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Diabetes-planning for the future
By Niall Hunter-Editor
A major shakeup of the provision of diabetes care in Ireland has been recommended in an as yet unpublished Government working group report.
The report, seen by irishhealth.com, calls for the establishment of a register of all diabetes patients in Ireland; for the development of shared care schemes between GPs and hospitals and for the development of more specialist hospital units; for patients to have timely and equitable access to primary care and regional specialist diabetes services; for more effective screening programmes for diabetes, including diabetic eye disease, and for the urgent development of podiatry services to prevent diabetic foot problems and amputations.
The report also recommends that strategies be developed to identify and treat people who may not know they have diabetes.
The working group, chaired by Department of Health Chief Medical Officer Dr Jim Kiely, says the incidence of diabetes is increasing in all age groups in Ireland.
Type I (insulin dependent) diabetes is increasing in children, particularly in under-fives while Type 2 (non-insulin dependent) diabetes is increasing across all age groups.
In Ireland, the incidence of type 1 diabetes is 16.8 per 100,000, which is above the European average, according to the report.
The report says there is a lack of data on the prevalence of diabetes in Ireland. It is estimated that for every diagnosed case of type 2 diabetes there is one case undiagnosed.
However, international research has estimated the prevalence of diabetes as being between 10% and 14% of the population aged over 40,with the World Health Organisation (WHO) estimating that the incidence of diabetes for all age groups will reach 4.4% of the world’s population by 2030.
The WHO, according to the report, estimated that there were 86,000 people with diabetes in Ireland in 2000 and that this will double to 157,000 by 2030.
The report says there were nearly 39,000 admissions to hospital with a diagnosis of diabetes per year in Ireland in 2003.
It identifies priorities for patient care in diabetes as:
*Care delivered by appropriately trained healthcare providers subject to audit
*Patients in high-risk groups getting timely access to appropriate treatment
*An agreed management plan for each patient
*Timely access to local services, both GP and hospital-based
*A comprehensive review at least once a year of each diabetic patient
*Management of cardiovascular problems associated with diabetes
*Screening for diabetic eye disease, which can lead to blindness if detected too late
*A full podiatry foot assessment at least once a year
*A consultation with a dietitian following diagnosis
*Access to smoking cessation services and psychological support
*Including each patient on a diabetes register
*Better patient education about their condition.
The report says the proposed patient register would be linked to primary care and hospital units and would allow for recall and review of patients.
On diabetes prevention, the report states that peripheral vascular disease and amputations are major complications of diabetes and much of this is preventable.
It calls for major diabetes prevention and screening programmes for the population as a whole and for high-risk groups. A structured screening programme for diabetic eye disease (retinopathy) should be provided nationally, according to the working group.
It says podiatry services should be developed as a priority issue to prevent footcare complications in diabetes patients. At present, there is a major shortage of podiatry services.
The report says services should focus on reducing health inequalities due to diabetes, with particular attention required for young people, ethnic groups and pregnant women.
It says 'shared care', where diabetes management is shared between GP/primary care and hospital services, is the best way of delivering high quality services.
It proposes a new model of diabetes care that includes:
*Diabetes networks: local diabetes service development groups to plan services for each region
*The development of shared care between GPs and hospitals, with the majority of care for type 2 diabetes delivered by GP teams
*Multidisciplinary primary care teams, to include GPs, specialist nurses dietitians, podiatrists etc, to manage diabetes patients
*Prevention and screening programmes to include health promotion, public education and targeted screening of at-risk groups
*Hospital-based specialist centres linked with primary care and rehabilitation services.
The report says the development of diabetes services should be prioritised at national level and be reflected in the HSE's national service plan.
The working group says its plan will require investment and implementation and should be phased in over six years.
It says the location and further development of the new services it outlines should be addressed by the HSE.
The diabetes taskforce also calls for the implementation of the recommendations of the National Taskforce on Obesity. Due to the dispute last year between the Department of Health and consultants on malpractice insurance, consultant members of the working group withdrew after one meeting. According to the Department, further work now needs to be done with all those with an interest in diabetes to finalise a diabetes strategy.
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