1 in 13 adults in Wales live with diabetes, with this figure on the rise each year. This has been exacerbated by the pandemic due to a pause in NHS activity resulting in cancelled appointments. Levels could be further impacted by the ongoing rise in living costs as healthy foods become more expensive.
With the Minister for Health and Social Care, Eluned Morgan, due to give a statement in the Senedd, on Tuesday (13 June) regarding diabetes, this article provides the latest statistics on the prevalence of the condition in Wales and what the Welsh Government is doing to prevent diabetes.
Diabetes in Wales
Wales has the highest rate of diabetes in the UK, with more than 200,000 people (8% of adults) living with the condition. There are a further estimated 65,500 people living with undiagnosed type 2 diabetes in Wales.
People with diabetes are unable to properly produce insulin, a hormone which regulates blood sugar levels. Patients with type 1 diabetes can’t make any insulin at all. People with type 2 diabetes either don’t produce enough insulin or make insulin which doesn’t work properly. Type 2 diabetes is the most common, making up 90% of cases.
Proportion of diabetes cases by type
Source: How many people in the UK have diabetes? 2021-2022. Diabetes UK.
Whilst some people with type 2 diabetes can reduce their blood sugar to a safe level, referred to as remission, this change is not always permanent. This means that most people will live with it for the rest of their lives.
Long-term, diabetes can lead to several serious health complications including heart attack, stroke, and foot or eye problems. Caring for people with diabetes costs NHS Wales £500m per year.
Diabetes is becoming more common, with diagnosed cases doubling over 15 years, up to 2021, in the UK. This is primarily due to more people developing type 2 diabetes.
However, unlike type 1, it is possible to prevent type 2 diabetes. Type 2 diabetes is linked with a number of risk factors, including excess weight gain. As a result, lifestyle changes, such as increasing physical activity and improving diet, can reduce the risk of developing type 2 diabetes.
Almost half of type 2 diabetes cases can be prevented through lifestyle changes
Source: Prediabetes. Diabetes UK.
The toll of the pandemic
Diabetes UK Cymru published a report in 2021 which highlighted the impact of the COVID-19 pandemic on people with diabetes.
People with diabetes are at a higher risk of serious outcomes of coronavirus infections. Diabetes UK Cymru reports that 1 in 4 people who died during the pandemic had diabetes in England and Wales.
Diabetes care was also impacted during this time and has struggled to bounce back since the peak of the pandemic. Patients with diabetes require regular appointments with their diabetes team to reduce their chance of developing any complications associated with the condition.
However, Diabetes UK Cymru reported in November 2021 that a third of people with diabetes reported having cancelled consultations which had still not been rescheduled. The same proportion had not had any contact with the team responsible for their care since the pandemic began.
The importance of resuming routine services for people with chronic conditions, like diabetes, was also highlighted in the Health and Social Care Committee’s report on the impact of the waiting times backlog in Wales.
Diabetes UK Cymru reported that using diabetes technology, such as devices which continually monitor blood glucose levels, helped many patients manage their condition during the pandemic. However, this technology is often only offered to patients with type 1 diabetes.
To address the impact the pandemic has had, Diabetes UK Cymru recommended that the Welsh Government:
- invests in diabetes care, support and prevention as a top priority;
- makes sure more people have access to life-changing diabetes technology; and
- takes action to reduce inequalities in diabetes care.
Impact of the cost of living
According to a report from Public Health Wales on the cost of living, soaring food prices may also impact rates of obesity-related conditions, including diabetes. Food prices have continued to rise since late 2021, with the annual inflation rate of food in the UK at 19.1% in April 2023.
Healthy food is now triple the price of unhealthy food, making less healthy options the more affordable choice. However, these less healthy options increase obesity risk, a key risk factor for diabetes.
Diabetes already disproportionately affects people living in more deprived areas of Wales. However, with Public Health Wales reporting that the soar in living costs will exacerbate pre-existing inequalities, this gap in diabetes rates could widen further.
When questioned about what the Welsh Government is doing to tackle the impact of the cost of living crisis on diabetes in January 2023, the Minister said:
We understand that the cost-of-living problems are going to have an impact on people, and we are aware that the people who are going to pay the greatest price are the poorest people in our society. That's why we've been targeting our funding towards those people.
Further information on the cost of living support currently available can be found in our guide.
Preventing diabetes in Wales
The Welsh Government published its Healthy Weight, Healthy Wales strategy in 2019, a requirement of the Public Health (Wales) Act 2017. This aims to support people to maintain a healthy body weight by promoting healthy lifestyle habits. It was hoped these changes would reduce the risk of diabetes, alongside other obesity-related conditions. The strategy is supported with £13 million of funding, across its lifetime, to achieve its goals by 2030.
As part of the strategy, the All Wales Diabetes Prevention Programme was introduced, the first of its kind in Wales.
By monitoring blood sugar levels, people at risk of developing type 2 diabetes are identified and enrolled in the programme. They attend a half-hour consultation with a specialist healthcare support worker who provides advice on how they can prevent the development of type 2 diabetes.
Patients can then be referred to other services to help them make changes as part of the All Wales Weight Management Pathway. The National Exercise Referral Scheme provides access to a 16-week tailored exercise programme, whilst weight management services, like Foodwise for Life, inform participants about healthy eating patterns and lifestyle choices.
The All Wales Diabetes Prevention programme has demonstrated some success, with patients who took part in the pilot study having lower blood sugar levels after one year than those who had not.
After this success, the programme is being rolled out across Wales. This is being supported with £1 million of funding per year, promised up to 2024, from the Welsh Government as part of the Healthy Weight, Healthy Wales programme.
More generally, the 2022-24 update to the Healthy Weight, Healthy Wales strategy includes further plans intended to help people make healthier choices. The Welsh Government has said it will introduce legislation on calorie labelling in restaurants and takeaways, limit price promotions for unhealthy food options and restrict junk food advertising by 2024. It will also encourage active travel, such as cycling, through measures including investing £1 million in electric bike schemes.
Article by Ailish McCafferty, Senedd Research, Welsh Parliament
Senedd Research acknowledges the parliamentary fellowship provided to Ailish McCafferty by the Medical Research Council which enabled this Research Article to be completed.
