DIABETES IS A condition whereby the body can’t properly process sugar from food, known as glucose.

Symptoms of the condition include tiredness, weight loss and urinating more than usual – in fact the name diabetes is derived from the Ancient Greek word diabainein, meaning “to pass through”.

It can also cause serious complications, including stroke and foot problems, leading to amputation in extreme cases.

There is no cure but the condition can be managed with medicine, diet and exercise.

A minority of people with diabetes have what is known as Type 1 diabetes, where the body’s immune system has malfunctioned and destroyed the cells that produce the hormone insulin.

However, the vast majority of people with the condition have Type 2 diabetes, which often develops as people age and gain weight (although it also has a strong genetic component).

As Ireland’s population is getting older and more overweight, cases of Type 2 diabetes are rising alarmingly.

This is a worldwide problem: the International Diabetes Federation has said that “diabetes is spiralling out of control”. The group estimates that over 10% of the global population now has diabetes, up from less than 5% at the turn of the century.

Here, around 8% of people over 50 have the condition, researchers found in 2016.

This is bad for people with diabetes and a strain on the public purse, because treating diabetes and its associated health problems inevitably costs money.

One figure that’s been cited for many years is that diabetes accounts for 10% of the Government’s spending on healthcare.

The claim has repeatedly been made using official sources – including by government ministers and the HSE itself.

But is it true?

The Claim

There are a number of official sources which appear to back up the claim that Ireland spends 10% of its healthcare budget on diabetes.

The Health Service Executive’s guidelines for treating the condition also say that “Type 2 diabetes is a huge financial burden to the Irish health service where diabetes care consumes up to 10% of the Irish healthcare budget”.

And responding to a written parliamentary question in 2016, Marcelle Corcoran-Kennedy – then a junior minister at the Department of Health – said that diabetes is “now one of our most common chronic diseases… consuming up to 10% of the Irish healthcare budget”.

The Evidence

The HSE’s total budget for 2020 was €20 billion, but this figure wasn’t broken down by disease so one has to do some work to calculate what proportion exactly was spent on diabetes patients.

We don’t know exactly how many people in Ireland have diabetes – unlike in Scotland, for example, there’s no “diabetes register” and researchers here have to estimate the prevalence of the condition.

Diabetes Ireland, a charity for people with the condition, has called for data on how many people have diabetes to be recorded.

So if there’s no specific diabetes budget and we don’t know exactly how many people have the condition in Ireland, how can the HSE know that 10% of its budget is spent on diabetes?

The short answer is that they don’t; a spokesperson for the health service told The Journal that the 10% figure is “inferred from NHS data”.

A UK study published in 2012, which relied on data from the National Health Service, found that diabetes accounted for “approximately 10% of the total health resource expenditure” and was projected to account “for around 17% in 2035/2036”.

This equated to around £1 billion (€1.18 billion) for Type 1 diabetes and a little under £9 billion (€10.6 billion) for Type 2 diabetes, compared with £100 billion (€118 billion) in total NHS spending in England.

Dr Kate O’Neill of University College Cork told The Journal that there is no research published using Irish data that reports such a figure.

“This is largely due to lack of data in the Irish setting,” she explained.

However, O’Neill has done some research on the subject, using what data is available in Ireland.

She found that extra health service use by diabetics aged 50+ cost €90 million in 2016 – less than 1% of the overall HSE budget. 

But this figure is only for things like the number of GP and hospital visits diabetics over the age of 50 take compared to people without diabetes, and doesn’t include the cost of diabetes drugs or treating complications like sight loss or foot problems. It’s therefore “most likely an underestimation of total costs of diabetes”, O’Neill says.

The most recent Ireland-specific research looked at just Type 1 diabetes, but tried to capture a wider range of treatment costs. It came up with a figure of €82 million for 2018 – again, a tiny fraction of the overall HSE budget. 

If total healthcare costs for the much more common Type 2 diabetes were similar – which, to be clear, is a real back-of-an-envelope maths based on big assumptions – that would get you to around 8% of the HSE’s 2020 budget, which is in the region of 10%.

Diabetes Ireland claimed last year that “diabetes-related expenditure accounted for 10-12% of the 2019 HSE budget”.

Asked how that was calculated, it pointed us in the direction of a 2006 study – using data from the turn of the century – which estimated that Type 2 diabetes ate between 4.1% and 6.4% of the healthcare budget at the time.

That doesn’t exactly support a claim that spending is now about twice that, although diabetes cases have surged over the past couple of decades, in line with the global trends.

In adults aged 18 years and over, the national prevalence of doctor diagnosed diabetes significantly increased from 2.2 % in 1998 to 5.2 % in 2015 – so it’s possible that the cost of of treatment has gone up roughly in proportion, though it’s hard to prove.

Diabetes Ireland also point out that there’s been more of a focus on treating the condition since that 2006 study, with the establishment of a National Clinical Programme for Diabetes in 2010.

Asked to respond last year to the 10% claim, Minister for Health Stephen Donnelly said: “I acknowledge that diabetes is a significant issue and driver of health expenditure”.

However, this neither confirmed nor denied the figure.

Verdict

It has been claimed by the HSE and members of previous Governments that Ireland spends 10% of its healthcare budget on diabetes.

However, there is no specific diabetes budget in Ireland and we don’t know exactly how many people have the condition here.

A spokesperson for the health service told The Journal that the 10% figure is “inferred from NHS data” – that is, it is not based specifically on Irish figures.

Although studies have been carried out in an attempt to calculate how much of the country’s healthcare budget is spent on diabetes patients, these use rough figures and back-of-the-envelope maths.

There is no official figure for the amount of the healthcare budget that is spent on diabetes patients every year.

We therefore rate this claim: UNPROVEN.

As per our verdict guide, this means that the evidence available “is insufficient to support or refute the claim, but it is logically possible”.

Correction: An earlier version of this article gave an incorrect percentage for the amount of the HSE budget that is estimated to have gone towards health service use by people with diabetes aged over 50. This was corrected on Saturday 21 May to say it was less than 1% of the overall HSE budget. 

Infographic: Fionn Thompson 

This work is also co-funded by Journal Media and a grant programme from the European Parliament. Any opinions or conclusions expressed in this work are the author’s own. The European Parliament has no involvement in nor responsibility for the editorial content published by the project. For more information, see here.