Should diabetics be more independent with their healthcare?

By Matt Bryan

After criticism from MPs, the healthcare of diabetes in the UK is being closely examined and this raises the question of how independent the patient should be.

Too many people with diabetes are developing complications because they are not receiving the care and support they need, according to a report by the Public Accounts Committee (PAC).

Barbara Young, Chief Executive of Diabetes UK, said: “This report sets out how a postcode lottery of care has been allowed to develop that means too many people with diabetes are getting healthcare that is simply not good enough. Given all the increasingly strong evidence of inadequate care, we simply cannot understand why the NHS has sleepwalked into this situation.”

Many specialists have claimed that this criticism has been unfair, simply due to the increase of diabetic patients. In particular, Type 2 patients who are generally diagnosed at a later age. Many factors cause this, however obesity is the primary driving force. As obesity figures in Britain have risen it subsequently increases the number of diabetes patients.

Diabetes specialist Naveed Sattar from University of Glasgow disagrees with the criticism the NHS is receiving.

He said: “I think it’s been unfairly criticised. If you look at the trend in health statistics you will see that diabetic patients are actually living longer than ever. Their rates of heart disease have come down substantially. There is also emerging evidence that there are now less amputations.

“On the other hand there are an increasing number of individuals developing diabetes which is a big concern. This is because of two main factors: The rising levels of obesity; and an increasing life expectancy. If people are kept alive longer then they have longer time to develop diabetes. These two things are pushing more people into the pot and providing huge amounts of pressure on the system in terms of workload. That is where the criticism has come from.”  

Almost three million people in the UK have diabetes. Only 10 per cent of these have Type 1, which is insulin dependent. This is generally treated and monitored by the patients themselves which makes it arguably a more independent disease.

“People with Type 1 diabetes are not left alone by any means,” Naveed stresses. “If anything they are seen more commonly in hospital settings with specialists than are patients with Type 2.

“It is a misnomer that people with Type 1 are left alone. That is completely not the case. The vast majority of Type 2 patients are only seen in their general practice. Type 1 patients receive more specialist care. This almost trains them into a more structured way of looking after themselves and we believe they are in good hands that way.

“The average age of developing Type 1 diabetes is 14, but many cases develop at a young age where the patient’s parents are usually the sole carers of the disease. Receiving this much care early on in life is good for children with diabetes as it blends in with the rest of their upbringing, so like everything else they will learn to be independent with their healthcare.

“However, it is still vital that specialists check diabetic patients regularly, and I am confident that Type 1 patients in particular are very well looked after by diabetes specialists.”

Deborah Harris, 24, from Motherwell says: “I am independent but I rely on check-ups and test results to ensure everything is all right and everything is working fine.

“I certainly still think I need advice every so often on my diabetes. Furthermore, I think it is important that my blood is taken and tested. The most important thing is that specialists know how you are doing because things can change very quickly with Type 1.”

Specialist care is important to diabetics in the long term, with there being many different types of insulin, doctors can make adjustments all the time based on the patient’s diet, growth, and lifestyle. However, the responsibility lies with the patient and they have to look after themselves.

Hannah Webster, 17, a student from Manchester agrees with this. She said: “I think it has to be a team effort. There is only so much the Health Service can do and it us that manage it every day. It is our condition, so we have to deal with it.”

There are many things in Type 1 diabetes that are still to be determined such as when it is appropriate to start treating their heart disease risk, and at what age should a cholesterol tablet be issued. This is because diabetes can develop at any age. And the younger the patient is when diagnosed, the more exposure they have to further complications.

It is therefore essential to stay educated and be aware more than anything of how diabetes works. Stuart Hunt, 39, is an engineer from Swindon, however he also studies diabetic nursing.

He said: “I started the course because I became my own carer when I developed Type 1 diabetes. I have gained so much from it and it has made me more aware, and very independent.”

It is clear the main goal with Type 1 diabetes is to control blood sugar levels throughout the patient’s life and ensure stability that will prevent complications as they get older.

Alice Knight, 20, student from Salford insists diabetics need to be independent. She said: “I think it is very important that we can deal with everything ourselves, but support should not be denied.  

“We need guidance from specialists to keep us in the loop. Although, without confidence and independence, how are we supposed to manage and accept our conditions?”

Despite recent criticisms, the treatment of diabetes has a lot of positives. There are improvements all the time. The most successful breakthrough has been the introduction of insulin pumps which has allowed insulin to get to the body more efficiently. However, no matter how easy the condition becomes to control, the responsibility will always be in the hands of the patient.

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