Warning over cost of diabetes complications

Funding being spent
  • Deborah Condon

Diabetes costs the health service around €2 billion per year, however very little of this money is spent on the prevention or effective self-management of the condition, leaving people at an increased risk of developing complications earlier, Diabetes Ireland has warned.

According to the national charity, there are an estimated 225,000 people living with diabetes in Ireland and this figure is projected to increase to over 278,000 by 2030.

The current cost of managing the condition is estimated to be 12-14% of the entire annual health budget - that is around €2 billion. But because this money is not being spent on prevention and effective self-management, people are presenting to the health service earlier with a range of complications, such as heart, eye, kidney and foot problems.

Speaking to TDs and Senators on World Diabetes Day (November 14), the charity pointed out that an estimated 65% of the annual diabetes budget is spent on dealing with these complications, with the remaining money being spent on things like staff, medication and blood glucose monitoring.

It insisted that a short-term focus on annual budgeting and cost savings has led to sub-optimal long-term outcomes for patients.

For example, figures just obtained from the HSE by Diabetes Ireland show a significant year-on-year increase in the number of people with diabetes who have been admitted to hospital for lower limb amputation or foot ulceration treatment.

The number of people admitted in 2018 was 3,378, up from 2,628 in 2017. In 2018, the largest increase was seen in Dublin, with an extra 300 people admitted for treatment, compared to the previous year.

According to the figures, between 2015 and 2018, a total of 11,240 people were admitted to hospital for lower limb amputation or foot ulceration treatment. At a conservative cost of €30,000 per admission, that amounts to over €330 million.

Research has shown that with earlier detection and outpatient treatment, up to 70% of these admissions could have been preventable. However, Diabetes Ireland pointed out in the last three years, there has been no investment in HSE community podiatry services.

Meanwhile, using the information available in a 2018 HSE survey of all public hospitals, along with other information available, the charity emphasised that there are simply not enough staff to cope with demands in this area.

For example, the number of full-time consultant endocrinologists working in this area is estimated to be 72% lower than the recommended international minimum levels, while the number of registered dietitians is 74% lower. There is also a 32% deficit in podiatrists, a 19% deficit in specialist nursing staff, and shockingly, a 95% deficit in psychologists working in this area.

"We need to critically look at the current cost of diabetes care with a view to working towards the development of a long-term plan, which has agreed cross party support for multi-annual budgetary allocations, so people with diabetes can get regular care and support to help them avoid developing the potentially devastating complications of poorly managed diabetes," commented Dr Anna Clarke of Diabetes Ireland.

She added that the Irish health service needs to move away from this "silo" way of thinking and look at delivering "a fully resourced integrated diabetes service".

"Otherwise, diabetes is just going to cost more and more, with funding spent in the wrong areas."

For more information on Diabetes Ireland, click here.


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