Diabetes: Diagnosis, Treatment and Prevention in Brent
This report provides an update for the Overview and Scrutiny Committee on diabetes services in Brent. It focuses on high risk factors, prevention, diagnosis and treatment initiatives in Brent and also addresses the system-wide approach to addressing the challenges of managing diabetes.
Dr Shazia Siddiqi (Clinical Director, Brent Clinical Commissioning Group (CCG) introduced the paper which provided an update on diabetes services in Brent, focusing on high-risk factors, prevention, diagnosis and treatment initiatives. Dr Siddiqi said that it was estimated that the total number of adults with both Type 1 and Type 2 diabetes in England was 3.8 million people, 90% of whom had Type 2 diabetes, costing the National Health Service (NHS) approximately £10 billion a year. She directed Members’ attention to table 7 on page 55 of the Agenda pack which showed how Brent compared to other boroughs. Prevalence of diabetes in Brent was higher than the national average and Public Health England had estimated that there were approximately 7,500 undiagnosed patients so engaging them should be a key priority for Brent Council and Brent CCG. Dr Siddiqi spoke of the Public Health England Diabetes Prevalence Model which had found that diabetes was more common in men, people from South Asian and Black ethnic groups and older members of society.
Dr Melanie Smith (Brent Council’s Director of Public Health) spoke about the need for a whole population approach to be adopted to prevent diabetes and she noted that intervention should be underpinned by three objectives – encouraging physical activity, reducing weight and eating a healthy diet. She referred to heath checks that had been commissioned from patients’ General Practitioners (GPs) (section 5.2 of the report on page 43 of the Agenda pack) and said that the Brent Integrated Diabetes Service had been launched in October 2014. Its main focus had been to strengthen and increase the overall management of the condition, improve health and reduce health inequalities among the Borough’s population and deliver high quality services that were easily accessible. Dr Smith explained that more information about the services available at different tiers could be found in Table 5 on page 47 of the Agenda pack.
Introducing diabetes.co.uk Charlotte Summers (Chief Operating Officer, diabetes.co.uk) said that it was the world’s largest diabetes community, providing a platform to facilitate conversation between people affected by the condition. The organisation had developed a low carb programme and had been working on weight loss, among other initiatives aimed at empowering people to achieve remission of Type 2 diabetes. Members heard that information could be tailored according to individual needs and it could be accessed online and on mobile devices to increase flexibility.
The Chair invited the Diabetes Community Champions present at the meeting to share their experiences. Tony Hennessey spoke about his experience of engaging people at various events ranging from health fairs, though visiting community groups to holding stalls at Brent Civic Centre. He emphasised the importance of getting the right message to residents and educating them about diabetes. Dee Sime shared her personal experience of being diagnosed with borderline Type 2 diabetes and the measures she had taken to try and reverse the condition. Ms Sime explained how she had decided to become a Diabetes Community Champion in February 2015 and said that her goal as a Champion was to share her knowledge and encourage people to be physically active. Responding to a question about engaging young people, Mrs Sime said that she had noticed that a large number of people thought that diabetes affected older people. She added that as a significant proportion of young people she had met at events did not think diabetes could affect them, it might be helpful to consider ways of raising awareness in schools and colleges. Dr Smith confirmed that engagement efforts had been focused on older age groups with the exception of some work that had been done with primary schools such as the Slash Sugar Campaign (a campaign about hidden sugar in food).
One of the reasons for high prevalence of diabetes in Brent was the ethnic composition of the Borough which was different from some of the other areas mentioned in the report. Dr Siddiqi emphasised the importance of promoting self-care, targeting vulnerable groups, including people with disabilities, and engaging communities to prevent the condition. Moreover, the Committee heard about a range of strategies and programmes related to tackling diabetes such as the Diabetes Action Group and the National Diabetes Prevention Programme, delivered by Public Health England, NHS England and Diabetes UK.
The Committee questioned the effectiveness of prevention programmes and enquired about the barriers to improvement. Dr Siddiqi responded that Brent Council and Brent CCG were optimistic about the National Diabetes Prevention Programme as it offered a combination of approaches to tackling the condition. In her view, any initiatives aimed at tackling diabetes had to look at a wide range of factors such as sugar in foods, eating patterns, diets and physical exercise, which had an impact not only on diabetes, but on conditions such as cardiovascular diseases and obesity. It was noted that if someone was in a pre-diabetic condition, it might be possible to prevent diabetes from developing, but this would be much easier of engagement and intervention had taken place earlier.
