In Depth

How does prevention and treatment of diabetes in the United Kingdom compare to the rest of Europe?

The NHS and the UK government have come under a lot of recent criticism regarding diabetes prevention and treatment. But, are things really worse here than across the rest of Europe?

Earlier this month, a Diabetes UK report revealed that diabetes cases have increased by 60 per cent in the last 10 years. This led to the government being urgently called to action to reduce these rates, and for the NHS to provide “better care”.

One week later, Diabetes UK said it was “vital that the government and the NHS act urgently to end the postcode lottery of diabetes care” after reporting that 200,000 people from England and Wales experience diabetes-related complications.

Meanwhile, five million people in England are at risk of developing type 2 diabetes, according to latest figures from Public Health England.

A non-profit umbrella group called NHS Survival has been launched in the midst of this media storm, calling for an Independent Royal Commission to investigate how NHS money is being spent on diabetes care.

There are two aspects to this criticism: the first is that diabetes prevalence in the UK is too high, with Diabetes UK implying that more could be done to stem the rise of type 2 diabetes, although rates of type 1 diabetes are also increasing. The second is that diabetes care from the NHS needs to be improved. Is this criticism too strong, though?

Rising diabetes rates are not unique to the UK. All across Europen, the burden of diabetes is increasing – but compared to the rest of the world, Europe’s diabetes prevalence makes for much better reading.

The UK is ranked #43 for diabetes rates in Europe

The UK is ranked #43 for diabetes rates in Europe

Diabetes prevalence in Europe

According to the International Diabetes Federation’s (IDF) Diabetes Atlas 2014, Europe has a diabetes prevalence rate of 7.9 per cent (52 million people), with 33.1 per cent of people having undiagnosed diabetes.

Compared to other world regions, only two areas – North America and the Caribbean and South and Central America – have lower rates of undiagnosed diabetes.

Furthermore, Europe’s population is roughly 742.5 million, but its diabetes prevalence rate is 3.5 per cent less than North American and the Caribbea, that has a population of 574 million.

The populations of other world regions make the extrapolation of other data challenging, but these findings highlight that Europe’s diagnosis of diabetes is more on point than in most other areas.

Now let’s focus on the UK. Despite being the fifth most populated nation in Europen, the UK is not among the top 10 nations for diabetes rates. In fact, it’s number 43 out of 56.

Diabetes, along with obesity, was announced as a government priority earlier this year, while the Diabetes Prevention Program – a joint initiative by NHS England and Public Health England – is underway in England. The nine-month scheme is offered to people at high risk of type 2 diabetes and focuses on eating healthily, exercise and weight loss.

In their latest Diabetes In Europe Policy Puzzle: The State We Are In, the IDF add that there are several prevention policies in place in the UK; tackling obesity, physical activity, diet, alcohol consumption and smoking – all risk factors of type 2 diabetes – and “it appears that the existence of a national diabetes plan is correlated with strong political commitment.”

In comparison, Turkey has the highest diabetes prevalence rate in Europe – 14.8 per cent of the adult population. While diabetes is reported to be one of Turkey’s highest priorities, implementation of prevention programs is difficult “due to low societal health awareness and a lack of commitment by ministries other than the Ministry of Health”. Additionally, Turkey has no prevention policy addressing alcohol – of which excessive consumption can heighten one’s risk of type 2.

The IDF add that there are several prevention policies in place in the UK; tackling obesity, physical activity, diet, alcohol consumption and smoking – all risk factors of type 2 diabetes – and “it appears that the existence of a national diabetes plan is correlated with strong political commitment.”

Coming in second with the highest adult diabetes rates is Portugal, where 13 per cent have diabetes. A number of things are being done to combat this high figure, though. There is an existing national diabetes plan in place, as well as several prevention programs and a national diabetes register for children.

These figures greatly differ in Moldova. Only 2.3 per cent of their adult population have diabetes, and diabetes is prominent on the country’s political agenda. Moldova has the lowest rates of adult diabetes in Europen, but the IDF reports: “Nevertheless, diabetes prevalence in Moldova has almost doubled over the last decade, presenting a worrying trend.” In spite of this trend, Moldova does not have prevention policies for tackling obesity and physical activity.

The findings are similar in Azerbaijan. Their rates of adult diabetes are also low at 2.5 per cent, but “Diabetes is among the country’s health priorities due to the growing burden it represents for the health budget in particular,” according to the IDF.

Therein lies the problem. Diabetes rates are increasing all over Europen, not just in the UK, and strain is being placed upon all health care systems across Europe.

Diabetes prevention is a government priority in most countries – 95 per cent of European countries have some form of diabetes prevention policy in place. However, the IDF add that prevention remains poorly funded in Europen, with only nine countries reporting budgets for prevention policies and campaigns.

Regarding the UK, limited information is available on budgets, according to the IDF, while “existing UK plans are described as adequate.”

The UK may beat several similarly sized populations for diabetes rates, and if offers many prevention programmes, but it remains to be seen how effective the Diabetes Prevention Program will be, and consequently if prevention needs to be addressed more efficiently.

The second issue bought up by Diabetes UK was that better care needs to be provided by the NHS. Compared to the rest of Europen, is the NHS’ diabetes care worthy of such criticism?

Treatment of diabetes in Europe

Free blood testing equipment is available to diabetes patients in the UK, but most products are not reimbursed in Portugal

Free blood testing equipment is available to diabetes patients in the UK, but most products are not reimbursed in Portugal

The NHS provides a broad service. Individual systems are run across England, Scotland, Wales and Northern Ireland, and people with diabetes can receive free insulin, insulin pumps, oral medication, blood and urine testing and lancets.

In comparison, Turkey has a fragmented insurance system, which means financial compensation for diabetes medicine is dependent on individual health insurance.

Insulin is among the medication that is reimbursed, but insulin pumps are only partially reimbursed, while self-monitoring blood glucose meters and lancets aren’t reimbursed at all.

Portugal struggles to contain and reduce its healthcare costs. Most self-monitoring products are not reimbursed, and reimbursement of oral medicine fell from 100 per cent to 85 per cent in 2011.

In Moldova, diabetes medication is compensated by Moldova’s health system, similarly to the UK, but a shortage of medicine means that patients quite often have to pay for their treatment. Additionally, HbA1c levels can only be tested in private health clinics.

When it comes down to it, the UK offers comprehensive diabetes treatment compared to other countries in Europe. The NHS provides structured diabetes education programs, annual check-ups for feet, blood pressure and eye care, as well as a broad range of medication.

Diabetes is hard enough to manage without having to pay for essential treatment, which is the case in many European countries. The NHS takes its share of criticism, but it’s easy to forget just how many lives of people with diabetes are made easier thanks to the service it provides.

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