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The presence of diabetes is based on the population aged 12 or older who reported that a health professional diagnosed them as having diabetes. Diabetes is an important indicator of population health because of its increasing prevalence, association with lifestyle risk factors, and far-reaching consequences. The aging population is the most important demographic change affecting diabetes prevalence worldwide. Family history (parent or sibling with diabetes) was associated with an increased risk of developing diabetes5. Diabetes becomes more prevalent with advancing age—1 in 6 senior males and 1 in 7 senior females reported a diagnosis of diabetes, compared with fewer than 1 in 200 people aged 12 to 24.
Overall, males were more likely than females to be diagnosed with diabetes, particularly at ages 55 or older.
These percentages were significantly different from the national percentage, even when accounting for the differing age structures in these provinces and territories.
Diabetes is a long-term condition in which the amount of sugar (glucose) in the blood is too high so that the body’s cells cannot use glucose properly. Type 1, which occurs mostly in childhood and young adulthood and is due to the failure of the pancreas to secrete insulin (the hormone which allow the cells to use glucose) and nearly always has to be treated with insulin injections. Type 2 occurs when the body cannot make enough insulin or when the insulin cannot work properly.
Diabetes leads to significant damage to the lining of blood vessels throughout the body leading to a variety of problems such as kidney failure, blindness, gangrene, loss of sensation and ulceration of the feet (see note 1), and to an increased risk of heart attack and an increased risk of dying from heart attack.
As diabetes can be asymptomatic it is difficult to estimate an exact prevalence in the borough. The proportion of people with diabetes has risen over the years and is higher in Enfield than in London or England (Quality and Outcomes Framework, QOF).
Comparisons between the predicted and recorded number of people living with diabetes in Enfield indicates that the gap between the diagnosed and estimated levels of diabetes may equate to as many as 2,688 undiagnosed cases of diabetes (14% of all expected cases). The proportion of people in Enfield with diabetes (diagnosed and undiagnosed) is predicted to rise by about 30% (5,700 people) by the year 2030 (Yorkshire and Humberside Public Health Observatory). Death rates from diabetes have been falling, with death rates in Enfield being similar to those in London and in England (Health and Social Care Information Centre). When diabetes is uncontrolled, the person may go into a diabetic coma and need emergency admission to hospital.
Lack of physical activity - it is estimated that if all the adult population met recommended levels of physical activity prevalence of diabetes in Enfield would be 14% less (1822 cases) (Health Impact of Physical Inactivity; Association of Public Health Observatories). A substantial number of the Enfield population are in higher-risk age bands (some 13,900 people aged 55-64 years, some 9,500 people aged 65-74 years and some 7,400 people aged 75 years and over). Many of the complications of diabetes can be prevented by a regime of treatment which keeps the blood sugar at the level it should be. People with diabetes can play a large part in looking after themselves and making decisions about their own care.
A National Diabetes Audit helps to monitor quality of diabetes care, and 22 out of 53 Enfield practices (41.5%) participate in this audit.
The rate of complications of diabetes in Enfield is higher than that for people with diabetes in England and Wales overall and this suggests that diabetes control is not as good as it might be. In a large number of patients in Enfield, diabetic control was good as shown by blood glucose (indicated by HbA1C), cholesterol and blood pressure. Data for all people with diabetes in Enfield (including patients of practices not taking part in the National Diabetes Audit) is available from Quality Outcome Framework (QOF) (see note 17).
In Enfield there is a specialist nurse diabetes team, which supports patients with diabetes and helps general practices to deliver diabetes care. There is a marked gap between observed and expected prevalence of diabetes; there is likely to be a group of residents currently undiagnosed and therefore would not benefit from advice and treatment. Diabetes is a common condition currently affecting about 19,000 people in Enfield of whom over 3,100 may be undiagnosed and are thus not being treated. The risk of developing diabetes increases with age, and above the age of 64 years, 1 in 7 people are likely to have diabetes. The complication rate for people with diabetes in Enfield is similar to the overall complication rate for England. General medical practice plays a very large part in management of people with diabetes and this is often shared with hospital care. The National Institute for Health and Care Excellence (NICE) has issued a very wide range of guidance on that management of diabetes over the years, including nine checks which should be carried out regularly on all patients with diabetes (NICE Guidance).
The proportion of people with diabetes who are well controlled in Enfield is similar to the proportion nationally.
Encourage and enable people to eat healthily and to have adequate levels of physical activity.
Continue to improve and support diabetes care in general practice and in hospitals in order to increase the proportion of people receiving all nine recommended checks each year. Further develop and encourage shared care between hospital diabetologists and primary care.
