Diabetes

This topic area covers statistics and information relating to diabetes in Hull including local strategic need and service provision.

This page contains information from the Office for Health Improvement & Disparities’ Fingertips. Information is taken ‘live’ from the site so uses the latest available data from Fingertips and displays it on this page. As a result, some comments on this page may relate to an earlier period of time until this page is next updated (see review dates at the end of this page).

In July 2022, Clinical Commissioning Groups (CCGs) ceased to exist and were replaced by the Integrated Care System. Data will still be available at CCG level for some time after July 2022 so this page continues to refer to CCGs and Hull CCG, and continues to present data at the CCG geographical level. Six local CCGs were also combined to form the Humber, Coast and Vale geographical area, which has also ceased to exist. It has been replaced by the Humber and North Yorkshire ICS. However, data will still be available at Humber, Coast and Vale geographical level, and will be presented within our JSNA.

Headlines

• Diabetes is a lifelong condition that causes a person’s blood sugar level to become too high which can have severe detrimental effects on health. There are two main types of diabetes. Type 1 is often diagnosed in childhood and type 2 often diagnosed at older ages. A substantial risk factor for developing type 2 diabetes is obesity. Rates of obesity and type 2 diabetes are increasing in Hull as they are nationally.
• In 2020/21 there were 18,596 patients aged 17+ years registered with Hull GPs who were diagnosed with (type 1 or 2) diabetes representing 7.7% of Hull’s registered population (higher than England at 7.1%), although it is estimated that there could be around 1,000 people in Hull who have diabetes but have not been diagnosed. There will also be significant numbers of people who have pre-diabetes where their blood glucose levels are too high and who are at risk of developing diabetes. In 2020/21, there were 7,847 patients registered with Hull GPs who had non-diabetic hyperglycaemic representing 3.3% of the registered population (although this ranged from 0.4% to 12.9% across Hull’s 32 general practices).
• Among type 1 patients, 35% had had all eight checks (blood test, cholesterol check, blood pressure check, serum creatinine test, urinary albumin test, record of their body mass index, record of their smoking status and foot check) at their GP practice for their diabetes compared to 42% for England. The rates were higher but similarly worse than England among patients with type 2 diabetes (53% versus 59%). In Hull compared to England, fewer type 1 patients (16% versus 20%) and type 2 patients (38% versus 40%) achieved all three treatment targets (low blood glucose, low cholesterol and blood pressure within normal range). Among newly diagnosed patients for both type 1 and type 2 diabetes, a higher percentage had attended the diabetes structured educational programme in Hull compared to England.
• Over the three year period, 2017/18 to 2019/20, there were 145 minor lower limb amputations (involving toes or foot) and 65 major lower limb amputations (above the foot) in Hull. Compared to England, the rate in Hull was higher but not statistically significantly so for minor lower limb amputations (24 versus 20 per 10,000 patients), and major lower limb amputations (10.0 versus 7.8 per 10,000 population). Rates of major diabetic lower limb amputations have increased slightly over the last 3-4 years and decreased slightly for minor diabetic lower limb amputations over the last 3-4 years, but this was reversed in the last year with rates of lower limb amputations decreasing slightly and rates of major limb amputations increasing slightly.
• Diabetes UK estimated that the NHS spend £10 billion a year on diabetes which is 10% of its entire budget, and that one in six people in a hospital bed has diabetes.

The Population Affected – Why Is It Important?

Diabetes is a lifelong condition that causes a person’s blood sugar level to become too high which can have severe detrimental effects on health. What all types of diabetes have in common is that they cause people to have too much glucose (sugar) in their blood. But we all need some glucose. It is what gives us our energy. If you don’t have diabetes, your pancreas senses when glucose has entered your bloodstream and releases the right amount of insulin, so the glucose can get into your cells. But if you have diabetes, this system doesn’t work.

