Áine Brady (Kildare North, Fianna Fail)

I welcome the opportunity to speak on the subject of diabetes. Diabetes mellitus is a chronic, progressive metabolic disease. There are two types of diabetes. Type 1, or insulin dependent diabetes, accounts for approximately 10% of cases and affects mainly children, adolescents and young adults and requires lifelong treatment with insulin. Type 2, or non-insulin dependent diabetes, accounts for 90% of all cases diagnosed in Ireland and affects mainly middle aged and older people. Its prevalence is rising rapidly owing to a number of factors, notably the ageing population, dietary habits and more sedentary lifestyle behaviour leading to obesity.

Approximately one in 20 people in Ireland has diabetes. A report, Making Diabetes Count - What Does the Future Hold?, published by the Institute of Public Health in 2005 estimated that over 140,000 adults in the Republic of Ireland had diabetes. It predicted that this figure would continue to rise in the coming years. The institute also estimated that over 10% of Government health care spending was diabetes related. It is worth noting that an estimated 90% of type 2 diabetes and 80% of coronary heart disease cases in the population could be avoided by healthier lifestyle behaviour such as eating a healthier diet, engaging in more physical activity and stopping smoking.

My Department recently launched a new cardiovascular health policy. I am glad prevention and health promotion measures are given particular prominence in this policy report. The recommendations in the report cover organised societal and public policy efforts to tackle smoking, diet, exercise and alcohol misuse, all contributory factors not only for cardiovascular disease but also for diabetes. It is clear that people need to be encouraged to take more responsibility for their own health. A central message is the need to increase awareness of the risks lifestyle and behaviour pose to health and the measures to help patients with diabetes to improve and prevent the onset of complications.

I will now deal with the risk factors that contribute to the incidence of diabetes. Learning to take responsibility for one's health requires a combination of factual knowledge and adopting appropriate values. Regular physical activity reduces the risk of developing chronic illnesses such as diabetes. Research shows that most Irish people are not as active as they need to be to maintain good health. The national survey of lifestyles, attitudes and nutrition, SLAN 2007, revealed that only 41% of Irish adults took part in moderate or strenuous activity for at least 20 minutes three or more times a week. Over one fifth of Irish adults, 22%, reported being physically inactive. This is a cause for concern. It is little surprise, therefore, that the same survey found that 38% of Irish people were overweight and a further 23% were obese.

In June 2009 I launched the national guidelines on physical activity which emphasise the importance of physical activity to overall health and well-being and give clear information on the recommended levels of physical activity required for different sectors of the population. The key message is that physical activity is for everyone and that any level of activity is better for one's health than none. The guidelines recommend that adults should be active, at moderate to vigorous levels, for at least 30 minutes five days a week.

The Department is in the process of concluding a revision of the food pyramid and healthy eating guidelines in an effort to help increase people's awareness of their nutritional requirements and the type of food and portion sizes required for good health. Little Steps, Food Dude and Walk to School Wednesday are examples of education programmes that raise awareness among children and adults.

We in Ireland drink too much alcohol. Apart from the many social harms caused by alcohol, it is a leading contributory factor in many medical conditions. It increases the risk of many diseases even at low levels of consumption. Alcohol consumption can make it difficult to recognise the symptoms of low blood sugar. Diabetics need to be careful with alcohol.

People with diabetes are three times as likely to die of cardiovascular diseases. Smoking and diabetes together substantially increase the risk of a heart attack or stroke. Smoking rates in the population still remain persistently high at 29%. In an effort to tackle these smoking levels, the Department has introduced several legislative measures to reduce the initiation and prevalence of smoking. These include the workplace smoking ban, a ban on the sale of ten-packs, a ban on in-store advertising and the display of tobacco products, a requirement that all retailers be registered and curbs on premises where self-service vending machines are permitted.

It has been estimated that up to half of those who have diabetes are undiagnosed. It is crucial that people are aware that diabetes is a disease which can be managed and many of the complications prevented. If an individual is concerned, they should seek medical advice because in many of these lifestyle diseases time is of the essence. The earlier diabetes is diagnosed, the better the prognosis.

