The Big Interview – Dr Bob Young
Dr Bob Young, the clinical lead for the National Diabetes Audit (NDA), unveiled some signifiant research findings at the Diabetes UK Professional Conference this week.
Data from the audit has unveiled that people who are diagnosed with type 2 diabetes before the age of 40 are 2.5 times more likely to die young, when compared to those who develop the condition into their sixties.
Here, he discusses the findings and the importance of measuring data.
Why was the National Diabetes Audit developed?
The NDA has been going for over 15 years, but it became substantial from about 2008. What we’ve got now is a data repository. It’s possible to look at what’s happened to people over time and that’s what has been done here and it’s revealed that people who are diagnosed when they’re young have much worse outcomes than people who are diagnosed when they’re a bit older.
Were you surprised at the findings?
No – in clinical practice this had got good face validity, which means the findings fit in with what one sees amongst patients. But this has been the first time it’s been possible to analyse a large number of people to be able to provide us with statistically robust confirmation that this does seem to be true.
Of course, the problem is in our overfed and sedentary society we’re pushing down the age of diagnosis of type 2 diabetes. So people who are going to get type 2 diabetes, will probably get it, but what this data shows is if you get type 2 diabetes in your sixties, the health impact is much less than if you get it when you’re younger and that really is the big message.
Do you think these findings will change people and their lifestyles?
I’m encouraged by the fact that there does seem to be a general awakening of the need to support and promote better eating and regular exercise. You only need to go back two to three years and that just wasn’t on the general public agenda in the way that it is now. We’re very much at the start of something but I hope that it will build and become something of a cultural change, that’s what we need.
How can intelligence improve diabetes care?
The NDA is a measurement mechanism for diabetes and in that sense, it provides intelligence for diabetes across England and Wales.
How valuable is this data?
There is no data repository of people with diabetes as large as this anywhere else in the world. So in that sense, the size and the quality of it provides great power for better understanding of a lot of different aspects of diabetes
Some people are concerned about sharing data, what would you say to them?
You need to be able to be confident that your data is going to be shared securely, I think that’s what people want to be reassured about. The thing is that by only using NHS Digital where all our data is stored, that means it doesn’t ever go out with that. It’s all there and we can be very confident that the data is secure.
Why should people participate in the audit?
The whole idea of the NDA is to provide comparative measurements. It allows services, general practice services, specialist services, CCGs, regions, the whole nation to know how diabetes care is going and to compare with their peers and to learn from, and to find whether they are as good as, worse than, or better than other services. So the whole idea of this measurement is to learn how to make things better. There’s very good evidence that if you’re going to make things better you need to be able to measure where to start, where the biggest problems are and you need to be able to measure what has worked, because not everything that you try will work and somethings will work spectacularly well, but unless you measure them, you’ll have no idea.
How can this sort of information be used positively?
I’ve just given a talk, where I gave examples of how using this kind of information in the south west of England has reduced amputation rates and in the east of England the risk of adverse outcomes in pregnancy in women with diabetes have been reduced, how in children and young people, the control of diabetes has been improved immensely over the past five years, how in people who are inpatients with diabetes, how medication errors have been reduced and there are many more examples. Using measurement enables us to make changes that produce improvement.
How does UK diabetes care compare with other European countries?
The problem with comparisons is that there’s hardly anywhere else that has a comprehensive diabetes measurement mechanism like us. The only European country that has something is Sweden and, by comparison with Sweden, some of the things we do are a bit better and some of the things we do are not so good. But it would be wonderful if there was more international comparisons available.
What does the future of diabetes care hold for the UK?
I’m ever the optimist, I just hope it will get better and better. I think a lot of these historical barriers are beginning to come down and people are recognising that what we need is a system that works throughout the whole of the lifetime trajectory of people with diabetes. It’s inevitably going to involve the prevention of diabetes, the diagnosis, the ongoing care and treatment of patients and that impacts on every little bit of the NHS. People are at least saying ‘yes we need an integrated approach’ and where it’s been done already it’s working well and I think also if the policy changes around eating and exercise are pursued, that will help diabetes care tremendously.