How much does diabetes cost the NHS?
All sorts of headlines have circulated on the spiralling cost of diabetes care. One even suggested it could bankrupt the NHS.
The extent to which the cost can be controlled by better prevention measures or more effective care has become a major policy debate.
So what is the best estimate of the cost? It has been widely asserted the bills for diabetes care swallow up a 10th of the NHS budget.
Total health spending in England in the 2018-19 financial year was £129bn, in Scotland £13bn and about £7bn in Wales.
A 10th of those budgets adds up to big numbers but it has not always been clear how they break down.
Now, a study has attempted to drill into the precise detail of some of the financial data associated with the condition.
Its stark message is "diabetes is the largest contributor to healthcare cost and reduced life expectancy in Europe".
The authors, Dr Adrian Heald, of Salford Royal Hospital, and Mike Stedman, of the health consultancy Res Consortium, presented the research at the annual meeting of the European Association of the Study of Diabetes.
They focus on the cost of hospital care in England, based on admissions and visits to clinics and accident and emergency units.
They conclude in the 2017-18 year a total of £5.5bn was spent on diabetes care, almost 10% of the overall hospital budget. This includes treatment of complications arising from the condition, and out-patient appointments.
How much of the bill is avoidable?
It must be stressed that type 1 diabetes is an autoimmune condition not linked to weight or age and affects about 10% of the diabetes population. The rest have type 2, which can be associated with lifestyle.
And the new report does not consider how much money could be saved if more cases were prevented, for example by better diets.
Instead, the authors look at what they call excess expenditure based on ineffective management of the condition by patients. This accounts for £3bn of the £5.5bn total hospital bill.
Poor control over blood sugar levels, they say, increases the risk of many long-term health problems including kidney disease and blindness.
Hospital treatment costs for diabetics, after adjusting for their older age, are at least twice as much as for those without diabetes.
And more than a third of these increased costs come from urgent and emergency care.
What isn't in the latest study?
It does not include the costs of medication or GP and community care. And indirect effects such as sick leave and the need for unpaid family care were not considered.
Other estimates of the bills associated with diabetes care are sometimes quoted. The charity Diabetes UK uses a figure of £10bn per year for the UK but this has not been updated for a couple of years.
The information and support group Diabetes.co.uk highlights a calculation of £14bn in 2012 for England and Wales. This includes a £1bn assumption for annual drug bills and an estimate for social-care costs.
There has been no calculation yet on the rate of increase of these annual NHS bills.
What about the future?
The Heald and Stedman report provides a baseline that can be tracked in future years at least for the hospital costs.
What is not in doubt is that diabetes prevalence is rising steadily. Numbers living with the condition in the UK have doubled in 20 years to 3.7 million, according to Diabetes UK.
Some are predicting that without policy and major lifestyle changes, that figure will rise to five million by 2025.
Accurate and timely data on diabetes care costs will be all the more essential as health authorities in the nations and regions try to allocate already stretched budgets.
They will also be a vital benchmark to help assess whether government policies to tackle the condition are working.