The increasing prevalence of obesity in the UK is a subject we’ve discussed at some length in previous posts.
To provide a brief insight: since 1980, when only around 7% of UK persons were obese, prevalence has increased just over three-fold in the 30 years since. 24.9% of UK adults were obese in 2013.
Unsurprisingly, this rise has also contributed to an increase in weight-related illnesses, including type 2 diabetes.
As you’ll read elsewhere on our site, type 2 diabetes is a condition which affects the ability of the body to produce or use insulin effectively. Put simply, insulin is responsible for processing the sugar (glucose) we absorb into our bloodstream from the food we eat, by enabling glucose to enter the body’s cells where it is used for energy.
When the body cannot produce enough insulin (or is unable to use it effectively), the level of glucose in the bloodstream becomes high (hyperglycaemia), which can cause lasting damage to various organs and lead to blindness, kidney failure and amputations.
The condition is a very prevalent one. The charity Diabetes UK estimates that there are 3.5 million Brits diagnosed with the condition, and an extra half a million extra cases undiagnosed. The NHS estimates that around 90 per cent of diabetes cases in the UK are type 2.
And obviously diabetes isn’t just a UK problem. According to The International Diabetes Federation, 1 in 11 adults live with the condition globally, and almost half of people with diabetes don’t know they have it.
Recently, we spoke to Dr David Cavan, Director of Policy and Programmes at International Diabetes Federation, to get more of an insight into the scale of the issue, what he thinks are the driving forces are behind it, and what the future holds.
Shape of things to come
Firstly, is the diabetes situation set to get better or worse?
‘IDF predicts that numbers are set to increase in the UK and globally.’ Dr Cavan tells us.
Currently, there are thought to be 415 million adults living with diabetes worldwide. The IDF estimates that this will increase to 640 million in the next 25 years, which constitutes a rise of more than 50%.
‘The biggest increases are predicted in many countries in Africa, the Middle East and Asia, where cases are set to double by 2040.’ Dr Cavan continues.
‘Most of the increase is due to type 2 diabetes; this is related to modern day lifestyles, associated with urbanisation, such as access to inexpensive high calorie foods and inactivity.’
Obesity and diet-related disease, in the UK media at least, is perhaps a more prominent issue than it ever has been.
But even though the lay person here may be more familiar with the condition, this isn’t the case everywhere.
‘In the UK there is certainly a lot more awareness of type 2 diabetes and also of the factors that cause it, with all the recent focus on sugar and inactivity. Globally, however, in many countries type 2 diabetes is a relatively new phenomenon and there is much less awareness.’
And despite the comparatively high level of awareness in the UK, diagnoses are still projected to rise; which begs the question, what other strategies can be implemented to tackle the condition?
‘The strategies most likely to be effective in reducing new cases are those that encourage people to change their lifestyles, such as:
- promoting fresh fruit and vegetables and making them more affordable (and making high sugar/high fat foods more expensive);
- promoting active transport (including public transport) and discouraging car use;
- and encouraging employers to facilitate physical activity (there was a recent report that said we need 60 mins activity to compensate for 8 hrs at a desk).
These are public health measures that need government action (such as taxation, curbing advertising and so on), just as with tobacco.’
Staying on the subject of taxation, the proposed sugar tax has been a prominent news feature in the UK over the past year, and the subject of much debate. On one side, there's the argument that it will reduce overall sugar consumption, particularly among teenagers and children. On the other side, there's the argument that it won't make any significant difference to people's habits, and only serve to penalise the poor.
We asked Dr Cavan for his opinion on the subject.
‘In Mexico, the tax on sugar sweetened beverages has already led to reduction in consumption and increase in consumption of water. Any such tax will have more impact on the poor (as with tobacco) but as it is the best interest of public health, that should not stop its introduction. Also, tap water is cheaper than fizzy drinks.’
‘But this alone will not be enough,’ Dr Cavan goes on to say, ‘there need to be other actions, targeting the other issues already discussed.’
Testing and early detection
Aside from the potential complications, one significantly dangerous aspect of diabetes is that it is so easy to miss.
According to the IDF, 46% of estimated global cases are undiagnosed, and this is largely because many may not notice early symptoms (such as fatigue, thirst, and increased urinary frequency).
With this in mind, we asked Dr Cavan: when should someone look into being tested?
‘There are risk scores available that anyone can take, for example on the Diabetes UK website. Anyone who is concerned they are at risk should see their GP. Most GPs will test those who they feel are at risk and as a result many people are being picked up much earlier than previously.’
‘Early detection is really important so that the individual can be encouraged to make lifestyle changes to achieve good control of their diabetes and reduce the risk of complications, such as blindness, amputation and heart attack.’
Lifestyle and medication
Treatment is available for those with type 2 diabetes. These function in a variety of ways (some in the liver, some in the gut, some in the pancreas) but all of them work in some way to assist the processes that keep blood glucose levels under control.
However, as Dr Cavan explains, medication alone isn’t enough to successfully manage the condition. Healthy dietary and exercise habits must be incorporated into a person’s treatment plan too:
‘As type 2 diabetes largely results from modern day lifestyles then it is obvious that lifestyle change really has to be the cornerstone of treatment. No medication will work well if the person has a very unhealthy diet and remains significantly overweight.’
So what lifestyle measures should someone with a diagnosis take?
‘Reduce sugar and other refined carbohydrates as much as possible,’ Dr Cavan advises, ‘eat more fresh leafy vegetables, focus on eating fresh foods rather than processed foods and try and walk more.’
As we’ve mentioned previously, regular physical activity can play a vital and useful role in diabetes management, and following the NHS guidelines (of 150 minutes of moderate exercise per week) is a great place to start.
You can find more resources on how to manage diabetes on the IDF website, along with further information on the global situation, and how to donate to Life for a Child; the scheme which focuses on providing insulin to children and young people with type 1 diabetes in developing nations. Unlike type 2 diabetes, people with type 1 diabetes need insulin to stay alive and many of these children would die without the support of this programme.