Monitor diabetes prevalence in Black, Asian and minority ethnic groups for which data is currently inadequately available with a view to identifying other high-risk groups. Note 1: Larger blood vessels have their own blood supply, that is small blood vessels that supply their walls and linings. Enfield Council uses cookies to improve your experience of our websites.To find out more about the cookies we use and how to delete them, see our cookie policy. The percentage of adults aged 45a€“64 and 65 and over with two or more of nine selected chronic conditions increased between 1999a€“2000 and 2009a€“2010.
The percentage of adults aged 45 and over with two or more of nine selected chronic conditions increased for all racial and ethnic groups between 1999a€“2000 and 2009a€“2010. During the 10-year period, the prevalence of two or more of nine selected chronic conditions increased for adults aged 45 and over in most family income groups. The percentage of adults aged 45 and over with the three most common combinations of the nine selected chronic conditions increased over the 10-year period. The percentage of adults aged 45a€“64 with two or more of nine selected chronic conditions who did not receive or delayed needed medical care in the past year due to cost, or who did not receive needed prescription drugs in the past year due to cost, increased over the 10-year period. Between 1999a€“2000 and 2009a€“2010, the percentage of adults aged 45a€“64 and 65 and over with two or more of nine selected chronic conditions increased for both men and women, all racial and ethnic groups examined, and most income groups. The percentage of adults aged 45a€“64 with two or more of nine selected chronic conditions who did not receive or delayed needed medical care due to cost increased from 17% to 23%, and the percentage who did not receive needed prescription drugs due to cost increased from 14% to 22%.
The percentage of adults with two or more chronic conditions increased for men and women in both age groups during the 10-year period (Figure 1).
In 2009a€“2010, 21% of adults aged 45a€“64 and 45% of adults aged 65 and over had been diagnosed with two or more chronic conditions. Between 1999a€“2000 and 2009a€“2010, the percentage of adults aged 45a€“64 with two or more chronic conditions increased 20% for non-Hispanic black, 35% for non-Hispanic white, and 31% for Hispanic adults (Figure 2). During this period, the prevalence of two or more chronic conditions among those aged 65 and over increased 18% for non-Hispanic black, 22% for non-Hispanic white, and 32% for Hispanic adults. In both time periods, the prevalence of two or more chronic conditions was higher among non-Hispanic black adults than among adults in other racial and ethnic groups. In both 1999a€“2000 and 2009a€“2010, the prevalence of two or more chronic conditions for adults aged 45a€“64 decreased with rising family income and was more than twice as high among those living in poverty as among those at 400% or more of the poverty level (Figure 3). Among those aged 65 and over, the percentage with two or more chronic conditions also decreased with increasing family income, but the percentage varied less by family income than among those aged 45a€“64. Between 1999a€“2000 and 2009a€“2010, the percentage of adults aged 45a€“64 with both hypertension and diabetes increased from 5% to 8% because of an increase in the share with hypertension and diabetes only, as well as an increase in the share with hypertension, diabetes, and additional chronic condition(s) (Figure 4). In 2009a€“2010, 23% of adults aged 45a€“64 with two or more chronic conditions did not receive or delayed needed medical care in the past year due to cost, and 22% did not receive needed prescription drugs due to cost (Figure 5). For adults aged 65 and over with two or more chronic conditions, there was no change in the percentage who did not receive or delayed needed medical care in the past year due to cost, while the percentage who did not receive needed prescription drugs in the past year due to cost increased over the 10-year period. These findings demonstrate the widespread rise in the prevalence of two or more of nine selected chronic conditions over a 10-year period. Growth in the prevalence of MCC was driven primarily by increases in three of the nine individual conditions.


Increases in the prevalence of MCC may be due to a rise in new cases (incidence) or longer duration with chronic conditions. The rising prevalence of MCC has implications for the financing and delivery of health care. Chronic disease, and combinations of chronic diseases, affects individuals to varying degrees and may impact an individual's life in different ways.
Estimates in this report are based on NHIS data, which provide information on the health status of the civilian noninstitutionalized population of the United States. All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated. Since the early 1980s, the prevalence of type 2 diabetes mellitus (DM) has doubled in Australians. According to the World Health Organisation (WHO), seven percent of populations in Western or developed countries suffer from diabetes and estimates are that by 2025, without significant lifestyle modifications, the number of people with type 2 diabetes will double to around 300 million people worldwide. The very good news is that type 2 diabetes is a chronic illness that can show significant improvement through the adoption of an integrated lifestyle approach. An assessment of overall lifestyle is the first step to responding to diabetes in an integrative way.
