Our approach to prevention, early detection and early intervention for type 2 diabetes
We have set out a number of guiding principles, which should considered by delivery partners to develop comprehensive weight management the pathways for those ‘at risk’, ‘at high risk’ and those diagnosed with type 2 diabetes.
Action to reduce health inequalities
Deprivation is closely linked to the risk of both obesity and type 2 diabetes. Prevalence of type 2 diabetes is 40% higher among people in the most deprived areas compared with those in the least deprived areas. The reasons for this are complex and multi-faceted but the health drivers of diabetes are higher amongst the most deprived. Self-reported physical activity, smoking, and self-reported consumption of fresh fruit and vegetables are all lower in adults in the poorest compared to better off households.
The importance of reducing health inequalities was reflected in the Diabetes Improvement Plan (2014) as Priority 4 – Equality of access, which aims to reduce the impact of deprivation, ethnicity and disadvantage on diabetes care and outcomes. Furthermore, in keeping with NHS Health Scotland’s health inequalities policy review recommendations, the provision of universal services under this framework should include added support for vulnerable groups. Additionally, it is recognised that there is a complex relationship between mental health problems, diabetes, obesity and those vulnerable to health inequalities. This therefore should be taken into account when planning the delivery of services.
Similarly, the focus of the Scottish Government’s Diet and Healthy Weight Delivery Plan, is the implementation of population-wide interventions which will impact everyone in Scotland. Evidence suggests that population-wide interventions are likely to be more effective in reducing inequalities as they do not rely on individual agency to achieve change. Sitting alongside our preventative approach, many of the actions set out in the plan are intended to provide support for children and families most at risk – targeting and tailoring programmes and support to better meet the needs of families on the lowest incomes.
It is crucial too that our stakeholders and delivery partners place a special emphasis on reducing inequalities when planning and delivering their programmes and interventions. This should be in line with the Health and Social Care standards.
Collective leadership and partnership
Ambitions and actions on this scale must be taken forward at a national, local and individual level. Tackling obesity is a shared responsibility, and central to the success of any initiatives taken forward. Furthermore, to deliver the support, guidance and services to enable individuals to take action to mitigate risk associated with obesity and related to type 2 diabetes, leadership, collaboration and commitment across the public, third and community sectors will be required.
Co-production of services and resources must be carried out to ensure that effective support, guidance and services are provided for the individuals who will use them. Integrating weight management services with diabetes specialist care, working with community partners and co-producing services with those ‘at risk’ and diagnosed with type 2 diabetes can achieve better outcomes for individuals. Co-production is also at the heart of reducing health inequalities and making progress to wider population health goals. NHS Boards will be expected to work with IJBS, local delivery partners, people with lived experience, families and communities to ensure weight management services are designed with people at the centre.
Person–centred approach and value-based care
The person-centred approach is a core component of all NHS delivery and included as Priority 3 of the Diabetes Improvement Plan. The aim of this priority is to ensure that people with diabetes are partners in their care, and are enabled and empowered to safely and effectively self-manage their condition by accessing consistent high-quality education and by creating mutually agreed individualised care plans. This extends to support offered to prevent the development of type 2 diabetes.
The care pathway an individual follows must be a decided upon by the individual with the healthcare professionals providing support and information about the possible options, the relative benefits, intensity and time commitment required so they can make an informed joint decision on their treatment pathway. This is in keeping with the recommendations within Realistic Medicine for value-based medicine.
Being sensitive to stigma and discrimination
It is important that implementation of this framework recognises that individuals affected by obesity or excess weight, frequently confront stigma and discrimination on a regular basis in their workplace, educational institutions, health care settings, socially and in many other areas. These experiences often have a negative impact on emotional wellbeing, and can lead to depression, low mood, anxiety, low self-esteem, and even suicidal behaviours. Unfortunately, weight stigma can adversely affect behaviour and lead to unhealthy lifestyle choices, thus increasing risk factors that exacerbate obesity and risk of diabetes. Awareness raising, promotion and delivery of weight management services must be sensitive to this and aim to ensure avoidance of weight stigma, to ensure positive promotion of both emotional and physical health.
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