1. Diabetes Health intelligence Jon Walker Advanced public health analyst Surrey County Council Jon.walker@surreycc.gov.uk 020 8541 7827

2. Outline Prevalence Prevalence gap Risk factors Complications Care processes

3. Prevalence diabetes estimated and diagnosed

4. Current diabetes prevalence

5. Estimated percentage diagnosed

6. Prevalence gap

7. Risk factors Age Deprivation Ethnic background Weight/BMI Waist circumference Diet Family history High blood pressure or history of cardiovascular disease Polycystic ovary syndrome or who have a history of gestational diabetes Mental health conditions or learning disabilities Fasting plasma glucose of 5.5–6.9 mmol/l or an HbA 1c level of 42–47 mmol/mol [6.0–6.4%]

8. Guildford and Waverley CCG population

9. Deprivation

10. Ethnicity

11. Trend in excess weight among adults 11 Patterns and trends in adult obesity Adult (aged 16+) overweight including obese: BMI ≥ 25kg/m 2 Source: PHE NOO

12. Trend in obesity prevalence among adults 12 Patterns and trends in adult obesity Adult (aged 16+) obesity: BMI ≥ 30kg/m 2 Source: PHE NOO

13. Percentage of adults classified as overweight or obese (2012)

14. National Child Measurement Programme

15. Percentage children aged 10-11 having excess weight

16. Diabetes projections

17. Diabetes: the fastest growing health issue There are more than 5m people in England at risk of Type 2 diabetes Diabetes accounts for 10% of the NHS budget Strong international evidence for effectiveness of lifestyle interventions to lower risk

18. Non-diabetic hyperglycaemia NCVIN estimates for Surrey CC suggest a prevalence of 11.3% or 106,000 adults (16+) with non-diabetic hyperglycaemia (HbA1c 6.0% - 6.4%) Around 19,000 in Guildford and Waverley CCG 5-10% of people per year with prediabetes will progress to diabetes, with the same proportion converting back to normoglycaemia (Tabak et al)

19. Additional risk of complications

20. Diabetic retinopathy complications

21. Nights in hospital for diabetic foot disease per 1,000 diabetics

22. Nine NICE annual care processes HbA1c Blood pressure Cholesterol Serum creatinine Urine albumin Foot surveillance BMI Smoking Eye screening (NHS retinopathy screening)

23. Percentage patients receiving the eight care processes (2012-13)

24. Percentage patients receiving care processes

25. HbA1c (2013-14)

26. Diabetes education programmes

27. Further information JSNA CVD chapter (can we get it uploaded in time?) Diabetes community health profile (2013): http://www.yhpho.org.uk/resource/view.aspx?RID=8470 http://www.yhpho.org.uk/resource/view.aspx?RID=8470 GP practice profile: http://fingertips.phe.org.uk/profile/general-practicehttp://fingertips.phe.org.uk/profile/general-practice NCVIN CVD profile – diabetes (2015): http://www.yhpho.org.uk/default.aspx?RID=203617 http://www.yhpho.org.uk/default.aspx?RID=203617 Footcare activity profile: http://www.yhpho.org.uk/default.aspx?RID=116836http://www.yhpho.org.uk/default.aspx?RID=116836 CVD intelligence pack (2015): http://www.yhpho.org.uk/ncvinintellpacks/pdfs/09N_SlidePack.pdf http://www.yhpho.org.uk/ncvinintellpacks/pdfs/09N_SlidePack.pdf NICE guidance: –https://www.nice.org.uk/guidance/cg87https://www.nice.org.uk/guidance/cg87 –https://www.nice.org.uk/guidance/ng17https://www.nice.org.uk/guidance/ng17 –https://www.nice.org.uk/guidance/ng18https://www.nice.org.uk/guidance/ng18 –https://www.nice.org.uk/guidance/ph38https://www.nice.org.uk/guidance/ph38 NDA CCG profiles –Report 1 Care processes and treatment targets: http://www.hscic.gov.uk/catalogue/PUB14970 http://www.hscic.gov.uk/catalogue/PUB14970 –Report 2 Complications and Mortality: http://www.hscic.gov.uk/catalogue/PUB16496http://www.hscic.gov.uk/catalogue/PUB16496