Health Comment: The war on diabetes needs facts, not scaremongering

By PROFESSOR CRAIG CURRIE

Published: | Updated:


Rising numbers: The number people diagnosed with diabetes has increased from 1.4¿million to 2.9¿million in 18 years

Rising numbers: The number people diagnosed with diabetes has increased from 1.4¿million to 2.9¿million in 18 years

Many people will have been worried by scary headlines last week suggesting one in three of us is pre-diabetic.

According to a British Medical Journal report, a third of Britons are on the brink of being diagnosed with type 2 diabetes and potentially wiping years off their lives.

Don’t panic!

As an expert who has spent 20 years studying the condition I know you either have the disease or you don’t.

This notion of pre-diabetes is  confusing and unhelpful when the disease is now so common.

To aid understanding of this crisis, we need clear facts.

Diabetes is a potentially serious disease and according to Diabetes UK, since 1996 the number diagnosed has increased from 1.4 million to 2.9 million.

That figure is forecast to hit five million by 2025.

While this is partly due to our ageing population, excess weight is the major cause in 90 per cent of type 2 diagnoses. A quarter of UK adults are now obese.

Type 2 develops when the amount of insulin in the blood is too high.

Being fat causes metabolic changes that mean we require more and more insulin for it to be effective. Insulin is the hormone that allows glucose to enter the body’s cells to be stored and later used as fuel. In the laboratory we can turn normal rats into diabetic rats just by over-feeding them.

Excess fat, and in particular fat stored on the abdomen, disrupts the body’s metabolic functions, further fuelling insulin resistance in overweight and obese people.

Those with type 1 diabetes have a very different disease that normally starts in early age.

Short-term, type 2 can cause blurred vision, fatigue, and slower healing of cuts and wounds. Long-term, it is the leading cause of blindness and amputations, and a major cause of heart attack, stroke and ultimately premature death.

High risk: Excess fat, and in particular fat stored on the abdomen, disrupts the body¿s metabolic functions, further fuelling insulin resistance in overweight and obese people

High risk: Excess fat, and in particular fat stored on the abdomen, disrupts the body¿s metabolic functions, further fuelling insulin resistance in overweight and obese people

All the term ‘pre-diabetes’ does is unnecessarily medicalise people whose blood sugar is at the high end of the normal range, many of whom will never develop diabetes.

The majority of pre-diabetics aren’t even initially given metformin, the most commonly used drug in the early treatment of type 2. Instead, their GP tell them to lose weight and increase activity. Most of us don’t heed that advice.

What’s really needed is research to establish whether intervening earlier with medication could improve the health of an individual genuinely at high risk.

At Cardiff University, we’ve just submitted data to a leading journal identifying a drug which, when given to a type 2 patient after diagnosis, appears to increase medium-term life expectancy compared to the non-diabetic population. But currently there is no proper evidence that medicating a person not yet diabetic can be beneficial.

Should studies prove this in future, there may be an argument for reducing the blood sugar threshold. But for now here’s what can really protect you.

If you’re constantly tired, thirsty and need to urinate more often, see a doctor as these are telltale signs of diabetes.

If you see an overweight person in the mirror, be concerned. If you become  lean or even a little bit more lean, this scourge can be prevented or even reversed.

We are in the grip of an obesity and diabetes epidemic. I suspect it will take legislation akin to the smoking ban to elicit meaningful change. Perhaps we could also ban the misleading term pre-diabetes.

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