Dr Siddiqi spoke of the perception of food in some cultures as mealtimes were seen as an opportunity for the whole family to spend time together. People who had diabetes were often isolated at events as they could not eat the food on offer or required members of the family to prepare special dishes for them. Public Health England had developed structured learning sessions for GPs to engage families and look at how they cooked and how they viewed food. She also acknowledged that children had to be engaged and educated about the importance of eating a healthy diet, but this could take time and results would not be imminent. Dr Ajit Shah (Co-Clinical Director, Brent CCG) pointed out that preventing diabetes in Brent was a cultural issue and noted that activity levels of families in the Borough were not as good as in other areas of the country, despite the efforts of the Local Authority. In his view, the diabetes epidemic in the Borough could be reversed, but this required Public Health, the Diabetes Community Champions, GPs and residents to work together for the common benefit.
Ms Summers added that diabetes.co.uk had developed a targeted programme for South Asian communities living in Slough, focusing on specific aspects of their culture. However, a similar approach had not been taken in Brent, although work had been done on specific diets and individual programmes had been delivered in multiple languages, among which Hindi and Tamil. An additional barrier to tackling the conditions was that individuals often did not feel ill and either refused to visit their GP for a check-up or, if they had already been diagnosed, underestimated the risk to their wellbeing. Members expressed concern that the current arrangements did not allow clinicians to screen patients who were working as often services were not available outside working hours. Dr Smith noted that Brent was fortunate because GP surgeries were extending their hours and pointed out that preventing diabetes should be a result of striking balance between raising awareness and providing clinical assessments.
In response to a question that related to the recruitment and retention of Diabetes Community Champions, Councillor Hirani (Lead Member for Public Health, Culture and Leisure) reassured Members that the 40 Diabetes Community Champions that had been recruited so far came from a wide range of backgrounds and were representative of Brent’s community. They had been trained using the train the trainer model so when they attended events, they could spread their knowledge to a large number of people. Dr Smith added that the work Public Health had delivered in collaboration with the Champions provided the foundation of grassroots movement as they were local people who had given up their time and who delivered results as people often listed to them in a way they may not have always listened to professionals. Furthermore, Diabetes UK had provided ongoing support to the Champions and the Council had supplied the tools, such as leaflets and stalls, necessary to deliver engagement sessions, some of which had been culturally specific, i.e. focused on Diwalli.
As far as the recruitment of more Champions was concerned, Dr Smith explained that the decision whether to expand the programme or whether to replicate it in other areas would depend on capacity and funding. Councillor Hirani explained that the programme had been funded through a Public Health grant, which would not be available after 2020 when it was expected that retention of business rates would fund Public Health initiatives. The Council remained keen to recruit more Champions as long as it could offer them a decent level of support.
The Committee heard that as far as prevalence was concerned, the CCG was confident in the data presented in the report. However, attendance at the DESMOND one-day self-care management course had been an area of concern, because data had not been recorded accurately due to practices not coding patients correctly. In addition, figures for the undiagnosed population had been estimated on the basis of list sizes at GP practices, residents’ weight, age, and background, weight, and other risk factors. In a number of cases, people had been diagnosed with diabetes because they had visited their GP for other reason. In relation to pre- and post-natal prevention, tests results were kept on file and specialists followed up mothers with diabetes and their children.
In terms of expectations for the future, Dr Shah said that it would be a positive outcome if long-term complications of diabetes were prevented so patients could have meaningful lives. He stressed the importance of engaging patients soon after they had been diagnosed with the condition as early intervention maximased the chances to prevent complications and achieve remission which reduced the risk for individuals’ health.
(i) The contents of the Diabetes: Diagnosis, Treatment and Prevention in Brent report, be noted;
(ii) The Committee’s appreciation of the constraints on the Public Health budget be placed on record;
(iii)Brent Council considers increasing the number of Diabetes Community Champions and continues to provide support to them;
(iv)The work carried out by the Diabetes Community Champions be extended to include organising focused community engagement sessions; and
(v) A briefing for Ward Councillors on Brent Council’s Healthy Catering Commitment and Planning policies regarding fast food outlets near schools be organised
(vi)Supports the Healthy Catering Commitment and the work with takeaway owners around food preparation and cooking.