Recent PostsOrganic Gemini Launches TigerNut Clusters Crunchies Freeze-Dried Snacks Keep It Simple with Just One Ingredient But My Family Would Never Eat Vegan! About Us & ContactVegan Magazine advocates health for people, animals and the planet through a whole foods, plant-based diet. Diabetes occurs when the body does not produce enough insulin, or when the insulin produced is not used effectively. In 2011, 6.1% of Canadians aged 12 or older reported that they had diabetes, unchanged since 2007.
Throughout the period from 2001 to 2011, males were more likely than females to report that they had diabetes.
Because diabetes is strongly related to age, provinces and territories with disproportionately 'younger' populations are expected to have lower diabetes rates than the national average. Additional data from the Canadian Community Health Survey are available from CANSIM table 105–0501. 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.
The diabetes rates were at approximately the national average in Prince Edward Island, Quebec, Manitoba, Saskatchewan, and Yukon2. 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.
Even if they aren’t having symptoms, people who are obese, older or have a family history of diabetes, as well as African Americans, Mexican Americans and American Indians, are at increased risk of developing type 2 diabetes.
To remove the effect of different age distributions, the diabetes rates were recalculated as if the age groups in each province and territory were the same as at the national age distribution. 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. When this was done, Quebec and British Columbia were the only provinces and territories with age-standardized rates lower than the national average. 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. Alberta and Northwest Territories joined Prince Edward Island, Manitoba, Saskatchewan and Yukon in the group of provinces and territories whose diabetes rates were about the same as the national average. 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.
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.
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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