Martin Mansergh (Tipperary South, Fianna Fail)

I thank the Senator for raising this matter on the Adjournment, to which I am replying on behalf of my colleague, the Minister for Health and Children, Deputy Mary Harney.

Diabetes is a chronic, progressive metabolic disease that impacts on almost every aspect of the person's life. There is a great deal of concern because diabetes is becoming more common throughout the developed world. There are two types of diabetes. Type 1 or insulin-dependent diabetes affects mainly young people and has a sudden onset. Type 2 diabetes is much more common and accounts for 90% of all cases. It usually has its onset in middle age. The prevalence of type 2 diabetes is increasing owing to a number of factors, including the ageing population and lifestyle factors such as obesity.

Diabetes can have a profound impact on lifestyle, work, well-being and life expectancy. It also causes significant morbidity. Studies have estimated that type 2 diabetes is present for an average of seven years prior to the diagnosis and that up to half of people at this stage may have evidence of complications of diabetes. These include eye, kidney and nerve damage, and vascular complications.

The Department of Health and Children policy on diabetes, Diabetes: Prevention and Model for Patient Care, was published in 2006. This identified a model of care which included shared care between primary care and acute services, retinopathy screening, patient education and empowerment and podiatry services as key areas for development.

The HSE established an expert advisory group, EAG, to take forward and implement the policy recommendations. The EAG framework document, which charts how this public health challenge can be addressed, was launched by the HSE in November 2008. The group's work represents the blueprint for the development of first-class services for people with diabetes. It is practical and patient-focused with a strong emphasis on prevention, service integration and community-based management supported by specialist services.

The EAG emphasised that real savings can be achieved in health care costs by preventing the complications of diabetes such as eye disease or retinopathy, kidney disease or cardiovascular disease. This will be achieved through patient education and empowerment, excellent primary care linked to specialist secondary care and special provisions for early detection and treatment of any complications that develop. A regional model of care is recommended for children and adolescents with diabetes.

The key recommendations include agreement of a core set of standards for diabetes care. A comprehensive set of clinical guidelines has been agreed for diabetes care. This is a significant development and included the Irish Council of General Practitioners and Irish Endocrine Society in the drawing up of these guidelines for an integrated care model between primary and hospital care. These will be of considerable clinical benefit, will advance patient care throughout the country and have the support of the Department of Health and Children.

The second key recommendation is education and empowerment which relates not only to education but empowering patients with diabetes to take greater control in the management of their condition. The third key recommendation is the development of information and communications technology to support diabetes care, especially in the primary care setting. The fourth key recommendation is the continuing roll-out of diabetic retinopathy screening. Diabetic retinopathy is one of the major causes of adult blindness. The fifth key recommendation is the prioritisation of podiatry services for patients with diabetes. With regard to capacity, the report includes recommendations on acute care service needs including consultant staff, diabetes nurse specialists, dieticians and other health care workers.

Current lifestyle patterns in Ireland are a major cause of concern as they play a significant part in the increase in type 2 diabetes. Prevention is key to halting the rise in incidence. Not many people realise that almost 60% of the disease burden in Europe is accounted for by seven leading risk factors, which we can influence: high blood pressure, tobacco, alcohol, high blood cholesterol, overweight, low fruit and vegetable intake, and physical inactivity.

Health care systems continue to focus on the treatment of diseases. However, prevention is a key issue in halting the rise in prevalence of type 2 diabetes. The Department of Health and Children will continue to focus on highlighting the risk factors which contribute to the development of chronic diseases such as this.