Diabetes in the UK is at an all-time high, according to analysis of NHS data released by Diabetes UK to mark Diabetes week. There are now 3.9 million people with diabetes in the UK and growing numbers are diagnosed each year.
It could be argued that these numbers reflect the fact that better treatment means people are living longer with diabetes rather than dying from it prematurely. And some of the increased incidence may be due to better awareness and diagnosis by patients and doctors. GPs are incentivised to identify previously undiagnosed cases of diabetes and penalised if their rates of diagnosis are deemed too low.
But let’s be honest. The main reason that rates of diabetes are so high is that we’re fatter than ever. A quarter of British adults are obese, compared with an average of 16.7% in the rest of Europe. And Simon Stevens, chief executive of NHS England, has said, rather tortuously, that something must be done. “The ghost of Christmases past reminds us that 20 years ago we didn’t have these problems as a nation. The ghost of Christmases future tells us that if we get our act together – as the NHS, as parents, as schools, the food industry – we can get back in shape.”
In type 2 diabetes, which accounts for over 90% of diabetes in the UK, the body doesn’t produce enough insulin or is resistant to its effects, so blood sugar levels rise, causing harm to blood vessels and the organs that they serve. The ill-effects include kidney, eye, brain, nerve and heart damage. Once diabetes develops, the best case scenario is that drastic changes to lifestyle and drug treatment keep complications to a minimum. But poor control of blood sugar levels significantly increases the risk of devastating conditions such as strokes, heart attacks, visual loss and gangrene.
It’s not all about what we eat. Genes play a role too, with some people being predisposed to diabetes and obesity. An EU project named Diabesity has been set up to try to identify the genes that regulate appetite and metabolism, with the aim of developing drugs to prevent and treat the condition.
But the brave new world of genetic manipulation is a long way off. Until then, it’s the old mantra of “eat less, do more” or face the consequences – especially if diabetes runs in your family. And there cannot be an adult in the country who doesn’t know this stuff.
If you were a GP, what would you say to a patient who is overweight and getting fatter, whose blood sugar is on the cusp of being classified as diabetes and who already knows the damage diabetes can cause because several family members have been through it? Despite all the guidance we receive, I haven’t found that anything I say really helps people to change.
Self-management and education programmes such as Desmond are available in many regions but evidence of their effectiveness is limited. In my area we can refer people to specialist nurses and dietitians which tends to be popular with highly motivated patients, but less successful with those who need it most.
Meanwhile the search is on for new drugs to treat diabetes and obesity. There are already some on the market, such as exenatide (Byetta), which causes modest weight loss, compared to the standard drug metformin, which has no effect on weight. But the newer drugs are expensive, may not be as safe in the long term, and aren’t quite the miracle workers that their marketing suggests.
The National Institute for Health and Care Excellence (Nice) recommends that all obese patients with type 2 diabetes should be assessed for weight loss (bariatric) surgery. Anyone with a body mass index (BMI) over 35 who has been diagnosed with diabetes in the past 10 years should be offered surgery, and anyone with diabetes and a BMI over 30 should also be considered. Both groups should be referred by their GP to a specialist weight-management service.
Surgery and the subsequent dramatic weight loss can cure diabetes. Of 4,000 diabetic patients in the UK who had bariatric surgery, 65% no longer needed any diabetes medication two years later. Nice estimates that at least 5,000 operations a year more should be performed. But not everyone wants to undergo an operation, and not everyone who wants one can have one, as an iniquitous level of postcode lottery prevails.
Diabetes UK says the new figures of rates of diabetes are a “stark call to action”. If only it were clear what action to take and how on earth to achieve it.
