Type 2 Diabetes: how to reduce the risk

    14 November 2019

    With World Diabetes Day falling on November 14th it is apposite that two significant headlines linked to this condition splashed across the news in recent days. The first is that the number of obesity-related annual NHS hospital admissions has risen to over a million for the first time, with the most rapid increase being seen in toddlers and young children. The second is from NHS Digital who revealed that diabetes prescriptions are now costing NHS England more than £1.075 billion a year, 13 per cent of the total cost of NHS prescribing in England.

    This eye-watering sum pales into insignificance however when compared to the total annual cost of diabetes to the NHS which is now over £10 billion a year, equating to over 10 per cent of the total NHS budget, and this is forecast to rise to the almost unsustainable level of £17 billion by 2035. However, some 80% of these direct costs for diabetes are spent on managing and treating the largely avoidable long-term complications that develop over decades, with 1 in 6 hospital beds currently occupied by people with diabetes.

    Diabetes is a condition where the blood sugar level is higher than normal and there are two main types – type 1 and 2. Type 1 diabetes (also called insulin-dependent diabetes) is usually diagnosed when young and is not linked to weight, whereas Type 2 diabetes (usually non insulin-dependent diabetes) tends to affect adults over 40 and overweight people although the rise of obesity in younger people means this type of diabetes is now being increasingly seen in teenagers.

    Insulin is a hormone produced by the pancreas gland in the abdomen, and this controls the use of glucose (sugar) within the body. The blood sugar level will rise if the pancreas produces little or no insulin (Type 1 diabetes), or if the pancreas produces insulin, but it’s inadequate for the body’s needs and its effectiveness is reduced (Type 2 diabetes). Type 2 – the most common type, affecting over 90% of people in the UK with diabetes – is undoubtedly related to factors associated with a Western lifestyle, since it is most common in people who are overweight and who don’t get enough exercise. Typical symptoms include increased thirst, frequent urination, tiredness and recurrent infections, many of which are often dismissed or ignored as being due to ‘getting older’.

    Diabetes is treated in two ways: a combination of healthy diet and exercise, and/or medication using tablets or insulin injections. A well-balanced diet low in sugar is best but calorie intake and watching your weight is still vital. There are different types of tablets used for treating Type 2 diabetes. Some of these increase the amount of insulin secreted by the pancreas, some increase the action of insulin in the body and others delay the absorption of glucose from the digestive system. Treatment for diabetes depends on the individual and so is tailored for each person with diabetes. Insulin injections are used in Type 1 diabetes and in some cases of Type 2, and increase the amount of insulin in your body and so bring down the blood sugar level.

    Ways of reducing your risk of developing diabetes include losing weight if you are overweight or obese – this is the single biggest way of reducing your risk of developing diabetes. Waist circumference is particularly important here as a waist size greater than 89cm in women and 102cm in men significantly increases the risk of developing diabetes. Be aware of the symptoms of diabetes if you have a history of it in your family, cut refined sugar out of your diet, stop smoking, have your blood pressure checked and treated if it is high and know what your cholesterol level is and reduce this if high.

    Although sticking to a diet known as a VCL (very low calorie) diet can achieve significant weight loss, reduce insulin resistance and allow people with Type 2 diabetes to reduce or even come off diabetes medication altogether, this is most definitely not for the faint-hearted as it involves sticking rigidly to a 800kcal/day diet where 600 calories are made up from meal shakes and the rest from non-starchy vegetables. This is a punishing regimen and an extreme form of dieting and should never be considered without seeking medical advice first. It is also virtually impossible to continue long-term over months or years.

    A lifelong commitment to a healthy lifestyle can be more effective than medication in many people with Type 2 diabetes but this is often very hard for people to do, or to stick with. However, with lifestyle changes to diet and exercise, many cases of Type 2 diabetes can be placed into remission with the number of complications reduced as a result, and patients now often prefer to be treated with lifestyle changes rather than medication.

    One of the key aims of the NHS Diabetes Prevention Programme is to provide digital tools and personalised support – typically via a smartphone – to enable patients to make, and maintain, these lifestyle changes as a sustainable way to free up healthcare professionals’ time, whilst moving patients away from medication whenever possible. The core principles of diabetes risk reduction are simple; reduce weight, exercise more and eat healthily. With over 400,000 people being admitted to an NHS hospital each year with diabetes-related complications, it’s better to act sooner rather than later.