Jul 28th 2018

Diabetes: the good news and the bad news – and what next for the future

 

Alarming stories about the diabetes epidemic that threatens millions of lives – and the NHS itself – have become commonplace, and with good reason. Around 4.6m people in the UK are living with diabetes while a further 12.3m are at increased risk of developing it. The NHS spends an estimated £14 billion a year on treating diabetes and its complications.

But there is some positive news amid the gloom. I chaired the 2018 World Congress on Prevention of Diabetes and its Complications, where experts from around the world came together to discuss progress in both science and prevention programmes.

Type 1: preventable?

Sometimes known as juvenile diabetes due to the age patients are normally diagnosed, type 1 is an autoimmune disease that attacks insulin-producing cells, leaving patients facing a lifetime of injections and deteriorating health. Improved care has focused on the ways that insulin is delivered and on minimising the impact of health complications on daily life. Scientists are now more convinced than ever that this type of diabetes can be prevented. Although type 1 diabetes is only 5% of all diabetes, it still accounts for tens of thousands of patients who face health challenges every day and require a lifetime of medical support. The impact of prevention of type 1 diabetes would be significant.

The two breakthroughs that underlie this new optimism relate to early detection and prevention therapy. The genetic risk of type 1 diabetes is becoming clearer, and we now have the ability to measure a range of blood factors that appear during the early stages of the disease. Which means we are developing tools to identify those most likely to develop diabetes.

From there, we now have real hope that immunotherapy can stop the insulin-producing cells being destroyed. This covers a range of treatments – including vaccination – designed to change the way a person’s immune system works. The important thing is to find a therapy that specifically shuts off the part of the immune system that attacks the insulin-producing cells, leaving the rest of the defence system intact. Fears that immunotherapy would be too toxic and non-specific for children are being challenged by evidence in clinical trials. These have shown that the therapy can be safe, and encouragingly, have shown signs of slowing down the progress of the disease.

Type 2: devastating

This is the most common form of the disease, directly related to obesity and other lifestyle factors. Type 2 diabetes is devastating; within five to ten years patients could lose their kidneys, eyes, or legs. They may suffer cardiovascular and other deadly diseases linked to diabetes.

Since roughly four out of every five people with diabetes are overweight, the most effective single way to prevent the disease is to avoid weight gain. For 20 years, Finland, US and Australia have conducted diabetes prevention programmes to encourage lifestyle changes, and they are seeing positive results in the health of their nations.

Many countries with very high levels of type 2 have followed suit. This involves “encouraging” people to agree to alter habits of a lifetime, and then provide years of support to maintain physical activity and improve their diet.

However, this alone may only reach around half of all type 2 diabetes, so these countries are increasingly targeting the obesogenic environment that makes it easy to put on weight and hard to lose it. This starts with talking to the food industry, but also has to include legislation to reduce the impact of the most damaging aspects of our diet. A sugar tax has already been introduced in many countries and we’ll learn very soon how effective it is in reducing diabetes and its health problems.

The Scottish government was met with tabloid fury and corporate lobbying over its Minimum Unit Pricing for alcohol and recent plans relating to 2-for-1 pizzas and “all you can eat” buffets. These measures are never popular but they are increasingly necessary. Taxes and subsidies can help reset the balance between the cost of healthy and unhealthy food. Making high-fat and high-sugar foods more expensive could help to increase demand for healthy alternatives and consequently reduce price.

Preventing complications

People don’t drop dead because they develop diabetes. They can live for decades with the condition, but quality of life is another matter. Type 2 diabetes prevention programmes should also include people who already have the disease.

Lifestyle changes can slow progression and reduce serious health issues, and, in some cases, even reverse the disease. For many, strictly following a low-calorie diet immediately after a diagnosis can put type 2 in remission. But its success depends on individual commitment, so there needs to be support to help each person achieve this difficult goal, and then maintain the lifestyle to prevent the disease returning.

The possibility of developing immunotherapy to prevent type 1, and proving that type 2 can be sent into remission, are the two most exciting developments in diabetes research for many years.

If it was possible to prevent at least half of type 2 cases – which we believe can be done by changing lifestyle and environmental factors – then the amount spent treating diabetes and its complications could be halved. That’s billions freed up for the NHS. Most importantly, it would improve patients’ quality of life and life expectancy.

The link between cheap, sugary and fatty food and obesity and type 2 diabetes is indisputable. The healthy/unhealthy food cost ratio has to change because the evidence is that education – while valuable – is not enough by itself. The evidence from many countries shows that in most chronic, lifestyle-related diseases, legislation is faster and often more effective.

The apocalyptic scenarios often painted are not inevitable, but they are likely if we carry on as we are. People need to accept some hard truths about their lifestyle, and bold political leadership is needed to make unpopular decisions for the benefit of the nation’s health.

