Comparison of Co-morbidity and Investigations For People with Diabetes in Bermuda and the UK.

What is the aim of the study and why is it important?

Our objectives were to:

Compare the prevalence of six major morbidities in the general population in Bermuda with the UK. This included diabetes, coronary heart disease, stroke, hypertension, heart failure and kidney failure.
Characterise the population of patients with diabetes. This included a description of the use of hypoglycaemic medication and the prevalence of diabetes related complications
To describe the uptake of blood tests and CT/MRI scanning imaging in the overall population and among those patients with diabetes.
Establish a baseline and assess the utility of insurance claims data through these exemplar analyses that could inform separate recommendations on the development of Electronic Health Record systems in Bermuda.

How is the research being done?

We used QResearch database linked to hospital episode statistics to identify patients aged 0-100 years who were registered with the practices contributing to the database during 2016. We used Read code and ICD10 codes to identify diagnoses and procedures in QResearch. We undertook a similar analysis using anonymised health insurance claims data from Bermuda

Chief Investigator

Julia Hippisley-Cox



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Are all data accessed are in anonymised form?


Brief summary of the dataset to be released (including any sensitive data)

Men and women registered during 2016 with 6 major morbidities - diabetes, heart disease, stroke, hypertension, heart failure and kidney disease. Data included these diagnoses, hypoglycaemic medication, uptake of blood tests and CT/MRI scans on either GP or linked hospital data

What were the main findings?

We found important similarities and differences in the recorded prevalence of several major diseases. For example, the recorded prevalence of diabetes is similar in both countries. In Bermuda claims data, the prevalence of diabetes is slightly higher than that reported in the self-reported Bermuda Census Data from 2010. However, it is highly probable that both are a gross under-estimate of the true prevalence of diabetes in Bermuda.   The IDF Diabetes Atlas 2015 reported the diabetes prevalence as 15.7 % (20-79 years). The prevalence of renal failure is substantially higher in Bermuda than in the UK although this is likely also to be an under-estimate because of the selected population.

There are significant differences in investigations. Whilst glucose monitoring among people with diabetes is similar between the two countries, the monitoring of kidney function and lipids among Bermudian patients appears to be less intensive than the UK. It is possible that this may contribute to the higher prevalence of complications such as renal failure in Bermuda.  This could be related to the high ‘co-pays’ for people, who may have tests requested but no follow-through on testing, due to costs.  This could also reflect a lack of test requests from the physician. However, it is not possible to tease these apart in the absence of care quality measures.

Implications and Impact

If Bermuda were to develop an Electronic Health Record System which facilitated accurate clinical coding at the point of care and which included clinical values and results of blood tests, then it would be possible to develop quality indicators similar to those used in the UK which could be used to monitor and improve health care for individuals in a systematic way. It would also be possible to use risk assessment tools to identify those at highest risk of developing complications for systematic targeted interventions with the aim of improving health outcomes.

Funding Source

The project was funded by Sean and Jenny Riddell. Sean was Cheif Executive of EMIS and Director of QResearch until his retirement in 2013.

Research Team

Julia Hippisley-Cox


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