Excess deaths on the rise as people with diabetes forced to ‘go it alone’ with healthcare

A shocking new report into the state of diabetes care in England has revealed thousands of excess deaths, ‘deeply alarming’ numbers of missed checks and stark health inequalities, with people from the poorest areas struggling most to access vital services.

The report, published today by the charity Diabetes UK, says that ‘fragmented’ access to services across the country is having a hugely damaging impact on the wellbeing of millions of people with diabetes.

It means far too many people with diabetes are being left to ‘go it alone’ in managing their condition, the charity’s chief executive says.

Figures highlighted in the report shows there were more than 7,000 excess deaths involving people with diabetes in 2022, a rise of 13 per cent from pre-pandemic levels – with data suggesting the majority of these were not attributable directly to COVID-19.

Worryingly, the situation has only worsened in the first part of 2023, with 1,461 excess deaths between January and March, three times as high as the same period in 2022.

Diabetes UK fears the increase may be linked to the backlog in routine diabetes care caused by the COVID-19 pandemic when services faced huge disruptions.

People with diabetes are supposed to have a series of checks, known as care processes, every year. These include things like blood pressure, cholesterol, and blood sugar, and are key to preventing serious diabetes-related complications. Diabetes UK’s concern over the number of missed checks comes after a major NHS study, published last year, linked a rise in deaths among people with diabetes with a fall in care processes the previous year.

The charity’s report maps just how slowly diabetes care is recovering in some parts of the country following the COVID-19 pandemic. It reveals:

• Less than half (47 per cent)of people with diabetes in England received all eight of their required checks in 2021-22, meaning 9 million people did not receive the care they need.
• Compared to the year before the pandemic (2019-20), almost 300,000 fewer people with diabetes received all eight checks.
• Regional variation in the delivery of these checks is huge, ranging from 25 per cent in the worst performing Integrated Care Board to 63 per cent in the best. At Primary Care Network level, the variation was even more stark, ranging from 10 per cent in the lowest performing to 86 per cent in the best.
• In a survey of more than 11,000 people with diabetes in England carried out by Diabetes UK, almost half (48 per cent) said they experienced difficulties managing their condition in 2022.

The survey also uncovered major issues with unequal access to diabetes care. It found that:

• One-in-three peoplein the most deprived areas found it difficult to contact their diabetes healthcare team in 2022, compared to one-in-four in the least deprived.
• One-in-10 peoplein the most deprived areas reported no contact with their healthcare team in more than a year and were almost 50 per cent more likely to have not had contact in this time than people in the least deprived areas.

Analysis released by Diabetes UK last month revealed there are now more than five million people in the UK living with diabetes – 4.3 million with a diagnosis of the condition and a further estimated 850,000 who have diabetes but are yet to be diagnosed. With the right care and support, diabetes can be managed well. But without it, it can lead to serious complications and, every week, diabetes leads to more than 184 amputations, 770 strokes, 590 heart attacks and more than 2,300 cases of heart failure.

Diabetes UK has set out a series of recommendations for how this care crisis can be tackled. The charity is calling for:

• A focus on diabetes in the UK Government’s Major Conditions Strategy, including plans to tackle the backlog in diabetes care, reduce health inequalities and provide more support to help people prevent type 2 diabetes.
• A fresh commitment from Government to implement its stalled obesity strategy in full and without further delay, including the restrictions on junk food marketing.
• Commitments in the plans of every Integrated Care Board in England to address the backlog in care, inequalities in access to care and to put type 2 diabetes prevention at the heart of their strategies.

Anthony Parker, 44, from Berkshire, has lived with type 1 diabetes for 34 years. He said: “Back in January 2020 I was due a check-up, but the appointment was cancelled and moved to March for a telephone appointment. This happened again and again, and I didn’t receive any further communication about appointments after that.

“I believe the lack of contact and support contributed to me developing retinopathy as I didn’t have an eye appointment for two years.

“The retinopathy has impaired my sight and also affected my health. I’ve not been as active as I usually would be and when I try to be active it makes matters worse. So since last June, I’ve put on a bit of weight and my health has suffered.

“Diabetes is a complex condition and the repercussions over time are very serious and as I have found life altering. There needs to be a commitment to managing my condition properly.”

Chris Askew OBE, Chief Executive of Diabetes UK, said: “Diabetes is relentless, and people living with diabetes need the close support and monitoring of healthcare professionals.

“This routine care can be lifesaving, and help prevent other serious complications such as amputations, strokes and heart disease.”

He added: “Yet far too many people with diabetes are being left to go it alone managing this challenging and potentially fatal condition, with deeply alarming numbers of checks either missed or delayed.

“We know health professionals are working incredibly hard to give people the care they need, but they are just too stretched to provide the time and personalised support that is required – and it’s having a catastrophic impact.

“The Government must commit to tackling this diabetes care crisis in its Major Conditions Strategy, while local health systems should make it a priority in their plans.”

Teams across the country have tried to resolve the diabetes backlog caused by the COVID-19 pandemic, including Lilly with its diabetes therapy review service.

Following the COVID-19 pandemic, Lilly UK was contacted by numerous healthcare professionals asking for help to overcome the backlog of people with diabetes, highlighting the lack of both resource and skill within primary care to review the number of individuals with the condition on waiting lists. In June 2022, in response to these requests and to support NHS recovery after the pandemic, Lilly launched a therapy review service for people with type 2 diabetes. The service was provided as a donation and delivered by Morph Clinical Services. Lilly had no influence over the clinical recommendations or decision making.

Morph’s specially trained clinical pharmacists provided therapy reviews across the UK, prioritising GP practices in areas of greatest health deprivation. Practices were able to tailor the service to their needs, and receive mentoring to upskill practice staff. People with type 2 diabetes had a 30 minute appointment with the clinical pharmacist to discuss their diabetes, medications and lifestyle. Morph’s team followed national or local treatment guidelines to recommend changes to the patients’ therapy that local prescribers could implement.

The service capacity was quickly filled. By April 2023, more than 500 clinic days had been delivered to over 100 practices in the greatest need of help and almost 5000 people had a valuable discussion with a skilled healthcare professional.

Diabetes UK is launching its new report, titled Diabetes Care: Is It Fair Enough?, as part of its Diabetes Is Serious campaign in Parliament today. People can add their voice to the campaign at: diabetes.org.uk. Anyone who has not been invited for their annual diabetes checks in more than a year should contact their diabetes team or GP surgery right away.