The Scottish Public Health Observatory estimated that there could be as many as 10,000 people with undiagnosed diabetes in Greater Glasgow and Clyde. What is the Health Board doing to identify these people, before the complications of diabetes become evident?
As you will be well aware, there are a range of risk factors linked to lifestyle which can signal a higher potential to develop Type II diabetes in particular. In general terms, NHS Greater Glasgow and Clyde’s health improvement policies are aimed at prevention of ill-health as much as they are about alleviating and managing conditions once they have developed. Consequently, much of the action we have in place to tackle the growing problem of diabetes is not necessarily badged as specifically addressing that condition.
Examples of this include the major smoking cessation programme we have available to everyone in Greater Glasgow and Clyde, either on a walk-in basis or via GP referral. We also have in place joint initiatives with local authorities and health professionals, again accessed via GPs, to encourage individuals to become more active and there is also our very successful Glasgow Weight Management Service, which shortly is to be joined by a parallel programme in Clyde. Thus we have a fairly comprehensive approach to the main behavioural factors that may lead to diabetes.
However, we do not feel that a systematic programme to screen all individuals for undiagnosed diabetes would be cost effective. Rather, our aim is to target particular communities which have greater prevalence of ‘high risk’ behaviours and health trends. In such communities, in partnership with GPs, we are screening people at risk – patients with a family history of diabetes, or who are overweight or have concomitant problems with hypertension. As you will know from your previous background, NHS Greater Glasgow and Clyde has participated in the first and second ‘waves’ of the Keep Well national initiative.
In addition to the above, there are educational programmes in place in relation to both Type I and Type II diabetes. These are DESMOND (Diabetes Education and Self-Management for Ongoing and Newly Diagnosed) and DAFNE (Dose Adjustment for Normal Eating) and also an independent programme tailored for patients of Asian origin.
DAFNE has been piloted at the Victoria Infirmary and this has proven to be highly successful. However we do have problems in recruiting appropriately trained staff and this is hindering our ability to roll the programme to every area. Other programmes, including DESMOND, have been rolled out widely.
Lastly, our Managed Clinical Network for diabetes is instrumental in developing policy and clinical practice.