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SCOTTISH DIABETES SURVEY 2002
Diabetes type
There are two main types of diabetes: Type 1 diabetes and Type 2 diabetes.
Type 1 is an autoimmune condition in which the body's own immune system destroys the insulin-producing cells in the pancreas. This deficiency needs to be treated with insulin injections. People with Type 1 diabetes are by definition insulin dependent who in the absence of insulin treatment would suffer fatal diabetic ketoacidosis. Type 1 usually occurs in people under the age of 30, often in childhood, although it can occur at any age. Virtually all people with diabetes under the age of 30 years have type 1 diabetes
Type 2 diabetes develops when the body is unable to produce enough insulin, or cannot use the insulin the body produces properly (insulin resistance). This type of diabetes usually appears in people over 40 and depending on its stage of development can be treated by a combination of diet and drugs, although insulin may also be required. The development of Type 2 diabetes is strongly linked to obesity and lack of physical exercise which explains the recent dramatic increase in the incidence of Type 2 diabetes, including the worrying trend of Type 2 diabetes being identified in ever younger patients.
European studies generally report that Type 1 diabetes accounts for around 10% of the diabetic population and type 2 for about 90%. The Survey data show 18.2% have Type 1 diabetes, 74.1% Type 2 diabetes, 0.8% have other types of diabetes (e.g. gestational) and 6.9% not known or not recorded. This would suggest that people with Type 2 diabetes are under-represented in the Survey sample.
Figure 13: Diabetes register: diabetes type
Figure 14: Comparison - Scotland 2001 & 2002. Type of diabetes
Date of diagnosis
The date of diagnosis is known for three quarters (76.9%) of registered patients. This data item was collected for the first time in this year's Survey. Date of diagnosis is useful because it enables duration of disease to be calculated, although Type 2 diabetes may be present for a number of years before diagnosis.
Figure 15: Diabetes register: percentage with date of diagnosis recorded
Note: Lanarkshire - data only available for secondary care.
Orkney - this information was not collected in 2001 Survey Shetland - No data submitted
HbA1c
The Scottish Diabetes Framework recommended that all people with diabetes should have had an annual HbA1c measurement by September 2002. However, in this year's survey, 81.2% of those registered with diabetes have had an HbA1c recorded; 70.8% within the last 15 months. It is disappointing that these figures fall short of the recommendation and show no improvement on last year. However, it is not known how many of the remaining patients (18.9%) have been tested but the information has not been collected for the Survey. In the absence of generally available effective IT, these and other figures can only remain an indication of service provision rather than a definitive judgement. Notwithstanding these caveats, in light of the importance of HbA1c measurement to effective diabetes care, the target of all records including an HbA1c measurement is retained for next year's survey.
Figure 16: Diabetes register: percentage with HbA1c measurement
Note: A&C - data is incomplete as one laboratory's data is missing. D&G - data is from out-patient clinic workloads only and does not include primary care patients. W.I. - no data submitted
Figure 17: Comparison - Scotland 2001 & 2002. Number on register with HbA1c measurement
Table 4: Diabetes register - HbA1c measurement
| < 15 months ago | > 15 months ago | Not measured |
Scotland 2001 | 76,880 | 72.7% | (Not requested) | 28,897 | 27.3% |
Scotland 2002 | 73,472 | 70.8% | 10,737 | 10.3% | 19,565 | 18.9% |
Argyll & Clyde | 4,260 | 44.7% | 1,623 | 17.0% | 3,639 | 38.2% |
Ayrshire & Arran | 8,366 | 93.0% | 0 | 0.0% | 632 | 7.0% |
Borders | 2,311 | 78.9% | 0 | 0.0% | 618 | 21.1% |
Dumfries & Galloway | 1,226 | 23.8% | 434 | 8.4% | 3,496 | 67.8% |
Fife | 7,883 | 79.8% | 568 | 5.7% | 1,430 | 14.5% |
Forth Valley | 3,594 | 52.5% | 3,251 | 47.5% | 0 | 0.0% |
Grampian | 4,774 | 83.4% | 421 | 7.4% | 531 | 9.3% |
Greater Glasgow | 3,600 | 85.9% | 370 | 8.8% | 221 | 5.3% |
Highland | 1,750 | 81.2% | 126 | 5.8% | 280 | 13.0% |
Lanarkshire | 10,643 | 65.1% | 741 | 4.5% | 4,974 | 30.4% |
Lothian | 14,014 | 74.1% | 2,733 | 14.4% | 2,170 | 11.5% |
Orkney | 0 | 0.0% | 0 | 0.0% | 377 | 100.0% |
Shetland | 561 | 92.3% | 47 | 7.7% | 0 | 0.0% |
Tayside | 10,490 | 93.0% | 423 | 3.8% | 364 | 3.2% |
Western Isles | 0 | 0.0% | 0 | 0.0% | 833 | 100.0% |
The interpretation of HbA1c data in relation to outcomes of care is difficult because of the number of methods of measurement currently used. Thus, different laboratories use different methods for measuring HbA1c each with its own reference range. Until there is Standardisation, any comparison of HbA1c between different centres must be treated with caution. The Monitoring Group strongly recommend that steps be taken to explore the potential to move towards a National Standardised HbA1c, linking with International Recommendations.
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