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1. INTRODUCTION
Diabetes
1.1. Diabetes Mellititus, recognised by an abnormally high blood glucose level, is the most common disorder of metabolism. Over 219,000 people, or one in twenty five of the Scottish population, have been diagnosed with the condition, and an estimated 90,000 remain undiagnosed.
1.2. There are two main types of diabetes; Type 1 and Type 2. About 13% of people with diabetes, or over 27,000 people in Scotland, have Type 1 diabetes. This develops when there is a severe lack of insulin in the body because most or all of the cells in the pancreas that produce it have been destroyed. Type 1 diabetes is one of the commonest long term conditions affecting children and adolescents in Scotland, which has one of the highest prevalence rates of Type 1 diabetes in Europe.
1.3. Type 2 diabetes develops when the body can still produce some insulin, although not enough for its needs, or when the insulin that the body produces does not work properly. Type 2 usually occurs in people over the age of 40 and its rise in prevalence is closely linked to rising obesity levels, the ageing population and reduced activity levels.
1.4. Over the past three years, Scotland has seen a steady increase in the incidence of diabetes (Fig 1). Although much of this rise can be attributed to better monitoring and data collection, it still represents a serious concern. This undesirable trend reflects what is happening in the rest of the UK and in other parts of the world. The number of people with Type 2 diabetes in Scotland is currently increasing at a rate of 4.9% per year.
Figure 1: Scottish Diabetes Survey 2008 - Number of people with diabetes 2001-2008
1.5. Diabetes has been recognised for some time as a classic example of a long term condition, both in terms of the growing number of people with Type 2 diabetes and in terms of the serious health complications it can cause. Maintaining and improving diabetes services against a backdrop of increased incidence and prevalence, with the consequent pressure on these services, is a challenging proposition.
1.6. Some Type 2 diabetes can be prevented, or its onset delayed. However, diabetes care accounts for some 10% of all NHS expenditure. Prevention of Type 2 diabetes, and the avoidance of the resulting complications would not only be extremely cost-effective, but even more importantly, would contribute greatly to people's quality of life. These facts provide the rationale for the 3-year Action Plan published in 2006 and continue to form the basis of this next phase.
1.7. This consultation process offers an opportunity to reassess the 2006 Action Plan's aims in the context of progress to date and future challenges.
1.8.Better Diabetes Care will build on the experience of implementing past strategies, by seeking views from those with a personal and a professional interest in diabetes on those areas of diabetes care where further work is needed, and on the priorities for the next phase of work, from 2009 to 2012.
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