Written evidence submitted by Diabetes UK (COV0122)
This written evidence is submitted to the committee by Diabetes UK, a charity representing the 4.8 million people living with diabetes in the UK. Diabetes is a life changing, and potentially devastating condition, but this doesn’t have to be the case, if people are supported to manage their condition well over the long-term. Diabetes is growing at an exponential rate. The number of people diagnosed with diabetes has more than doubled in the last 20 years – today, one person is diagnosed with diabetes every two minutes.
People with diabetes are twice as likely to have a heart attack or stroke, and twenty times more likely to have a lower limb amputation. It is estimated that the NHS spends £10 billion on diabetes care, 10 per cent of its budget, each year. The majority of this is spent on largely preventable complications.
Food is a vital tool in the management of diabetes, it is important for people living with diabetes to have access to the right food for them, in order to achieve good management of their blood glucose levels. Having access to healthier food options also helps people living with diabetes to manage their blood glucose, cholesterol and blood pressure levels to reduce the risk of serious complications. Our research has shown that obesity is responsible for 80 to 85% of someone’s risk of developing type 2 diabetes, while 3 out of 5 cases can be prevented or delayed. Today, there are an estimated 12.3 million people at increased risk of Type 2 diabetes in the UK. It is essential that they have access to the right food to maintain a healthy diet and help to manage their risk of developing the condition.
Prior to the current restrictions due to coronavirus, people already reported challenges in maintaining a healthy diet, with unclear labelling and promotions and advertising skewed toward unhealthy choices will higher salt, sugar and fat.
People with diabetes have been identified as being at increased risk of becoming seriously unwell if they develop Covid-19 and are listed in the Government’s clinically vulnerable group, and should stringently follow social distancing guidance. This has led to anxiety and concern for many. Diabetes UK set up a coronavirus survey in order to identify the areas where people with diabetes were suffering – access to food was a key issue.
1. Food Deliveries from Supermarkets
A total of 31% of those surveyed expressed difficulties accessing delivery slots at supermarkets, for many this resulted in them having to leave the isolation of their homes to go to the shop more than they otherwise would have liked to. This is a cause of anxiety for people with diabetes in particular, as they are trying to follow the government advice, having been identified as a clinically vulnerable group.
The survey found that 40% of key workers with diabetes reported having at least one issue accessing food. However, this was not the largest group, 74% of people self-isolating reported at least one issue accessing food. This points to a lack of provision and support for those living with diabetes and highlights the need for greater consideration from the Government and supermarkets alike, to help support these groups going forward.
We received over 2,000 responses to our open question about what could be done to support people, and of these over half stated that better access to delivery slots for people with diabetes would help them get the food they needed.
1 in 10 of respondents stated that other ways of prioritising people living with diabetes’ access to supermarkets would help them get the access to the foods that they need. Other ways could include priority click and collect booking to reduce their exposure in stores, or being included in reserve shopping times – along with other vulnerable people – as people with diabetes have also been identified as a clinically vulnerable group at risk, by the government.
2. Accessing the right food when isolating
Public Health England have identified people with diabetes as having an increased vulnerability, encouraging them to stringently follow social distancing measures, however, they have not been placed in the shielding group. Some people living with diabetes have been placed in shielding due to other underlying health conditions.
In our survey, for those reporting to be in the shielding group, almost half reporting issues with getting delivery slots online.
We are also aware that there are issues for those receiving delivery parcels from national or local government – in terms of the suitability of these, not taking into account their dietary needs, not proving gluten free options and hypo treatments.
It appears to be a lack of clarity from the government and lack of understanding from the supermarkets of the vulnerability to people living with diabetes, creating an inability to access delivery slots. Responses to our survey include:
3. Accessing specialist foods
People living with diabetes face difficulties in obtaining the food that they need due to a lack of clear guidance. Up to 10% of people with coeliac disease have type 1 diabetes, meaning they cannot eat gluten. In responding to our survey, 5% of people reported an issue accessing specialist food. This is particularly worrying, especially for those with coeliac disease, where the symptoms can be severe.
4. The availability of healthier foods
Almost one fifth of respondents declared access to healthy food as an issue. Healthy food is a vital tool in the management of diabetes. Many people with type 2 diabetes will be managing their diabetes through lifestyle, and having access to healthier food options and regular activity is key to this. It is also important for people who have been identified at an increased risk of type 2 diabetes to have access to healthy foods in order to prevent it developing.
If healthy food is not available, it can lead to poorer blood glucose levels and cause complications further down the line such as, sight loss, nerve damage, and kidney problems. It is essential for people living with diabetes to have access to the food that they need.
We saw a small number of people who had been able to book delivery slots report issues with shortages of stock meaning deliveries turn up with many essential items missing or with unhelpful substitutions. This is frustrating for people with diabetes and is counterproductive, as it then forces those taking extra care to minimise outside contact to leave their homes to fill in the gaps in their weekly shop – which in the current context is a source of great anxiety. There needs to be a greater understanding from supermarkets of the needs of people living with diabetes, the greater vulnerability they face, and the importance of diet.
13% of respondents said that product unavailability was an issue when getting food delivered.
While over half of the 2,000 qualitative responses to our survey stated that better access to delivery slots for people with diabetes would help them get the food they need. 1 in 10 of responses said that other ways of supermarkets prioritising people living with diabetes to supermarkets would help them get access to the food that they need. This includes supermarkets making sure people living with diabetes have priority access to click and collect, not having to queue or being included in reserved shopping times – along with other vulnerable people.
The lack of priority people with diabetes have through deliveries and also accessing supermarkets means that they have faced challenges in supermarkets of getting the right foods they need to manage their health condition.
An essential tool in managing diabetes is diet, with access to food severely impacted during this period of isolation, many people with diabetes are failing to obtain the foods they usually eat. This subsequently causes fear and anxiety that blood glucose levels will begin to fluctuate due to an abnormal routine.
Several of the respondents laid bare the issues that they face:
5. Access to Hypo (Hypoglycaemia) treatments
Hypoglycaemia is when blood glucose levels are too low. This can happen because of an imbalance in food, diabetes medication and physical activity. Hypoglycaemia can be dangerous for people with diabetes, so it is essential they have access to the right foods to treat these incidents as soon as possible. Common treatments include sugary drinks (like Lucozade) or sweets (like Jelly Babies) for example. These foods help to quickly increase blood glucose levels when people are having a hypo – to help bring them back into a safe or normal range.
In our survey, 8% of respondents expressed issues in accessing their regular hypo treatment due to stock issues, a further 6% of respondents said they has experienced restrictions on the number of treatments they could buy. When supermarkets began general restrictions on multiple purchases, it impacted people living with diabetes ability to have adequate supplies for hypo treatments. This is worrying and could have dangerous impacts on people living with diabetes.
6. Anxiety & Diabetes Management
Diabetes is already a challenging and hour by hour, self-managed condition. The issues raised above are a cause of additional anxiety among people living with diabetes. In fact, 14% of respondents to our survey expressed anxiety or a feeling of being overwhelmed that meant they were uncertain of what they should be eating.
Food is essential to effective management of diabetes, the difficulties facing people living with diabetes accessing this food and the resulting challenges in adequately managing their diabetes, can lead to both short-term and longer-term health impacts. It is vitally important that the government and food industry do all they can together, to ensure that those with medical conditions such as diabetes have the food they need to manage their conditions well during this period.