A health watchdog has criticised the treatment of diabetes patients and claims many only receive a basic level of care.
The Healthcare Commission looked at England's primary care trusts (PCTs) and gave 111 a "fair" rating for commissioning primary and secondary services to help sufferers manage their illness.
But the review also found 18 are weak, with 16 good and seven classed as excellent.
Patients from those trusts that are rated fair know when and what medication to take, and get yearly check-ups.
However, these trusts, and those classed as weak, are not providing services that give support to people with diabetes to manage their condition.
The report says frontline healthcare professionals should now offer diabetes patients more individual help, and trusts should improve the way they commission programmes.
Diabetes is caused when the amount of sugar in the blood is too high because the body cannot process it properly.
Data from 2006 shows nearly 1.9 million people were diagnosed and registered with the condition, but this is just the tip of the iceberg as hundreds of thousands more are unaware they have it.
About 5% of NHS costs, or around £1.3bn, was spent on diabetes care in 2002. But estimates from 2006 suggest this could rise to 10% - around £9bn - for 2007-08.
The Healthcare Commission
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