Risk factors: Blood pressure, cholesterol and smoking status
There is very strong evidence in people with diabetes that lowering blood pressure, cholesterol and stopping smoking are highly effective primary and secondary prevention methods. Lifestyle modification to stop smoking, and measurement and treatment of blood pressure and cholesterol are essential components of modern diabetes care. These risk factors have been recorded in over 70% of people with diabetes. This is a major achievement, especially as two factors, blood pressure and cholesterol were requested for the first time in this 2002 survey.
Unlike HbA1c, both blood pressure and lipids are measured across Scotland using methods that may be compared between Health Board areas. The survey, to date, has concentrated on quantitative information rather than qualitative data. It should be possible in further years to analyse actual blood pressure and cholesterol results from important subgroups (e.g. patients aged 50 to 60 years) to look for population differences. This type of analysis will be dependent on the recording methods used within each Board area, but should be supported for those using SCI-DC systems in the future.
Figure 33: Diabetes register: percentage with blood pressure measured
Note: A&A - excludes 53 patients who are under 12 years old. D&G - data is from out-patient clinic workloads only and does not include primary care diabetics. Orkney - no data submitted. W.I. - no data submitted.
Figure 34: Diabetes register: percentage with cholesterol measured
Note: A&A - data excludes 53 patients who are under 12 years old. 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 diabetics. Orkney - no data submitted. W.l. - no data submitted
Figure 35: Diabetes Register: Smoking status
Note: A&A - data excludes 53 patients who are under 12 years old. D&G - data is from out-patient clinic workloads only and does not include primary care diabetics. Lanarkshire - data only available for secondary care.
It is disappointing that 16% of registered patients with diabetes continue to smoke. This is a national problem, not only relating to those with diabetes. The recent SIGN guideline on diabetes includes a useful review of methods to encourage smoking cessation.
(23)
Figure 36: Comparison - Scotland 2001 & 2002. Smoking status
Diabetes and cerebrovascular disease
The survey data again emphasises the impact of stroke on people with diabetes. Guidance was provided for the 2002 survey to clarify the definition of stroke: "Stroke (cerebrovascular accident) - defined as rapidly developing signs of focal (and/or global) disturbance of cerebral function lasting more than 24 hours or leading to death with no apparent cause other than vascular origin." Against a background of improving data recording and data quality (e.g. the exclusion of transient ischaemic attacks) the overall percentage of patients who have had a stroke rose from 3.4% to 4.9%.
Figure 37: Diabetes register: percentage recorded as having had a stroke
Note: Borders - only clinic form records stroke. Lanarkshire - data only available for secondary care
Shetland - no data submitted. Orkney - no data submitted
Figure 38: Comparison - Scotland 2001 & 2002. Number on register having had a stroke
Diabetes and the foot
As in 2001, the survey found different rates of recorded foot ulcer and amputation across each NHS Board. The increasing rate in most areas is likely to indicate improved data capture.
Figure 39: Diabetes register: percentage recorded as having had a foot ulcer
Note: Lanarkshire - data only available for secondary care. Shetland - no data submitted.
Orkney - no data submitted
Figure 40: Comparison - Scotland 2001 & 2002. Number on register having had a foot ulcer
Figure 41: Diabetes register: percentage recorded as having had an amputation
Note: Lanarkshire - data only available for secondary care. Tayside - data previously included digits.
Shetland - no data submitted. Orkney - no data submitted
Figure 42: Comparison - Scotland 2001 & 2002. Number on register having had lower limb amputation