Diabetes

Diabetes is a long-term condition that can have major impacts on the person and their family. Classifications of diabetes are: 

• Type 1: or Type 1 Diabetes Mellitus (T1DM) develops when insulin producing cells have been destroyed so the body is unable to produce insulin. Type 1 diabetes accounts for about 10% of all adults with diabetes. It can develop at any age but usually manifests before the age of 40. It is the most common type of diabetes in childhood. Type 1 diabetes is becoming increasingly common in the UK. 
• Type 2: or Type 2 Diabetes Mellitus (T2DM) develops when the insulin producing cells in the body cannot produce enough insulin, or when insulin sensitive tissues fail to respond to insulin that is produced. It is the most common form of diabetes, accounting for between 85–95% of cases. T2DM usually appears in people over the age of 40, although some groups are at a greater risk, and in such cases, it may appear earlier. An increasing number of children are developing T2DM. 
• Gestational Diabetes Mellitus (GDM): when high blood sugar develops during pregnancy. This usually resolves after delivery, although women who have had GDM are at increased risk of T2DM in the future. 
• There are other specific types of diabetes, for example, drug/chemical induced diabetes. (Source: Diabetes UK). 

Diabetes is one of the most common chronic diseases in the UK. In Lincolnshire and nationally, it continues to affect an increasing number of the population. Genetic factors are the main risk factors for T1DM. For T2DM, risk factors are more varied and include: 

• The risk increases with age. 
• Obesity and inactivity. Obesity accounts for 80–85% of the overall risk of developing T2DM, which is a major public health issue (Source: NICE). In England, obese adults are five times more likely to be diagnosed with T2DM than adults of a healthy weight (PHE). 
• High blood pressure. 
• A family history of diabetes. 
• Ethnicity (for example, people of Asian and African descent are 2–4 times more likely to develop T2DM). 
• Smoking, being sedentary and drinking too much alcohol are also risk factors. 

(Source: Diabetes UK) 

People living in deprivation are at increased risk of developing type 2 diabetes and there are inequalities in receiving the appropriate clinical care which reduce the chance of developing many complications of diabetes (Source: Diabetes UK).  Deprivation is strongly associated with higher levels of obesity, physical inactivity, unhealthy diet, smoking and poor blood pressure control, all of which are linked to the risk of developing Type 2 diabetes and the risk of serious complications amongst those already diagnosed with both Type 1 and Type 2 diabetes  (Source: Diabetes UK).  

A wide range of long and short term complications can be caused by diabetes (Source: Diabetes UK).  These include, for example: 

• Short term – hypoglycaemia, hyperglycaemia diabetic ketoacidosis.  
• Long term – eye problems, kidney disease, diabetic neuropathy, foot problems.      

• The 10 Year Health Plan for England recognises the role of addressing diabetes health as part of the Plan’s focus on innovation, neighbourhood health and prevention. 
• NICE provides clinical guidance for diabetes.  
• The Quality and Outcome Framework (QOF) financially rewards general practices for providing quality care, helping to standardise improvements. There is a specific diabetes clinical domain. 
• The Core20PLUS5 approach to reducing health inequalities amongst children and young people identifies diabetes as one of five clinical areas for improvement, particularly for vaccination uptake. 
• Lincolnshire’s Joint Health and Wellbeing Strategy focusses on prevention – supporting people to improve their own health and wellbeing. 
• The delivery plans of the NHS Lincolnshire Joint Foward Plan 2023-2027 includes diabetes in a number of the priorities for example, primary care, health inequalities and prevention, children and young people. 

The General Practice Quality Outcome Framework (QOF) register provides data on the diabetes prevalence for people aged 17 years and over.  This shows that the prevalence is higher in Lincolnshire than in England, and the overall trend shows an increasing prevalence (Source: Department of Health and Social Care). 

The national data also shows the mortality rate for deaths involving diabetes, with the 2022-24 data showing that the rate in Lincolnshire being worse than England.    

The Lincolnshire Primary Care Network (PCN) profiles provide information on the demographics and health of the PCN populations.  They provide a wide range of information in relation to diabetes, which includes: 

• The Global Burden of Disease (GBD), which show that in Lincolnshire, diabetes is one of the main causes of years lived with disability. The profiles provide information for each PCN.    
• The disease prevalence for diabetes for each GP practice and how this compares to Lincolnshire and England.  Some of the highest levels of diabetes are in the areas of highest deprivation, for example the First Coastal PCN.    
• The slope index of inequality for diabetes hospital admissions, which shows diabetes admission rates are significantly greater in the 20% most deprived communities.    

Obesity and lack of physical activity is associated with a range of health conditions including type 2 diabetes.  In Lincolnshire: 

• A higher proportion of children in reception and year 6 are overweight/obese compared to England (2024/25) 
• A higher proportion of adults are overweight/obese than in England (2023/24) 
• A lower proportion of children and young people are physically active (2023/24) 
• A lower proportion of adults are physically active (2023/24)

(Source: OHID)

The National Diabetes Audit (NDA) shows variation across general practices in Lincolnshire of the completion of the eight care processes (HbA1c measurement, blood pressure, cholesterol measurement, retinal screening, weight check, serum creatinine testing, urinary albumin testing, and foot checks); and three treatment targets (HbA1c, blood pressure, and cholesterol). Integrated Care Board (ICB) NDA information is available at the National Diabetes Audit – NHS England Digital, which includes structured education.   

Diabetic eye screening is a test that looks for an eye condition called diabetic retinopathy that can be caused by diabetes.  People with diabetes aged 12 years or over are invited for screening.  

Information on Lincolnshire’s Diabetic Eye Screening Programme, which includes invitations and uptake is available at Diabetic eye screening: 2022 to 2023 data – GOV.UK. 

