Diabetes mellitus is a condition in which the amount of sugar in the blood is too high because the body cannot use it properly. There are two main types of the condition.
Type 1 diabetes develops if the body cannot produce any insulin from the pancreas. Insulin is a protein hormone which helps the sugar to enter the cells where it is used as fuel by the body. Type 1 diabetes usually appears before the age of 40. It is the less common of the two main types and accounts for around 10 % of all people with diabetes.
Type 2 diabetes develops when the body can still make some insulin, but not enough, or when the insulin that is produced does not work properly (known as insulin resistance). In most cases this is linked with being overweight. This type of diabetes usually appears in people over the age of 40, although in South Asian people it can often appear after the age of 25. Recently more children are being diagnosed with the condition as well, some as young as seven. Type 2 is the more common of the two main types of diabetes and accounts for around 90% of people with the disorder.
Diabetes is one of the most prevalent medical conditions in the population. The UK is currently facing a huge increase in the number of people with diabetes. Since 1996 the number of men, women and children diagnosed with diabetes has increased from 1.4 million to 2.9 million. At current rates it is estimated that by 2025 some 5 million people in this country will have diabetes. Of these the vast majority will have type 2 diabetes because our population is getting older and increasingly overweight.
Right now there are more than 366 million people in the world with diabetes. In the UK 1 in 20 people has the disease, with more than 400 people diagnosed every day. In this country alone there are also an estimated 850,000 people who already have diabetes which has not yet been diagnosed. To put this into a local context, 17% of the in-patients at Watford General Hospital at any one time have diabetes, which is virtually the only medical condition that can be found on every ward.
Managing diabetes is therefore very labour intensive and requires huge resources. It is currently estimated that about £10 billion is spent by the NHS on diabetes per annum. This works out at around 10 per cent of the NHS budget (with a 2012/2013 budget for the NHS of approximately £109 billion). Or:-
- £192 million a week
- £27 million a day
- £1 million an hour
- £17,000 a minute
- £286 a second
The total cost (direct care and indirect costs) associated with diabetes in the UK currently stands at £23.7 billion and is predicted to rise to £39.8 billion by 2035/6.
Dr Michael Clements was a junior doctor in Watford in the late 1970’s and he went on to train in diabetes in London, Cambridge and Manchester before he was appointed as a consultant endocrinologist at Watford General Hospital (now the West Herts NHS Trust) in 1989. He has worked locally for the whole of his consultant career to create a centre of excellence at the hospital for the treatment of patients with diabetes. This has involved a long collaboration with many specialists and trainees combined with the support of hospital management, a number of charities, individual patients, local diabetic organisations, and not least the pharmaceutical industry with whom he has had many joint research projects. Finally he accrued enough funding to refurbish a large detached building at the front of the hospital which was opened in October 2012 and named the Michael Clements Diabetes Centre in his honour.
The Centre has brought together all the diabetes specialists, trainee doctors, diabetes specialist nurses, dietitians and secretarial support under one roof to provide a highly coordinated service. It contains modern comfortable consulting rooms for patients, educational facilities, meeting and lecture rooms as well as a metabolic day unit for the biochemical investigation and treatment of patients.
The aim of the Diabetes Centre is to become a beacon site for the management of diabetes locally and an important resource for the community. It is providing increasing availability to structured education for patients with diabetes and members of staff and will allow patients, particularly those with type 1 diabetes, more direct access to specialist teams and technically sophisticated treatment. The new Centre will also provide enhanced training for the next generation of diabetes clinicians, which in light of the astonishing rise in the frequency of the condition, is vitally important.
This is a very exciting time for the world of diabetes. More is known about the condition than ever before. Much more work is being done on prevention of the condition by healthy diet and exercise, and many ways are now known to reduce the risk of medical complications. Multiple new therapies have become available in recent years and with technological advances treatment has become highly successful so that patients can lead increasingly normal lives. Young patients can use monitors to continually record their blood sugar and treat their diabetes with sophisticated mini-pumps. Trials are underway to delay or reverse the disease at diagnosis, and for longer standing patients transplantation of insulin-producing cells is being developed at several national centres. Discoveries are likely to proceed at a rapid pace but with financial austerity and the changing structure of the NHS increasingly innovative ways will need to be found to support local diabetes services for all our community.