Public health burden of diabetes in Ireland: time trends, determinants of complications and the implementation of a public health intervention to improve health outcomes for people with diabetes

Abstract

Aim: To estimate the public health burden of diabetes in Ireland and to evaluate the implementation of a public health intervention to prevent and delay the development of a complication for people with diabetes. Methods: Data from four nationally representative studies were used to explore trends in diagnosed diabetes prevalence between 1998 and 2015. Cross-sectional analysis of data from The Irish Longitudinal Study on Ageing (TILDA) (2009–2011) was carried out to estimate the prevalence of diagnosed type 2 diabetes and its related complications in adults aged 50 years and over. Trends of visual impairment and blindness due to diabetic retinopathy in adults aged 18–69 years over a decade were explored using data from the National Council for the Blind of Ireland, (2004–2013). Finally, a realist evaluation was carried out to evaluate the initial uptake of the national diabetic retinopathy screening programme. Results: In adults aged 18 years and over, the national prevalence of doctor diagnosed diabetes significantly increased from 2.1% in 1998 to 5.2% in 2015. In TILDA, diagnosed type 2 diabetes prevalence was 8.4% and the overall prevalence of macrovascular and microvascular complications were 15.1% and 26.0%, respectively. Over a decade, the incidence of visual impairment due to diabetic retinopathy increased in both the total population and the population with diagnosed diabetes. Findings from the realist evaluation suggest that people were more likely to consent to the national diabetic retinopathy screening programme when they perceived that the service was a relevant to them and had a relative advantage over existing services. Conclusions: Research in this thesis is an important contribution to our understanding of the public health burden of diabetes in Ireland. Findings from this thesis have provided a key source of information to facilitate diabetes program planning and to inform policy decisions, including resource allocation..