The Lincolnshire Pharmaceutical Needs Assessment provides information on pharmaceutical services against local health needs.  It is a useful resource for diabetes health because of the role that pharmaceutical services have in supporting people manage their diabetes, in the provision of their essential, advanced and enhanced services, for example, influenza vaccinations.  A profile for each PCN is available from the Lincolnshire Health Intelligence Hub.  

A wide range of services take place to support the prevention, management and treatment of diabetes. 

An Integrated Lifestyle Service (ILS) is commissioned across Lincolnshire until April 2027, to support residents to lead healthier lifestyles. This includes key measures to prevent T2DM such as weight management, physical activity, reducing alcohol consumption, and smoking cessation. Let’s Move Lincolnshire is another local preventative approach, working to increase physical activity levels. Both approaches align with the Better Health initiative. 

The NHS Health Check programme, provided by Lincolnshire GPs seeks to improve the health and wellbeing of eligible adults aged 40 – 74years (i.e. without specific pre-existing conditions) through the promotion of early awareness, assessment, and management of the major risk factors of diabetes (Source: NHS). 

The NHS (ICB and NHS England (NHSE)) commissions a range of prevention services which support the prevention and management of diabetes.  This includes: 

• Healthier You Diabetes Prevention Programme – Lincolnshire – Preventing Diabetes. 
• NHS Type 2 Diabetes Path to Remission Programme – Diabetes Remission Programme. 
• ‘Healthy Living’ for people with type 2 diabetes which is an online service to learn more about type 2 diabetes – Healthy living for people with type 2 diabetes. 
• NHS Digital Weight Management programme, for people who have obesity and a diagnosis of diabetes or hypertension or both – The NHS Digital Weight Management Programme. 
• Lincolnshire community based tier 3 weight management which includes weight management injections for the management of obesity for certain patients – Weight management injections. 
• The use of new technologies, such as continuous glucose monitors and hybrid closed loop systems that can help people with diabetes manage their blood glucose levels – Continuous glucose monitoring and hybrid closed loop for diabetes – NHS.  
• Much of the management and monitoring of diabetic patients, particularly those with T2DM, is undertaken by GPs and primary care team staff. The general practice QOF includes a range of indicators related to the management of diabetes.  Lincolnshire healthcare staff deliver the NHS England Diabetes Transformation Programme, specifically focusing on the NICE Three Treatment Targets, and Multidisciplinary Footcare. 
• Lincolnshire Community Health Service NHS Trust provides specialist diabetes care to patients with complex, intermediate diabetic problems by promoting healthy lifestyles, producing treatment and care plans and educating patients – Lincolnshire Community Health Services NHS Trust. 
• United Lincolnshire Hospitals NHS Trust provides a specialist diabetes service. This comprises inpatient diabetes management, managing diabetes related emergency admissions, diabetes education (for Type 1) and a specialist dietetic service –Diabetes medicine – United Lincolnshire Hospitals.  Some people from Lincolnshire will access out of county NHS hospital providers for specialist diabetes services.   
• A structured education programme is available for people with Type 2 diabetes.  SPIRIT’s EMPOWER programme, which is QISMET-accredited, is delivered in local groups, either face-to-face or virtually.   Each course is led by a Diabetes practitioner, lasts four hours, and focuses on essential lifestyle guidance and self-management strategies for individuals living with Type 2 Diabetes. 
• The National Diabetes Eye Screening Programme offers an annual screening test for diabetic retinopathy to everyone with diabetes aged 12 and over. 
• Diabetes UK provide products and services to help people manage diabetes.

There is a countywide diabetes steering group, which includes a wide range of stakeholders, and oversees the diabetes work programme.   

Estimated diabetes prevalence for Lincolnshire is higher than registered prevalence, suggesting many in the population have undiagnosed diabetes. Many people have T2DM for years without realising because early symptoms tend to be general. Raising awareness about diabetes for the whole population, and use of diabetes screening tools, will enable people with a confirmed diagnosis to be offered help and prevent unwanted complications. 

In addition to diagnoses, there is a continual need to identify and offer interventions for people at risk of diabetes. This partly achieved by the NHS Health Check Programme, National Diabetes Prevention Programme, and other risk assessment tools. 

Prevention of obesity is complex and challenging at the population level. The food and physical activity landscape of the UK contribute to an overly obesogenic environment. Nonetheless the known inequalities of childhood obesity demonstrate that weight gain is not inevitable. It is linked to an individual’s environment and their resources – as these constrain their ability to choose less convenient, maybe more expensive options, when making choices regarding nutrition and activity. There are gaps in addressing excess weight and obesity across the four-tiered service model. The JSNA Healthy Weight topic provides further information. 

Data from the National Diabetes Audit (NDA) show variation in diabetes care across general practices which need to be addressed if people are to be provided with optimum care. This is somewhat addressed by the NHS England Diabetes Transformation Programme. NICE guidance includes education recommendations for patients of both T1DM and T2DM. There are known gaps in the delivery of NICE recommendations in the county.

• Continue to take action on obesity and physical activity by implementing the priorities and objectives in Lincolnshire’s Joint Health and Wellbeing Strategy. 
• Continue to deliver the programmes and services that support with diabetes prevention, focusing on communities with the greatest health needs. 
• Continue to deliver the diabetes parts within the Delivery Plans for the NHS Lincolnshire Joint Forward Plan.  
• Continue to provide the healthcare checks (the eight care processes), to reduce the chance of people developing complications of diabetes and address any variation that has been identified by the National Diabetes Audit.  
• Embed the prevention, identification and management of diabetes in the Lincolnshire Neighbourhood Health Service developments.