Diabetes a key priority in strategy to reduce cardiovascular deaths

Improvements in diabetes prevention and treatment are set to play a central role in the Government’s new Cardiovascular Disease Modern Service Framework. Published on 7 July, the framework aims to reduce premature deaths from heart disease and stroke in England by 25% within the next decade. Cardiovascular disease is one of the country’s leading causes of premature mortality, contributing to health inequalities, avoidable pressure on the NHS and significant economic loss.

The modern service framework (MSF) calls for a shift from reactive, hospital-based care towards the proactive identification, prevention and management of cardiovascular-kidney-metabolic (CVKM) risk within communities and neighbourhoods. Diabetes features prominently within this broader CVKM approach, alongside hypertension, raised cholesterol, obesity, chronic kidney disease (CKD), atrial fibrillation and smoking.

The MSF reinforces the need for diabetes care to continue to move beyond a narrow focus on glycaemic control. It identifies hyperglycaemia, including pre-diabetes and type 2 diabetes, as a major modifiable risk factor for myocardial infarction and stroke, and emphasises the importance of managing overlapping conditions through integrated pathways, rather than separate disease-specific services.

A central priority is the identification of the “missing millions” of people with undiagnosed or sub-optimally managed CVKM risk factors. Nurses working in diabetes, primary care and community services are likely play a pivotal role in this agenda through opportunistic screening, systematic recall, NHS Health Checks, proactive case-finding and targeted outreach to populations at greatest risk.

The importance of consistently delivering all nine diabetes care processes to prevent complications and identify deterioration at an early stage is also emphasised, alongside treatment optimisation. Priorities include improving management of blood pressure, lipids and kidney disease, together with the wider appropriate use of SGLT2 inhibitors for eligible people with type 2 diabetes, chronic kidney disease or heart failure.

The framework places a strong emphasis on health inequalities. It calls for targeted action in deprived communities and among populations with poorer outcomes, where diabetes and cardiovascular risk often develop earlier, are less consistently identified and may be less effectively managed.

Over the next three years, the immediate focus will be on driving improvements in priority areas where evidence for reducing premature mortality is strongest and performance is currently inconsistent. Nurses involved in the care of people with diabetes will be at the centre of driving and delivering this change.

The full policy paper can be read here.