Blood glucose meter
The SABRE study has hit the headlines for its research into the high levels of diabetes in minority ethnic communities. The study reveals the extent of ethnic differences in the risk of developing type 2 diabetes, but the problems that it highlights deserve our attention whatever our ethnicity. There are 2.9 million people diagnosed with diabetes in the UK and an estimated 850,000 people who have the condition but don’t know it. The SABRE statistics published this week challenge us to scrutinise the management, treatment and prevention of diabetes in the UK.
Speaking at a press briefing for SABRE Dr Mike Knapton, Associate Medical Director at the British Heart Foundation, warned that diabetes is often underestimated, even by those who suffer from it. For type-2 diabetics, dietary controls and lifestyle changes can be enough to successfully manage the disease. As such the patients and their families may not fully realize the seriousness of the condition. Although diabetes itself is rarely fatal, it often leads to life-threatening conditions such as coronary heart disease and stroke. If we do not act to reduce the instances and impact of this disease, then, as Dr Knapton commented, “the cost to the health service is going to be huge”.
The NHS performs health checks on all adults over the age of 40. The aim is to pick up on undiagnosed health problems and to assess an individual’s risk of developed chronic diseases such as diabetes. Monitoring patients in this way creates opportunities for GPs intervene early and help the patient to reduce their individual risk through lifestyle changes, such as taking up exercise or quitting smoking. The SABRE discovery that diabetes is often developed much earlier in South Asian men – who were diagnosed 5 years younger on average than other men – has raised the question of whether 40 is too late an age to begin such checks. Iain Frame, Director of Research at Diabetes UK, is adamant that “these communities should be screened earlier than the general population – from the age of 25 rather than 40.” But are such targeted measures the right response to the rise in diabetes?
The NHS already uses targeted programs to screen those most at risk from illnesses such as breast cancer, for which family history is known to be an important indicator of risk. These initiatives help to catch illnesses in their early stages, which both benefits the patient and saves NHS resources. However we must be careful not to develop a narrow response to disease prevention, one that is too focused on high-risk groups. At the SABRE briefing, Dr Therese Tillin, from the National Heart and Lung Institute at Imperial College London, was keen to stress that the results of the SABRE study do not mean that diabetes is a minority problem, saying “we need to remember that Europeans are at risk as well”.
One of the key findings of the study was that the increased instance of diabetes amongst South Asian, African and African Caribbean women was often due to higher levels of truncal or abdominal obesity (excess weight around your waist). This data will be valuable in informing the response to diabetes in these communities, but it also affirms the importance of nutrition and exercise initiatives in tackling the rise of the disease nationwide. Dr Hélène Wilson, Research Advisor at the British Heart Foundation, said, “it underlines the fact that controlling your weight by eating well and getting active can have a significant protective effect on your health. There’s a wealth of existing evidence that keeping the weight of by eating a healthy balance diet and being physically active will reduce your risk of heart disease and type 2 diabetes, whatever your ethnic group.”
The key, then, to slowing the march of this damaging disease may well lie not in having health checks at 25 or quitting smoking at 40, but in ensuring that from an early age, eating well and exercising regularly are a normal part of everyday life for children in the UK. This is not a new or surprising development and it is easier said than done. We are bombarded by new initiatives, ad campaigns and events which hope to make this vision a reality. A sea change in behavior, even after our spectacular summer of sporting events, is unlikely, and it is easy to be worn down by the slow rate of progress. But Knapton, for one, is indefatigable. “Could we do more [to combat diabetes]? Yes, we could always do more”. And we should.
Image credit: Wellcome Library, London
Filed under: Development, Ageing and Chronic Disease, Environment, Nutrition and Health, Funding Tagged: Chronic disease, Diabetes, Obesity, SABRE