Of these, obesity is perhaps the most common risk factor for diabetes and with 60 to 70 percent of Australian adults being overweight, it is not surprising that diabetes is so common in this country.
When diagnosed with diabetes, typical medical interventions may include advice to limit some types of foods (particularly high-sugar content foods), increase exercise and single or combined drug therapies based on prescription medicines that control the blood glucose levels, but do nothing to deal with the cause of the disease. Integrative Medicine takes this one step further into an approach that has the purpose of modifying risk factors and can restore the body to achieve normal blood glucose without medication. Review diet and nutritional status – See a health practitioner who has dietary expertise for guidance. Engage in regular activities such as walking, tai chi, yoga and so on, and try to increase physical activities in daily life – walk instead of driving where possible, take the stairs instead of the lift, ride a bike or walk the dog, walk with a friend for social interaction and exercise that is effective and enjoyable. Smoking increases the risk of type 2 diabetes by approximately 50 percent and this figure increases the more a person smokes.
Magnesium, zinc and chromium are often deficient in diabetics and can support insulin sensitivity. An integrated approach is not only effective for diabetes, but will be protective against many other chronic diseases such as cancer and cardiovascular disease as well. Professor Avni Sali is Founding Director of the National Institute of Integrative Medicine (NIIM). The emergency admission ratios of a number of wards in the Eastern half of the borough, including Enfield lock, Enfield Highway and Edmonton Green have significantly higher emergency admission ratios than the overall Enfield ratio, with 13 of Enfield’s wards having significantly higher ratios than that of London. Deprivation has also been shown to impact upon the rate of emergency admissions, with data from 2008 suggesting that people living in the quintiles of highest deprivation in Enfield experience significantly higher rates compared to those living in the quintiles of lower deprivation (2). Looking at these admissions by age group, 383 were amongst children under the age of 5, the most common cause of which was acute respiratory infections (34% of admissions amongst under 5s). Emergency readmission rates are a measure of the effectiveness of a range of health interventions and social care services including enablement, rehabilitation and intermediate care, that are designed to help support people following periods of illness. As the graph above shows, there has been a gradually increasing rate of readmissions within 30 days between 2001 and 2011 in Enfield, London and across England. What is a skin tag?Skin tags are common, acquired benign skin growths that look like a small, soft balloons of hanging skin. View pictures of the most prevalent adult skin diseases such as eczema, shingles, psoriasis, rosacea and more.
Common complications include heart disease and stroke, vision problems or blindness, kidney failure, and nerve damage1.
Even if incidence rates were to remain stable, because of the growing number of seniors, the overall prevalence of diabetes would increase2,5. Rising percentages of Canadians in these categories7 could increase the prevalence of diabetes. While this may indicate a genetic predisposition, shared behaviours and increased awareness that leads to testing might also be factors associated with the family history.
The actual number of people with diabetes is likely to be even higher8 because many people with diabetes may not be aware of it. Females in the 25 to 34 year old age group were more likely than males to report such a diagnosis. An algorithm to differentiate diabetic respondents in the Canadian Community Health Survey. It used to be called ‘maturity-onset diabetes’ because it was normally only seen in people in their late 50s and 60s.
The predicted rise in Enfield is greater than that for England overall because the proportion of older people in the general population of Enfield is rising, as well as the number of people in ethnic groups with higher diabetes risk. Mortality rates fluctuate widely due to the small number of deaths and differences are not statistically significant.
As stated above these include heart disease, stroke, blindness, peripheral neuropathy and kidney disease, each of which has significant health and financial implications.
Other non-modifiable risk factors include ethnicity (Black African, Asian) and some medical conditions such as pituitary disease.
National data suggests that the prevalence of diabetes is about three times higher in people from India, Pakistan, Bangladesh and the Caribbean (Health Survey for England, 2004). In addition, a sizable proportion of the population come from ethnic groups with an increased risk of diabetes.
Most hospital care for people with diabetes in Enfield is provided by the North Middlesex University Hospital NHS Trust or Barnet and Chase Farm Hospitals NHS Trust. In Enfield, just over half of patients with diabetes (51.4%) cared for by practices participating in the National Diabetes Audit, had eight checks that they should have had in the past 15 months. The percentage of patients with good control was similar to that for the country generally.
These results appear slightly better than those recorded by the National Diabetes Audit, but these QOF data must be regarded as less reliable as practices that take part in the National Diabetes Audit may have better management of long-term conditions that those that do not. Enfield Diabetes Support Group, a branch of Diabetes UK, holds regular meetings for people with diabetes and their relatives at Chase Farm Hospital.