There are two main types of diabetes – type 1 diabetes and type 2 diabetes. The charity Diabetes UK states that there are 3.9 million people who have been diagnosed with diabetes in the UK and in addition there are almost a million people living with type 2 diabetes who don’t know they have it because they haven’t been diagnosed yet, bringing the total number up to more than 4.8 million people (around one in fifteen people). Numbers have doubled in the last 20 years. Additionally, many more people have blood sugar levels above the normal range, but not high enough to be diagnosed as having diabetes. This is sometimes known as pre-diabetes. If blood sugar level is above the normal range, the risk of developing full-blown diabetes is increased. It is very important for diabetes to be diagnosed as early as possible because it will get progressively worse if left untreated. In type 1 diabetes, the body’s immune system attacks and destroys the cells that produce insulin. As no insulin is produced, the glucose levels in the body increase, which can seriously damage the body’s organs. People with diabetes have an increased risk of cardiovascular disease (heart attacks, heart failure and strokes), kidney disease, sight loss, and lower limb amputations. As well as increased death through an increased risk of cardiovascular and kidney disease, there is a more direct risk through diabetic ketoacidosis.

Diabetes UK state that people with diabetes when compared with people without diabetes are nearly 2.5 times more likely to have a heart attack, more than 2.5 times likely to experience heart failure, and twice as likely to have a stroke, 20 times more likely to suffer an amputation, 1.5 times more likely to get glaucoma, twice as likely to get cataracts (both of which can lead to sight loss), and five times more likely to need either kidney dialysis or a kidney transplant. Having diabetes can also adversely affect mental health and emotional wellbeing.

Type 1 diabetes is often known as insulin-dependent diabetes. It’s also sometimes known as juvenile diabetes or early-onset diabetes because it usually develops before the age of 40, often during the teenage years. Type 2 diabetes is where the body doesn’t produce enough insulin, or the body’s cells don’t react to insulin. This is known as insulin resistance. In the UK, around 90% of all adults with diabetes have type 2 diabetes. Control of symptoms may be managed through healthy eating, exercising regularly, and monitoring blood glucose levels, although eventually medication may be required. During pregnancy, some women develop gestational diabetes (affecting up to 18% of women during pregnancy). People with pre-diabetes have an increased risk of developing type 2 diabetes.

Early diagnosis is essential. Diabetes UK estimated that complications can begin five or six years before some people actually find out they have type 2 diabetes, and that six in ten people have no symptoms when they are diagnosed with diabetes. They estimate that one in three people diagnosed with type 2 diabetes will have complications with their eyes, feet, kidneys or nerves by the time they are diagnosed with type 2 diabetes.

Obesity, family history, ethnicity, high blood pressure, poor diet and lack of physical activity are the main key risk factors for type 2 diabetes. For women, having had gestational diabetes in pregnancy also increases the risk of type 2 diabetes (to about 30% versus 10% for the general population). The effects of diabetes can be made worse by smoking. With the ageing population and the increasing trends in the prevalence of obesity, it is anticipated that the number of people with diabetes will increase. South Asians and Black people are two to four times more likely to develop type 2 diabetes compared to White people.

Diabetes UK estimates that the NHS spend £10 billion a year on diabetes which is 10% of its entire budget, and that one in six people in a hospital bed has diabetes. They estimate that people with diabetes are twice as likely to be admitted to hospital then people without diabetes.

The diagnosed prevalence of diabetes can be examined from data collected as part of the Quality and Outcomes Framework within primary care. Quality of care indicators are also included, and it means that high percentage of the patients diagnosed with diabetes have annual reviews which gives medical staff the opportunity to provide information and encourage their patients to improve their lifestyle behaviours to improve their health, and lower their risk of morbidity and mortality from their condition. Local analysis of the QOF data has been completed with prevalence calculated for each GP practice and Primary Care Network group.

The Hull Picture

Number of People With Diabetes

The percentage of people from Black and Minority Ethnic groups is relatively low in Hull compared to England, and Hull’s population is relatively young compared to the England average so the prevalence of diabetes would be expected to be lower, but this is counter-balanced by Hull’s high levels of deprivation and higher levels of unhealthy lifestyle behaviours which increase the risk of developing diabetes.

The Office for Health Improvement & Disparities’ Fingertips gives the percentage of patients registered with Hull GPs who are diagnosed with diabetes among those aged 17+ years. In 2020/21, there were 18,596 patients aged 17+ years registered with Hull GPs who had been diagnosed with diabetes representing 7.7% of the registered population aged 17+ years (which was higher than England at 7.1%). In 2020/21, there were 7,847 patients registered with Hull GPs who had non-diabetic hyperglycaemic representing 3.3% of the registered population (although this ranged from 0.4% to 12.9% across Hull’s 32 general practices).

