Publication, Part of Prescribing for Diabetes

Prescribing for Diabetes in England 2008/09 - 2018/19

Official statistics

Publication Date:: 7 Nov 2019
Geographic Coverage:: England
Geographical Granularity:: Country, Primary Care Trusts, Clinical Commissioning Groups, Primary Care Organisations
Date Range:: 01 Apr 2008 to 31 Mar 2019

Background and scope

Scope

Prescriptions written in England and dispensed in the UK
Prescriptions written in primary care settings and dispensed in the community (e.g. from pharmacies)
Data from April 2008 - March 2019

Prescriptions written in Wales, Scotland or Northern Ireland
Prescriptions written but not dispensed
Prescriptions dispensed in secondary care settings
Prescriptions written in secondary care settings that are dispensed in the community
Dental prescribing
Private prescriptions

Background

Diabetes mellitus occurs due to a lack of insulin or resistance to its action. It is diagnosed by measuring fasting or random blood-glucose concentration (and occasionally by an oral glucose tolerance test). Although there are many subtypes, the two principal classes of diabetes are Type 1 diabetes and Type 2 diabetes.

The number of patients on the diabetes register aged 17 and over in England in 2018/19 was 3.3 million, which is a prevalence of 6.9% (Quality and Outcomes Framework).

In 2017/18, 7.7% of diabetes occurrences were Type 1 and 92.3% were Type 2 or Other (National Diabetes Audit, England and Wales). Type 1 diabetes occurs as a result of a deficiency of insulin following autoimmune destruction of pancreatic beta cells. Patients with Type 1 diabetes require administration of insulin. Type 2 diabetes occurs due to reduced secretion of insulin, peripheral resistance to the action of insulin, or a combination of both. Although this condition may be controlled by diet alone, many patients also require oral antidiabetic drugs and/or insulin to maintain satisfactory control. In overweight individuals, Type 2 diabetes may be prevented by losing weight and increasing physical activity.

This publication cannot distinguish between the prescribing for different types of diabetes.

Medication for diabetes

The three main areas of prescribing for diabetes are:

Insulins

Insulin is a replacement hormone that plays a key role in the regulation of carbohydrate, fat and protein metabolism. It is usually self-injected.

Human sequence (or human-analogue) insulin is produced bio-synthetically using recombinant DNA technology and has replaced some use of more established, cheaper insulins.

Antidiabetic drugs

Antidiabetic drugs are generally used for the treatment of Type 2 diabetes and are taken by mouth to help manage levels of sugar in the bloodstream.

They should be prescribed only if the patient fails to respond adequately to at least three months’ restriction of energy and carbohydrate intake and an increase in physical activity. They should be used to augment the effect of diet and exercise, and not to replace them. For patients not adequately controlled by diet and oral hypoglycaemic drugs, insulin may be added to the treatment regimen or substituted for oral therapy. Weight gain and hypoglycaemia may be complications of insulin therapy but weight gain may be reduced if the insulin is given in combination with metformin (a biguanide antidiabetic drug).

Diagnostic and monitoring devices

This category includes devices and their consumables used for monitoring the symptoms of diabetes. No diabetes meters or sensors are dispensed in primary care via prescription and are therefore not included within this publication.

BNF classification of diabetes medications analysed in this publication

BNF Paragraph	BNF Sub-paragraphs	Notes
6.1.1 Insulins	6.1.1.1 Short-acting insulins 6.1.1.2 Intermediate- and long-acting insulins	Sub-paragraph 6.1.1.3, Hypodermic equipment, is excluded from the analysis as prescribing against this category is classified by NHS Prescription Services under “Other appliances”; this is a pseudo BNF section that also includes a number of other types of appliance not used in the treatment of diabetes
6.1.2 Antidiabetic drugs	6.1.2.1 Sulfonylureas 6.1.2.2 Biguanides 6.1.2.3 Other antidiabetic drugs	Metformin is the only biguanide currently available
6.1.4 Treatment of hypoglycaemia	NA	Prescribing under this category is included when this report refers to all prescribing for diabetes, but is not examined separately in the Results section
6.1.6 Diagnostic and monitoring devices	NA	Includes blood monitoring, urinalysis and oral glucose tolerance tests

Administrative Sources

NHS BSA, Quality and Outcomes Framework,ePACT, QOF, NDA

Last edited: 11 November 2019 3:52 pm