The risk of developing diabetes is also higher in people from India, Pakistan and Bangladesh as well as in Black Caribbean populations. Department of Health and Human Services established a strategic framework for improving the health of this population (2). The most common combinations of chronic conditionsa€”hypertension and diabetes, hypertension and heart disease, and hypertension and cancea€”rincreased during this time. During this 10-year period, prevalence of hypertension increased from 35% to 41%, diabetes from 10% to 15%, and cancer from 9% to 11%, among those aged 45 and over. The prevalence of obesitya€”a risk factor for certain types of heart disease and cancer, hypertension, stroke, and diabetesa€”increased in the United States over the past 30 years, but has leveled off in recent years (7a€“9). Persons with MCC are more likely to be hospitalized, fill more prescriptions and have higher annual prescription drug costs, and have more physician visits (3). Questions about all nine of the selected chronic conditions were answered by 30,682 respondents in 1999a€“2000 and 29,523 respondents in 2009a€“2010.
Multiple chronic conditions: Prevalence, health consequences, and implications for quality, care management, and costs. Recent trends in the prevalence of high blood pressure and its treatment and control, 1999a€“2008. In people with type 2 diabetes, there is a problem with the way the body uses or makes insulin. The ageing of populations and the effects of modernisation on lifestyle, especially through stress, lack of exercise and poor diet leading to weight increase, have resulted in a dramatic rise in the prevalence of diabetes globally.
As with other chronic illnesses, this is where Integrative Medicine has an important contribution to make to diabetes treatment and prevention. By adopting an integrated approach, diabetes sufferers have a real opportunity to actively manage their condition and for some people this means a reversal of the diabetic condition.
Just two hours walking (total) per week can significantly reduce mortality from all causes of disease, including diabetes. Activities such as walking, tai chi, yoga and so on, and try to increase physical activities in daily life – walk instead of driving where possible, take the stairs instead of the lift, ride a bike or walk the dog, walk with a friend for social interaction and exercise that is effective and enjoyable.


Both oversleeping and under-sleeping have been shown to increase the risk of developing diabetes. Smoking impacts on the pancreas, causes internal inflammation and increases abdominal fat – all factors that affect insulin resistance. In place of a top 10, the HNA toolkit provides hospital statistics for a range of common causes of admission.
Admissions for ‘other cancers' (including cancers of the blood, bone, and brain) had the highest rate of admissions of the cancer groups, but this may be influenced by the wide range of cancer types that fall within the ‘other cancer’ category. Admission rates for accidents, accidental falls, all respiratory diseases and infectious or parasitic diseases were significantly lower than seen across England. Admissions in Enfield for CHD have declined, but still remain statistically higher than the England rate. Amongst children under 2 years of age, there were 228 admissions, There were 838 admissions amongst people aged 65and over (42% of all admissions), of which 738 were aged over 70 years.
Examples include congestive heart failure, diabetes, asthma, angina, epilepsy and hypertension (3).Despite admission being largely preventable, a significant proportion of all acute hospital activity is related to ACS conditions. Learn about each skin condition, its diagnosis, symptoms, and treatment through doctor reviewed medical images of the most common skin problems. Global prevalence of diabetes: estimates for the year 2000 and projections for the year 2030.
But it is now seen in people of all ages and, most worryingly, in an increasing number of children.
A further 3,100 (roughly1% of the registered population) may have undiagnosed diabetes equating to an overall prevalence of 8.6%. Whilst there has been a general downward trend in the mortality rate from diabetes in Enfield, it should be remembered that the DSR is based on diabetes as the underlying cause of death. The rate of complications of diabetes in Enfield is higher than that for people with diabetes in England and Wales overall and statistically significant differences were found for both angina and renal replacement therapy. National Institute for Health and Care Excellence (NICE) has also published detailed guidance on different aspects of diabetes care for Type 1 diabetes (CG15), Type 2 diabetes (CG66), diabetic foot care (CG119), patient education models (TA60) and prevention (PH35) (NICE).
The proportion of patients with diabetes receiving each check was similar to national figures.
The group has also published a handbook “Living with Diabetes” (Enfield Diabetes Support Group, 2008), available at GP surgeries in Enfield in four languages (English, Turkish, Somali, Bengali).
Principally, because obesity is more common amongst people living in deprived areas, so too is diabetes.
