Poor diagnosis and ineffective diabetes treatment 'puts lives at risk'

1st March 2011 - Poor diagnosis and ineffective treatment are putting people in England and Scotland at risk of early death from diabetes, according to a study.

Researchers tried to find out the reason behind such failings in seven countries. They looked at how the health services of England, Scotland, the US, Colombia, Iran, Mexico and Thailand dealt with diabetes.

The research found that although diabetes rates were lowest in England and Scotland, both countries performed poorly when it came to meeting treatment targets.

The study also included the diagnosis and treatment of other heart disease risk factors such as high blood pressure and high levels of cholesterol.

Socio-economic factors ‘unimportant’

Overall, the researchers from the Institute for Health Metrics and Evaluation (IHME) at the University of Washington found that a country’s relative wealth had no bearing on the standard of diagnosis or treatment of diabetes.

It is estimated that around 6.4% and more than 280 million people in the world have diabetes. There are 2.8 million people diagnosed with diabetes in the UK and an estimated 850,000 people who have the condition but don’t know it.

Among the seven countries in the study, Mexico stood out as having the greater prevalence of the disease, with 24% of men and 21% of women over the age of 35 having it. England and Scotland had the lowest prevalence.

Treatment targets

In all surveys only a small fraction of individuals with diabetes met treatment targets. The United States was the best performer, with about 26% of individuals with diabetes meeting treatment targets. In Colombia, 27% of men and 24% of women were meeting the targets. The researchers found that England and Scotland were among the worst performers.

Overall, high blood pressure was a common problem across all the countries. The worst rates were found among women in Scotland and the lowest rates in Mexican women. Both Scotland and England scored well when it came to diagnosing cases of high blood pressure.

‘Missed opportunity’

"Too many people are not being properly diagnosed with diabetes and related cardiovascular risk factors, said Stephen Lim, an associate professor of Global Health at IHME and a co-author of the study. “Those who are diagnosed aren't being effectively treated. This is a huge missed opportunity to lower the burden of disease in both rich and poor countries."

However, the authors also acknowledge that improvements might have been made in England and Wales as a result of changes in guidelines for diagnosis and treatment introduced by the National Institute for Health and Clinical Excellence (NICE) in 2004, a year after the study data was recorded

Dr Iain Frame, Director of Research at the charity Diabetes UK, says in an emailed statement: “This study ... has a number of limitations which the researchers have also highlighted. These include using data that is no longer recent which means that changes in diagnosis and treatment guidelines have occurred in several of the countries since the study.

“Much of the analysis is self-reported and there was only a small number of individuals taking part in the surveys in Colombia, England and Scotland. These and other limitations concerning the way the research was conducted mean that it is not possible to make reasonable recommendations on the basis of this research that will be meaningful to policy makers and people living with diabetes.”