Diabetes in context

The cost of diabetes and its complications to the health service is huge – around 10 per cent of the total NHS budget, which equates to over £1.5m an hour and £14bn annually. The cost of medication for the complications of diabetes is estimated at three to four times that of medication for the condition itself. There are also significant costs on a wider societal level stemming from diabetes, with some £8.4bn a year spent on covering work absence, £6.9bn on early retirement and over £150m on benefits.

There is much that can be done to delay or even prevent diabetes complications and reducing the burden in terms of ill health – mental as well as physical – and disability, which also impacts on the family and friends who support individuals with the disease.

Understanding complications

A number of problems can arise as a result of diabetes. These can be categorised as acute or chronic:

• Acute complications: These can occur at any time and sometimes are the presenting symptoms that lead to a diagnosis of diabetes. These include hypoglycaemia, hyperglycaemia, hyperosmolar hyperglycaemic state (HHS) and diabetic ketoacidosis (DKA). All are metabolic in nature and are described throughout this module
• Chronic complications: Many involve damage to blood vessels that occurs as a result of high blood glucose levels over a long period of time, which in turn can cause an increase in the level of fats in the bloodstream.

Chronic complications can be macrovascular or microvascular in origin. Macrovascular complications involving the larger blood vessels include cardiovascular disease, which is the leading cause of death in people with type 2 diabetes, and peripheral arterial disease, which can impact on the extremities such as the feet.

This module deals with the microvascular complications including:

• Nephropathy, which contributes to diabetic kidney disease. Hypertension and renal ischaemia are also contributing factors
• Retinopathy: the leading cause of preventable sight loss in the UK
• Peripheral neuropathy: a significant contributor to diabetic foot disease
• Autonomic neuropathies that can affect multiple body systems.