joint strategic needs assessment foundation profile - JSNA

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10.3 Diabetes
10.3.1 Risk Factors
There are some postulated risk factors for diabetes. For type 1 diabetes, less is known
about the risk factors than for type 2 diabetes, but family history can play a part. For
type 2 diabetes, obesity is a key risk factor and family history is important. With the
prevalence of obesity increasing nationally it is anticipated that the prevalence of
diabetes will increase. Indeed in some areas of the country it is reported that the
prevalence of type 2 diabetes is increasing by 15% per year (Roberts 2007).
Being overweight increases the risk of diabetes considerably (Wild and Byrne 2006). In
a 14 year follow-up period, the risk of developing diabetes in nurses aged 30-55 years at
baseline was 49 times higher among women whose baseline body mass index (BMI)
was more than 35 compared to women whose baseline BMI was less than 22. A BMI of
22.0-22.9 also increased the risk of developing diabetes compared to women with a BMI
of less than 22. Similar findings have been reported for men from a United States
cohort of 51,529 male health professionals aged 40-75 years in 1986 who were followed
up until 1992.
However, other risk factors which have been reported for diabetes include: family
history, impaired glucose tolerance, low activity level, poor diet, being overweight,
having excess body weight particularly around the waist area, ethnicity, high blood
pressure, high levels of triglycerides in the blood, and a high level of high density
lipoprotein (HDL) cholesterol. In addition for women: polycystic ovary syndrome,
diabetes during a previous pregnancy or having given birth to a heavy (9lb+) baby. It is
also possible that alcohol can increase the risk of developing diabetes due to the
damage alcohol can cause to the pancreas. Most of these risk factors are discussed on
diabetes.co.uk (Diabetes.co.uk 2009).
10.3.2 Diagnosed and Modelled Prevalence
As part of the Quality and Outcomes Framework (QOF), general practices compile
disease and medical condition registers. From these registers, the prevalence of these
various conditions can be estimated. However, there may be a high proportion of
patients who have the disease or medical condition, but it is undiagnosed and the
patient is not included on the register(s). Furthermore, the figures are unadjusted for
influencing factors, such as the age of the patients and deprivation. Practices with a
high proportion of elderly patients and practices in the most deprived areas will tend to
have a higher prevalence of disease (and generally a higher prevalence of undiagnosed
disease). See section 12.13 on page 782 for more information on QOF and issues
associated with presenting the prevalence at practice level. Also see Table 28 and
Table 49 for mean age of patients and mean deprivation scores for each practice (which
will influence the prevalence on the disease registers). One such register is for
diabetes, which covers patients with diagnosed type 1 or type 2 diabetes who are aged
17+ years.
Joint Strategic Needs Assessment Foundation Profile – Hull Health Profile: Release 3. March 2011. 564