The prevalence of diabetes among those aged 17+ years has progressively increased over time at a similar level to increases observed for England and across the Yorkshire and Humber region between 2009/10 and 2014/15, but since then Hull’s rates have increased at a faster rate and the overall prevalence of diabetes in Hull is greater than England and the region.

Non-diabetic hyperglycaemic was measured for the first time in 2020/21 so there is no data relating to trends over time.

From local analyses there was a statistically significant association between average age of the practice patients aged 17+ years and the prevalence of diagnosed diabetes across the 32 practices in Hull. The prevalence estimates were 6.0%, 7.4%, 8.0%, 8.4% and 8.1% for the practices serving the youngest, second youngest, middle, second oldest and oldest practice patients with practices grouped into approximate fifths in terms of total list size. There was no difference in the prevalence when practices were grouped into five deprivation groups.

The numbers and prevalence of diagnosed and undiagnosed diabetes in Hull has been estimated among people aged 16+ years. Age gender specific prevalence estimates were applied to Hull’s population structure to estimate the number of people, and the model also used ethnicity and deprivation to adjust for these two factors. In 2017, it was estimated that 8.3% of people aged 16+ years had diabetes in Hull.

It was estimated that there were 19,481 patients with diagnosed and undiagnosed diabetes in Hull who were aged 16+ years in 2017 compared to 18,308 patients aged 17+ years registered with Hull GPs who had been diagnosed with diabetes for 2019/20. There are differences in the ages and the time periods, but for Hull the prevalence of diagnosed diabetes is closer to that of the estimated prevalence of diagnosed and undiagnosed diabetes compared to other Clinical Commissioning Groups (CCGs) within Humber, Coast and Vale. People in more deprived areas are more likely to be diagnosed at a later stage, but it is possible that work in primary care has reduced the numbers of people with undiagnosed diabetes in Hull (assuming the model is a reasonable estimate of the numbers of people with diabetes).

In 2019/20, Hull had a lower percentage of people with type 1 diabetes aged 40+ years, but a higher percentage among people aged under 40 years than England and the other CCGs across Humber, Coast and Vale.

In 2019/20, 57% of people with type 1 diabetes were men which was the higher than England and among the highest across Humber, Coast and Vale.

From the 2011 Census, around 6% of Hull’s population were non-white, and given that the prevalence of diabetes is higher for some Black, Asian and Minority Ethnic groups, the prevalence of type 1 diabetes seems low in Hull among BAME groups. It is unclear why the numbers do not sum to 100% and it is possible that these two groups do not include all people with type 1 diabetes and/or there are people with type 1 diabetes who do not have their ethnicity recorded.

For 2019/20, a higher percentage of people with type 2 diabetes in Hull are aged under 65 years compared to England and the other CCGs in Humber, Coast and Vale. One might expect this given Hull’s younger population structure, but it is also possible that people in Hull due to increased deprivation and health risk factors develop type 2 diabetes at a younger age compared to England and across the Humber, Coast and Vale. The numbers of people with type 2 diabetes who are aged under 40 years is low, but the percentage in Hull is higher than England and the highest across CCGs within Humber, Coast and Vale.

The majority of people with type 2 diabetes in Hull were male (55%) which was among the lowest across Humber, Coast and Vale where percentages ranged from 56% to 57%, although the percentage in Hull was similar to England.

The percentage of people with type 2 diabetes who are of minority ethnic origin is 5.5% for 2019/20, but this is still lower than the estimated percentage of Hull’s population who were estimated to be non-white in 2011. This illustrates that there are probably higher percentages of people who are of minority ethnic origin that have undiagnosed diabetes compared to people who are white. Again, it is not clear why the percentages do not sum to 100% and it is possible that there is another ethnic group that is not included and/or that there are people with type 2 diabetes that do not have ethnicity recorded.

Projected Numbers With Diabetes

The Projecting Adult Needs and Service Information (PANSI) and the Projecting Older People Population Information Service (POPPI) provide current estimates and future projections at local authority level of the number of people with different health needs for those aged 16-64 and 65+ years respectively.

