system for diabetes care, with the patient at the centre. The new model for diabetes will focus on education, prevention of Type 2 diabetes, improved management, self-care and reducing the number of complications associated with both Type 1 and Type 2 diabetes - so that patients get high quality care, no matter which NHS service they use.
Diabetes - next five years