This report presents estimates of the population aged 45 and over with two or more of nine self-reported chronic conditions, using a definition of MCC that was consistent in the National Health Interview Survey (NHIS) over the recent 10-year period: hypertension, heart disease, diabetes, cancer, stroke, chronic bronchitis, emphysema, current asthma, and kidney disease. Between 1999a€“2000 and 2009a€“2010, adults aged 45a€“64 with two or more chronic conditions had increasing difficulty obtaining needed medical care and prescription drugs because of cost. A limitation of this report is that it includes only respondent-reported information of a physician diagnosis; thus, estimates may be understated because they do not include undiagnosed chronic conditions.
Advances in medical treatments and drugs are contributing to increased survival for persons with some chronic conditions. Out-of-pocket spending is higher for persons with multiple chronic conditions and has increased in recent years (5).
For more information about NHIS, including the questionnaires used, visit the NHIS website. All comparisons reported in the text are statistically significant unless otherwise indicated.
Bernstein, and Mary Ann Bush are with the Centers for Disease Control and Prevention's National Center for Health Statistics, Office of Analysis and Epidemiology.
Insulin is needed for the body to move blood glucose into the cells where it is eventually used for energy production. The same lifestyle principles are also highly effective for preventing diabetes, particularly in those who are pre-diabetic. Low glycaemic index (GI) foods can be as effective as medication in improving glycaemic control in diabetes. Environmental lighting, longer working hours, TV and computer usage has all been shown to negatively impact on sleep patterns.
The conditions above represent the 10 greatest causes of admission in Enfield from a list of 37 conditions, the full list of which can be found at the HNA toolkit website.
People aged 65 and over were most commonly admitted for diseases of the urinary system (primarily urinary tract infections) which accounted for 306 admissions, and influenza or pneumonia, accounting for 271 admissions.
He obtained his BA degree in bacteriology, his MA degree in microbiology, and his MD at the University of California, Los Angeles. There he was involved in research in radiation biology and received the Huisking Scholarship.
Its principal cause is overweight and obesity and this is significant: as an increasing number of people become overweight and subsequently obese, we can expect an increasing number of people to develop diabetes. However, diabetes would have been an indirect cause in many more deaths by increasing the risk of other conditions such as heart attack, stroke and kidney failure. There is a mass of evidence that good diabetic care with good control of blood glucose levels better enables people with diabetes to live a normal enjoyable life and to avoid the serious complications of the disease. Damage caused to the vasa nervorum, because of diabetes, itself damages peripheral nerves, especially in the feet.
Examining trends in the prevalence of MCC informs policy on chronic disease management and prevention, and helps to predict future health care needs and use for Medicare and other payers.
During this 10-year period, death rates for heart disease, cancer, and stroke declined (9).
The four heart disease questions were combined into one variable and considered as one chronic condition. A key factor leading to diabetes is insulin resistance, resulting in the accumulation of glucose in the blood stream, a condition referred to as hyperglycemia (high blood glucose). Being pre-diabetic can be considered a wake-up call for good health – it means the conditions are present in the body for the development of type 2 diabetes, but there is a good chance these can be reversed.
The glycaemic index (GI) is a measure of how quickly the glucose in a food or drink is absorbed from the digestive system into the blood. Unfortunately, this is not achieved in a high proportion of diabetic populations leading to increased risk of complications. With, for example, a consequential loss of pain sensation minor damage to the feet goes unnoticed. In recent years, the percentage of Americans who were aware of their hypertension, and the use of hypertension medications, has increased (8). Other definitions of MCC are used in the literature and differ based on analytic objectives and the data sources used in the analyses (2,3). This occurs slowly over time and is a condition commonly found in the overweight and more likely in the elderly. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine.
And because the blood supply to the feet is compromised by the effect of diabetes on blood vessels supplying the skin and underlying tissues, small areas of damage heal poorly, if at all, leading to ulceration and further tissue damage including ‘dry’ gangrene where large areas of tissues, such as whole toes, literally die and become black and mummified. The medical name for skin tag is acrochordon.Skin tags are bits of flesh-colored or darkly pigmented tissue that project from the surrounding skin from a small, narrow stalk (pedunculated). There is also a form of diabetes called type 1 diabetes, which occurs in children and younger adults; however, type 2 diabetes is by far the most common form of diabetes.
Some people call these growths "skin tabs."Early on, skin tags may be as small as a flattened pinhead-sized bump. Unfortunately, because the blood supply to the feet is damaged, this surgical procedure runs the risk of leading to poor healing and ulceration and it is often necessary to make an amputation at a relatively high level to ensure an adequate blood supply to ensure adequate healing.



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