How will we afford the diabetes epidemic?

The oldest adage in the book “prevention is better is cure” could never have been more apt than now. We didn’t really need reminding, after all the figures are already terrifying but this week’s publication of the SABRE study does rather highlight the point, there’s a lot of diabetes around and it’s getting worse.

Specifically, the SABRE study has shown that in an urban population of middle aged people followed up for 20 years, by the end of follow up, 15% of the Europeans had developed diabetes, 33% of the Asian Indian population had it and 30% of the African Caribbean subjects had developed it.
 
The figures for the European subjects are bad enough and very much chime with the ~15% prevalence of inpatient diabetes found by the national diabetes inpatient audit, but for the ethnic minorities they are staggering, and mean that roughly 1:3 of all Asian Indian and African Caribbean patients in many parts of the country may have diabetes. Furthermore, these figures were used to predict that by age 80, the prevalence will be 1 in 2 in these groups, in other words, it will be safer to ask “does my patient not have diabetes?” rather than “might they have it?”
 
Of course these figure should not be a surprise, we already know that globally, the WHO is predicting ~440M with diabetes by 2030 and that approximately 10% of all NHS budget is now spent on diabetes and diabetes related conditions/complications. Thus, it is well recognised that the current rate of growth is un-sustainable and will bankrupt the NHS if nothing is done. So surely now is the time to focus on diabetes prevention strategies. The Diabetes Prevention Programme and Finish Diabetes Prevention Study (as well as several other smaller/less well publicised studies) established the precedent, it is possible.
 
Now the challenge is how to convert the theory of diabetes prevention in to practice. Leaving aside the pharmacologic interventions used in some study arms, the principles are simple, identify the higher risk individuals and get them to make modest adjustments in their diet, aim for relatively small weight loss and modest increases in physical exercise. The challenge is to convert these principles in to a pragmatic, practical, achievable strategy on the ground. The sorts of resources employed by the investigators in the DPP and DPS diabetes prevention programmes, if scaled up to a population level, would also, like the costs of diabetes itself, potentially bankrupt the NHS.
 
The challenge will therefore be to scale up these sorts of interventions on an affordable footing. The results of the Norfolk Diabetes Prevention Study and others employing less intensive, more “real-world” interventions to affect diabetes prevention should provide clearer ideas on how best to achieve diabetes prevention on an affordable basis. In the meantime, studies such as SABRE only serve to remind us of the extreme importance of this particular public health challenge.

Tags for this article: prevention

The author - Dr Jeremy Turner

Jeremy Turner A consultant diabetologist and endocrinologist in Norfolk, and author of Diabetes Bible

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My blog expresses my personal views on the rapidly advancing field of diabetes. It is aimed at fellow physicians and is not offering medical advice to readers. I will not respond to requests for clinical advice. If you have health concerns please contact your GP or specialist.

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