03/07/2013 13:19 BST | Updated 02/09/2013 06:12 BST

Are Diabetes Deaths Going Up or Down?


People with diabetes are used to bad headlines. Whether it is stories about poor care in hospitals or the low number of people getting the checks they need to manage their condition, it can sometimes feel like news around diabetes is unremittingly bleak. As if living with diabetes is not hard enough, it is as if every day the news is focused on the challenges ahead.

And then, last month, there was some good news. A new study found there had been a significant drop in the mortality rate for people with diabetes in the UK and Canada. Both the BBC and Nursing in Practice said the study showed diabetes deaths were "well down", while Medical News Today reported that excess deaths had "fallen dramatically".

So how can the mortality rate be going down if healthcare for people with diabetes is so poor? And does this mean things really are getting better rather than worse?

Well, it depends on your perspective.

If you have diabetes then, yes, you are less likely to die before your time than you would have been 20 years ago. In the mid-1990s, someone with diabetes was roughly twice as likely to die in any given year as someone without it.They are now one-and-a-half times more likely to die in any given year.

So if you're the kind of person who always sees the glass as half full then you might see this as good news. It means new technology such as insulin pumps, new drugs and better treatment are all helping people to live longer with more years of good health and hopefully better quality of life.

But while things might not be as bad as they were in the mid-1990s, they are still well short of being good enough. While a significant number of people with Type 1 diabetes might now be using insulin pumps, insulin pump usage in the UK is still lagging far behind that of comparable European countries. And yes, the proportion of people with diabetes getting their annual checks might have gone up, but still almost half of people are not getting them.

This, as well as lack of ongoing support, significant problems accessing structured education and poor hospital care, is why independent reports from the National Audit Office and the Public Accounts Committee have concluded that many people are dying as a result of the NHS not offering care that is good enough, often enough. Given this, it is no wonder that most people with diabetes are unlikely to see the news that they are one-and-a-half times more likely to die in any given year than their friends without the condition as a case of their glass being half full.

Also, while for an individual person with diabetes the chance of dying in any given year has gone down, there hasn't been a corresponding reduction in the number of diabetes-related deaths. This is because at the same time as the mortality rate has fallen, the number of people with diabetes in the UK has risen dramatically, doubling since the 1990s. This is because of the growing numbers in Type 2 diabetes, and the lack of societal support to help people reduce their risk. But the number of people with Type 1 diabetes, which isn't linked to lifestyle, has also increased, for reasons we don't fully understand.

This huge increase in numbers - and 3million people in the UK have been diagnosed with diabetes - is likely to have more than offset the reduction in mortality rate. So if you have diabetes then the chances of dying early might have gone down for you personally, but the number of people dying early because of diabetes may even have gone up.

In terms of the actual numbers, every year about 24,000 people with diabetes in England and Wales die before their time. We do not know how this compares to the 1990s because the National Diabetes Audit only recently started recording the number of early deaths in people with the condition. But what is clear is that many thousands of these deaths could have been prevented if those people had received better healthcare and better support to enable people with both Type 2 and Type 1 diabetes to be able to live well with their condition.

We know what needs to happen to fix this: we need to get better at preventing Type 2 diabetes to halt the rise in the number of people with the condition. For those people who have diabetes, the NHS needs to ensure they get the care, education and support that can help people manage their own condition. To achieve this, hospitals need to give better care for people with diabetes through having more specialist nurses and for all medical staff gaining greater understanding of the condition. Finally, healthcare needs to improve how it co-ordinates care between general practice and specialist teams so that people with long term conditions such as diabetes can access the right care, in the right place, at the right time.

If the NHS can get this right, we really will see a significant fall in the number of people dying early because of diabetes, which would mean more people living long enough to see their sons and daughters get married and have children. Now that really would be news worth celebrating.