The economic and social cost of type 2 diabetes by health inequalities

Diabetes is a common condition that can lead to significant ill health and early death. It is also expensive to manage. Health impacts include foot amputation, blindness, kidney failure and early death. It is estimated that around 10% of the NHS's budget is spent on managing diabetes and illness caused by it. The data upon which these estimates are based are old. Understanding the cost of diabetes care, the impact on patient health and how this is influenced by management of the condition is important. Understanding the impact of ethnicity and deprivation can help the NHS improve care in those who might benefit most. This study will review the current literature to highlight what is already known about the progression of diabetes over time, the cost impact and the factors which influence disease progression. This study will then update that understanding by utilizing extensive English health records. The study will access routine data from GP notes and hospital records to quantify the cost of diabetes and the impact on patient health as the disease progresses from diagnosis. It will examine the impact of good blood sugar control on costs and key health impacts such as amputation and stroke over time. It will then examine how ethnicity, poverty and living in an urban or rural area influence diabetes costs and outcomes, both directly, and indirectly though their impact on blood sugar control. Health care commissioners are moving towards the use of linked data on health and social care to better manage patients with long term health conditions. The student will work with local commissioners to access this linked data and use to understand the impact of diabetes and the rate of disease progression on social care costs. This analysis will exploit more detailed data on social support and mental health to understand the impact of these factors on the rate of disease progression. The project will undertake interviews with health care commissioners and patients with diabetes to understand the practical barriers and facilitators of good management of diabetes and access to care for people with diabetes. The study will update our understanding of the long term costs and outcomes of diabetes and the impact of maintenance of healthy blood sugar levels. It will identify how environmental and social factors influence diabetes management and the progression of the disease. Interviews with patients and commissioners will contextualize these factors and help to understand why poor management of disease occurs and what can be done to improve it. These results will help commissioners of care to manage diabetes more effectively and target support to patients most at need whilst containing costs within available budgets.