 

Calum Sutherland, Reader School of Medicine, University of Dundee

This article was originally published on The Conversation. Read the original article.

 

Editor's note:

To contact Facts & Arts please write to the Editor, Olli Raade, at info@factsandarts.com

For notifications of a new article, please follow me on Twitter:  @olliraade 

Browse articles by author

More Current Affairs

Mar 18th 2024
EXTRACT: "....the UK’s current economic woes – falling exports, slowing growth, low productivity, high taxes, and strained public finances – underscore the urgency of confronting Brexit’s catastrophic consequences."
Mar 18th 2024
EXTRACTS: Most significant of all, Russia’s Black Sea fleet has suffered significant losses over the past two years. As a result of these Ukrainian successes, the Kremlin decided to relocate the Black Sea fleet from Sevastopol to Novorossiysk on the Russian mainland. Compare that with the situation prior to the annexation of Crimea in 2014 when Russia had a secure lease on the naval base of Sevastopol until 2042." --- "Ukrainian efforts have clearly demonstrated, however, that the Kremlin’s, and Putin’s personal, commitment may not be enough to secure Russia’s hold forever. Kyiv’s western partners would do well to remember that among the spreading gloom over the trajectory of the war."
Mar 8th 2024
EXTRACT: "As the saying goes, 'It’s the economy, stupid.' Trump’s proposed economic-policy agenda is now the greatest threat to economies and markets around the world."
Mar 8th 2024
EXTRACT: "Russia, of course, brought all these problems on itself. It most certainly is not winning the war, either militarily or on the economic front. Ukraine is recovering from the initial shock, and if robust foreign assistance continues, it will have an upper hand in the war of attrition."
Mar 8th 2024
EXTRACT: "...... with good timing and good luck, enabled Trump to defeat [in 2016] political icon Hillary Clinton in a race that appeared tailor-made for her. But contrary to what Trump might claim, his victory was extremely narrow. In fact, he lost the popular vote by 2.8 million votes – a larger margin than any other US president in history. Since then, Trump has proved toxic at the ballot box. " -----"The old wisdom that 'demographics is destiny' – coined by the French philosopher Auguste Comte – may well be more relevant to the outcome than it has been to any previous presidential election. "----- "Between the 2016 and 2024 elections, some 20 million older voters will have died, and about 32 million younger Americans will have reached voting age. Many young voters disdain both parties, and Republicans are actively recruiting (mostly white men) on college campuses. But the issues that are dearest to Gen Z’s heart – such as reproductive rights, democracy, and the environment – will keep most of them voting Democratic."
Mar 8th 2024
EXTRACTS: "How can America’s fundamentalist Christians be so enthusiastic about so thoroughly un-Christian a politician?" ---- "If you see and think outside the hermeneutic code of Christian fundamentalism, you might be forgiven for viewing Trump as a ruthless, wholly self-interested man intent on maximizing power, wealth, and carnal pleasure. What your spiritual blindness prevents you from seeing is how the Holy Spirit uses him – channeling the 'secret power of lawlessness,' as the Book of 2 Thessalonians describes it – to restrain the advent of ultimate evil, or to produce something immeasurably greater: the eschaton (end of history), when the messiah comes again."
Mar 1st 2024
EXTRACT: "The lesson is that laws and regulatory structures are critical to state activities that produce local-level benefits. If citizens are to push for reforms and interventions that increase efficiency, promote inclusion, and enable entrepreneurship, innovation, and long-term growth, they need to recognize this. The kind of effective civil society Nilekani envisions thus requires civic engagement, empowerment, and education, including an understanding of the rights and responsibilities implied by citizenship."
Feb 9th 2024
EXTRACT: "Despite the widespread belief that the global economy is headed for a soft landing, recent trends offer little cause for optimism."
Feb 9th 2024
EXTRACT: " Consider, for example, the ongoing revolution in robotics and automation, which will soon lead to the development of robots with human-like features that can learn and multitask the way we do. Or consider what AI will do for biotech, medicine, and ultimately human health and lifespans. No less intriguing are the developments in quantum computing, which will eventually merge with AI to produce advanced cryptography and cybersecurity applications."
Feb 9th 2024
EXTRACTS: "The implication is clear. If Hamas is toppled, and there is no legitimate Palestinian political authority capable of filling the vacuum it leaves behind, Israel will probably find itself in a new kind of hell." ----- "As long as the PLO fails to co-opt Hamas into the political process, it will be impossible to establish a legitimate Palestinian government in post-conflict Gaza, let alone achieve the dream of Palestinian statehood. This is bad news for both Israelis and Palestinians. But it serves Netanyahu and his coalition of extremists just fine."
Jan 28th 2024