Diabetes has a profound impact on lifestyle, work, well-being and life expectancy. Diabetes also causes vascular complications resulting in coronary heart disease, stroke and peripheral vascular disease which are the main causes of premature death for people with diabetes. Diabetes is the commonest cause of blindness and amputations in the working population. Foot problems are a common cause of diabetic admissions to hospital.

Many patients with a chronic condition such as diabetes do not require hospital admission but can be managed in the primary and community care settings if the appropriate support is available and agreed protocols and pathways are followed. This also applies to self-management and support. It is important in this challenging economic climate that patients receive the best treatment possible in the most cost-effective manner.

In 2006, the Department of Health and Children published a policy report on diabetes, Diabetes: Prevention and a Model for Patient Care. This set out a model of care based on shared care between primary care and acute services which would deliver quality diabetes care at the appropriate level.

The Health Service Executive established an expert advisory group to implement the policy recommendations. Its report was launched in November 2008. A key element was the publication of integrated care guidelines which represented a new way of primary care and acute specialist services working together to reduce the burden of this condition. The group emphasised real savings could be achieved in health care costs by preventing the complications of diabetes. These would be achieved through patient education and empowerment, primary care linked to specialist secondary care and special provisions for early detection and treatment of any complications that would develop. In this shared care model, roles and responsibilities are clearly understood and it is supported by agreed protocols. Such care has been shown to be particularly effective for the management of type 2 diabetes.

The national diabetes programme was established under the governance of the quality and clinical care directorate of the Health Service Executive to progress a national diabetes plan which has five key objectives: to establish a national diabetic retinopathy screening service; to establish a national diabetes register; to progress foot care services nationally; to facilitate integration of diabetic services between primary and secondary care; and to develop strategies to improve diabetic control and risk reduction to prevent diabetic complications.

A clinician has been appointed recently to take the lead on the diabetes clinical programme. He is engaging with all stakeholders, including the Diabetic Federation of Ireland, clinicians and podiatrists, to establish a multidisciplinary package for diabetic patients.

General practitioners are competent in managing diabetes and its complications, including those affecting the foot. Chiropodists and podiatrists are specialists in all aspects of foot health and also treat people suffering from the complications of diabetes such as peripheral vascular disease. The aims of the podiatry service include maintaining mobility and independence in older people through assessment, treatment, education and support in a clinical and home environment and the education, assessment and care of diabetic patients to prevent complications of the foot.

The HSE provides a podiatry service to medical card holders. Patients requiring podiatry assessment and treatment may be referred from GPs, primary care team members, diabetes services and hospital services. Several initiatives have been undertaken recently such as the development of a standardised podiatry assessment tool for diabetic patients. This will enable referring GPs and practice nurses to give the podiatry department an accurate assessment of the status of a diabetic patient's foot condition which will in turn ensure the department can identify and prioritise high-risk diabetics and provide timely intervention as required.

Services may be provided by chiropodists and podiatrists employed directly by the Health Service Executive. Chiropodists and podiatrists are also contracted under the General Medical Services scheme. These provide services on a sessional basis for clients eligible under the scheme. Chiropodists and podiatrists who undertake these sessions are taken from the list of approved chiropodists and podiatrists who have been assessed as eligible to practise in the public health service.

Podiatry input is recognised as an essential element in the multidisciplinary approach required to maintain the health of the diabetic population. Primary care teams, acute hospital services and the regional diabetes services implementation groups are working together to improve provision and access to podiatry services for people with diabetes.

The expert advisory group in its 2008 report identified retinopathy as one of the commonest serious complications of diabetes. Among its key recommendations was the introduction of a diabetic retinopathy screening programme to prevent eye disease. Retinopathy national screening has been identified as a priority for the national diabetes programme. As Senator Mooney noted, a pilot project has been in operation in the north west for several years. Extending that programme beyond the north west is a priority for the Health Service Executive. An implementation model is being developed by the HSE and it is hoped that implementation will commence in 2011.

It is vital to improve the quality of life for people with diabetes. At the same time, the risks of people getting the condition and the onset of complications in those who have it need to be reduced. The Health Service Executive, through the new national diabetes programme, is progressing a national delivery plan which will provide a blueprint for the delivery of services for patients with diabetes over the coming years. Putting a greater focus on prevention is the most cost-effective and sustainable intervention we can make.