They use estimates for the estimated prevalence from different surveys and research which have generally been derived at a national level (generally different prevalence estimates for different age groups for men and women separately). They then apply these prevalence figures to Hull’s population. For instance, if the prevalence among males in England in a specific age group is 5% and there are an estimated 500 men living in Hull in that age groups, they would estimate there were 25 men in that age group living in Hull with that condition. For many conditions, there is an increased prevalence in populations with higher levels of deprivation, and in most cases, deprivation is not taken into consideration. Thus in many cases, these estimates for Hull are likely to underestimate the numbers in Hull due to the high levels of deprivation in Hull.

Further definitions are available from www.pansi.org.uk and www.poppi.org.uk.

Combining the information from these sources, it is estimated that around 10,000 people have type 1 or type 2 diabetes who are aged 18+ years, and this is projected to increase by around 800 people by 2040.

Age	2020	2025	2030	2035	2040
18-24	239	240	269	272	253
25-34	511	480	449	466	499
35-44	580	629	648	618	576
45-54	1,506	1,345	1,318	1,430	1,480
55-64	2,193	2,219	2,062	1,853	1,815
65-74	2,939	2,980	3,278	3,372	3,142
75+	2,014	2,285	2,456	2,708	2,991
All 18+	9,981	10,177	10,479	10,718	10,757

Quality of Care Indicators Among People With Diabetes

There are also quality of care measures which are part of the Quality and Outcomes Framework, and the percentage of registered patients receiving eight of these health checks are available on Fingertips.

Patients should have a blood glucose check (all ages), and those aged 12+ years should also have a cholesterol check, blood pressure check, serum creatinine test, urinary albumin test, and an annual foot check as well as having their body mass index and smoking status recorded. The percentage of patients recorded as having all eight checks undertaken (all ages) is also recorded (“all checks” among those aged under 12 years denotes having their blood glucose check only as the others are not recommended for under 12s). Information is available for type 1 and type 2 diabetes separately as well as the percentage of patients offered and attending a diabetes structured educational programme within 12 months of their diagnosis.

For type 1 patients, there is mixed performance in Hull relative to England against the measures for 2019/20. The percentage of patients who had a blood test, had the body mass index recorded and smoking status recorded was higher than England. However, the percentages are relatively low in Hull for the percentages receiving a cholesterol check, urinary albumin test, and annual foot check. Furthermore, only 35.2% of patients with type 1 diabetes had had all eight care processes for diabetes which was the lowest across Humber, Coast and Vale, and statistically significantly lower than England.

For type 2 patients, a higher or similar percentage of patients in Hull had a blood test, had a serum creatinine test and had their body mass index recorded in 2019/20 compared to England. However, the percentage who had a cholesterol check, who had a urinary albumin test, had their smoking status recorded and had an annual foot check was statistically significantly lower than England and for the majority of these indicators was the lowest across Humber, Coast and Vale.

Just over half (53%) of Hull patients with type 2 diabetes had had all eight care processes in 2019/20 which was the lowest across Humber, Coast and Vale, and statistically significantly lower than England’s 59%.

The percentages achieving different levels of blood glucose, cholesterol and blood pressure is also noted as well as the numbers achieving all three targets, and the information is available for type 1 and type 2 diabetes separately.

For patients with type 1 diabetes, the percentages achieving the treatment targets is lower in Hull for the majority of the three measures, and significantly so for blood glucose and cholesterol levels being under 5mmols/l. The only indicator where Hull performed significantly better than England was for blood pressure where 78% of patients had blood pressure less than or equal to 140/80 compared to 74% for England. Only 16% of patients achieve all three targets for 2019/20 compared to 20% for England.

Among patients with type 2 diabetes, whilst the percentage with the lowest blood glucose levels (under 48 mmol/mol) was significantly better than England, the percentage with levels lower than 58 and 86 mmol/mol were statistically significantly worse than England. The percentage with cholesterol levels of 5 mmol/l was also significantly worse than England as was the percentage with blood pressure less than or equal to 140/80. Overall, 38% met all three treatment targets which was the lowest across Humber, Coast and Vale, and statistically significantly lower than England (40%). Whilst there were statistically significant differences among the indicators, the actual differences in the percentages between Hull and England were generally relatively small.

The percentage of patients offered and attending a diabetes structured educational programme within 12 months of their diagnosis is also available from Fingertips.

