Find out our plans for tackling diabetes in our area and how well we are doing on those plans.
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 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.
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 services focus on two areas; creating new models of care and our Bradford Beating Diabetes programme.
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:
Our 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.
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.
For adults, these treatment targets include HBA1c, cholesterol and high blood pressure.
You can find information for the public on NICE treatment guidelines for adults with diabetes here.
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.
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:
Our CCG performance on the diabetes nine care process are below:
Our performance is currently as follows:
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.
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:
The 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 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.
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.
The 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:
Our CCG has completed phase one of the Bradford Beating Diabetes programme and started phase two.
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.
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.
Across 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.
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.
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.