EXTRACTS: "According to estimates by the United Nations, China’s working-age population peaked in 2015 and will decline by nearly 220 million by 2049. Basic economics tells us that maintaining steady GDP growth with fewer workers requires extracting more value-added from each one, meaning that productivity growth is vital. But with China now drawing more support from low-productivity state-owned enterprises, and with the higher-productivity private sector remaining under intense regulatory pressure, the prospects for an acceleration of productivity growth appear dim."
Jan 28th 2024
EXTRACT: "When Chamberlain negotiated the notorious Munich agreement with Hitler in September 1938, The Times did not oppose the transfer of the Sudetenland to Germany without Czech consent. Instead, Britain’s most prestigious establishment broadsheet declared that: “The volume of applause for Mr Chamberlain, which continues to grow throughout the globe, registers a popular judgement that neither politicians nor historians are likely to reverse.” "
Jan 4th 2024
EXTRACTS: "Another Trump presidency, however, represents the greatest threat to global stability, because the fate of liberal democracy would be entrusted to a leader who attacks its fundamental principles." ------"While European countries have relied too heavily on US security guarantees, America has been the greatest beneficiary of the post-war political and economic order. By persuading much of the world to embrace the principles of liberal democracy (at least rhetorically), the US expanded its global influence and established itself as the world’s “shining city on a hill.” Given China and Russia’s growing assertiveness, it is not an exaggeration to say that the rules-based international order might not survive a second Trump term."
Dec 28th 2023
EXTRACT: "For the most vulnerable countries, we must create conditions that enable them to finance their climate-change mitigation" ........ "The results are already there: in two years, following the initiative we took in Paris in the spring of 2021, we have released over $100 billion in special drawing rights (SDRs, the International Monetary Fund’s reserve asset) for vulnerable countries.By activating this “dormant asset,” we are extending 20-year loans at near-zero interest rates to finance climate action and pandemic preparedness in the poorest countries. We have begun to change debt rules to suspend payments for such countries, should a climate shock occur. And we have changed the mandate of multilateral development banks, such as the World Bank, so that they take more risks and mobilize more private money."
Dec 27th 2023
EXTRACT: "....if AI causes truly catastrophic increases in inequality – say, if the top 1% were to receive all pretax income – there might be limits to what tax reforms could accomplish. Consider a country where the top 1% earns 20% of pretax income – roughly the current world average. If, owing to AI, this group eventually received all pretax income, it would need to be taxed at a rate of 80%, with the revenue redistributed as tax credits to the 99%, just to achieve today’s pretax income distribution; funding the government and achieving today’s post-tax income distribution would require an even higher rate. Given that such high rates could discourage work, we would likely have to settle for partial inequality insurance, analogous to having a deductible on a conventional insurance policy to reduce moral hazard."
Dec 21st 2023
EXTRACT: "Shocks are here to stay, and our task is not to predict the next one – although someone always does – but to sharpen our focus on resilience. Staying the course of politically mandated policies while minimizing the inevitable dislocations is easier said than done. But that is no excuse to fall for the myth of being victimized by the unprecedented."
Dec 21st 2023
EXTRACTS: "A new world is indeed emerging. It will be characterized not only by more interdependencies, but also by more insecurity, danger, and war. Stability in international relations will become a foreign concept from a bygone age – one that we did not fully appreciate until it was gone."
Dec 14th 2023
EXTRACT: "Yet one must never forget that Putin is first and foremost an intelligence officer whose dominant trait is suspicion."
Dec 2nd 2023
EXTRACTS: "In a recent commentary for the Financial Times, Martin Wolf trots out the specter of a 'public-debt disaster,' that recurrent staple of bond-market chatter. The essence of his argument is that since debt-to-GDP ratios are high, and eminent authorities are alarmed, 'fiscal crises' in the form of debt defaults or inflation “loom. And that means something must be done.' ----- "If, as Wolf fears, 'real interest rates might be permanently higher than they used to be,' the culprit is monetary policy, and the real risk is not rich-country public-debt defaults or inflation. It is recession, bankruptcies, and unemployment, along with inflation." ---- "Wolf surely knows that the proper remedy is for rich-country central banks to bring interest rates back down. Yet he doesn’t want to say it. He seems to be caught up, possibly against his better judgment, in bond vigilantes’ evergreen campaign against the remnants of the welfare state."
Nov 27th 2023
EXTRACT: "The first Russia, comprising those living in Russia’s two biggest cities, Moscow and Saint Petersburg, can pretend there is no war at all." ---- "Then there is the other Russia, the one you find in small towns and villages scattered across the country’s massive territory. Here, the Ukraine war is a source of patriotic pride,"