Among newly diagnosed type 1 patients in 2018/19, fewer people are offered a diabetes structured educational programme in Hull compared to England (33% versus 42%) but a higher percentage of people attend (11.1% versus 6.1%). Whilst there are relatively high numbers of people with type 1 diabetes overall, there are relatively few who are diagnosed within a single year period.

Due to the small number of type 1 people who are newly diagnosed each year, only 15 patients offered an educational programme and only five attended in 2018/19 (numbers have been rounded to the nearest five people).

Among newly diagnosed type 2 patients in 2018/19, a similar percentage of people were offered a diabetes structured educational programme in Hull compared to England (73% versus 75%) but a higher percentage of people attend (18.5% versus 13.2%).

Numbers are much higher for type 2 diabetes with 1,000 patients offered an educational programme in 2018/19 and 255 attending (numbers have been rounded to the nearest five people).

Lower Limb Amputations

Lower limb amputation is a serious potential consequence of diabetes, and Fingertips gives information on the number of hospital stays for diabetic foot disease (per 10,000 patients with diabetes), median length of stay and adjusted length of stay adjusting for the gender and age of the patient as well as the rate of lower limb amputations per 10,000 patients with diabetes.

Over the three year period 2017/18 to 2019/20, Hull had a significantly higher rate of hospital spells for diabetic foot disease per 10,000 diabetic patients compared to England, and whilst for 2015/16 to 2017/18 the median length of stay was the same as England the adjusted length of stay was longer. So taking into account the patients treated in Hull in terms of their gender and age, length of stay was longer in Hull.

The rate of minor diabetic lower limb amputations involving toes, the foot and up to the ankle was higher in Hull in the three year period 2017/18 to 2019/20 compared to England (25.9 versus 22.1 per 10,000 diabetic patients) as were major diabetic lower limb amputations involving the hip to below the knee (10.0 versus 8.1 per 10,000 diabetic patients).

There were 160 minor diabetic lower limb amputations in Hull in the three year period 2017/18 to 2019/20, and the rate has increased slightly between 2013/14-2015/16 to 2016/17-2018/19, although has decreased in the last year.

The rate of major diabetic lower limb amputations has decreased in Hull since 2014/15-2016/17, but increased in the last year. There were 65 such major diabetic lower limb amputations in Hull in the three year period 2017/18 to 2019/20.

Strategic Need and Service Provision

People aged 40-79 years who are eligible for the NHS Health Check should be encouraged to attend. People already diagnosed with diabetes should attend their annual reviews so that they get the best on-going treatment for their condition.

Pre-diabetes is poorly understood across the medical profession, therefore education amongst health professionals is an essential focus. The screening, treatment and appropriate management of pre-diabetes are essential for the prevention of diabetes in later life.

The NHS Diabetes Prevention Programme was implemented locally in 2018, and therefore it is essential that those at risk are referred in appropriately. Individuals who have been told that they are at risk of diabetes are referred to the programme either by their GP or by a Health Check professional.

The following video from the Office for Health Improvement & Disparities (previously Public Health England) outlines the roll-out of the NHS Diabetes Prevention Programme and how it is reaching those most at risk.

https://youtu.be/8kEv1YxL1Qw

Diabetes management is challenging as it fits within a wide spectrum of long term conditions care. The overarching need is to ensure that diabetes care is managed in an integrated fashion, adequately resourced, with appropriate governance and staff who have the necessary competencies to deliver care.

People who have diabetes and who are at risk of familial hypercholesterolemia should be identified so that they can commence treatment and/or be referred for specialist care for familial hypercholesterolemia as their risk of coronary heart disease will be high.

Resources

Diabetes UK. Number of people with diabetes reaches 4.8 million: https://www.diabetes.org.uk/about_us/news/diabetes-prevalence-2019

Diabetes UK. Annual diabetes prevalence figures 2018 published February 2019: https://www.diabetes.org.uk/professionals/position-statements-reports/statistics

NHS Digital. Quality and Outcomes Framework. https://qof.digital.nhs.uk/

The Office for Health Improvement & Disparities’ Fingertips: https://fingertips.phe.org.uk/

Updates

This page was last updated on 11 July 2022.

This page is due to be updated / checked in December 2022.