Diabetes treatment in Ireland needs a radical rethink to focus on preventing the disease, say experts here. Ronan McGreevyreports
There are few more incendiary issues in modern medicine and no greater looming threat to public health than type two diabetes.
As waistlines have expanded across the western world so too has the prevalence of a disease which is directly linked with obesity. Type one diabetes, which usually occurs in childhood, is otherwise known as insulin-dependent diabetes. It is not preventable and easily treatable with insulin injections.
Type two diabetes is, invariably, preventable, yet despite warnings that the toxic combination of lack of exercise and bad diet can lead to the disease, the epidemic is set to get worse, not better.
Abnormal fat distribution leads to an increased demand for insulin which is the hormone that converts food into energy for the body. The body can't always cope with the extra insulin demands, leading in time to diabetes. If left untreated, type two diabetes can lead to a myriad of complications, including heart and kidney disease, chronic infections, blindness and foot infections.
The prevalence of type two diabetes in Ireland has been identified by the Institute of Public Health as one of the most serious health issues facing this country. It estimates that the number of people with the disease will reach almost 200,000 by 2015, an increase of 37 per cent.
The cost to the health service will increase from €580 million to €770 million in the same time frame. A recent study found that diabetes costs €2,468 for every patient in Ireland every year.
Currently, 4.7 per cent of the population have type two diabetes, a figure which experts believe is an understatement, as the European average is around 6 per cent. It is estimated that within 25 years, 10 per cent of the adult population in the EU, the equivalent of 400,000 people in Ireland, will have type two diabetes.
The rise has been directly linked with an explosion of obesity in Ireland which has gone from 6 per cent of the population in 1983 to about 25 per cent now.
The epidemic of type two diabetes will be the major theme of a health conference at Dublin Castle on Saturday and Sunday week. The title of the conference, Diabetes in crisis - A multidisciplinary approach to the treatment of diabetes, reflects the seriousness with which the issue is being viewed by the medical profession. It will be open to all healthcare professionals and will address a spectrum of the key "moving points" in diabetes care, from genetics, through epidemiology to clinical care, and the challenge of living with diabetes.
The conference will feature some of the leading practitioners in the field, including Prof Philippe Froguel, chair of the department of genomic medicine at Imperial College London, who recently discovered evidence for new type two diabetes-associated genes, and Prof Kenneth Lee Jones from the University of California, a world-expert on type two diabetes in children.
Epidemiologist Prof Jaakko Tuomilehto (Finland) is a leading expert on diabetes prevention, while Prof Eberhard Standl (Munich), the president of the International Diabetes Federation, EU region will speak on diabetes and cardiovascular disease.
Closer to home, the speakers will include Dr Donal O'Shea, consultant endocrinologist at St Colmcille's Hospital, Loughlinstown and St Vincent's Hospital, Dublin and Dr Richard Firth from the Mater Hospital.
Conference organiser Prof John Nolan says: "We want to draw attention to the problem. Diabetes is a huge one because of its complications. Obesity and type two diabetes is the leading set of chronic diseases."
The conference will be opened by the Minister for Health Mary Harney on Friday, February 22nd. Nolan has been a vociferous critic of the Government's approach to the problem and he is hoping that the central message of the conference will not be lost on the Minister. "There has been very little progress in nearly 20 years. On one side you have an epidemic growing in frequency and flexibility.
"On the other side, you have a complete standstill in health services and there are huge problems with access to care," he says.
"We want to make a plea for frontline resources for care because we are way behind our neighbouring countries including Britain.
"What Ireland needs now is commitment from the government to implement a national diabetes strategy which will address the problem of access to specialist care for all people diagnosed with diabetes.
Nolan believes that more money should be invested in early assessment and preventative care. That means early access to specialist assessment for all adults and children diagnosed with diabetes, and regular reviews in an integrated programme linking diabetes centres with GPs.
"It is a commonly stated myth that the Irish government has invested massively in health, with no return. Our study shows that large sums of money are spent - but on treating preventable, late complications of diabetes. Diabetes care in Ireland urgently needs investment in frontline services," he says.
Dr Donal O'Shea says he favours a more aggressive approach to dealing with type two diabetes in obese people who weigh on average more than 20 stone.
Currently, Loughlinstown Hospital is carrying out an average of one gastric bypass operation, also known as stomach stapling, every week on morbidly obese people who have developed type two diabetes, with successful results.
"Our realisation is that aggressive treatment of obesity actually causes the diabetes to go away," he intends to tell the conference.
The conference will also address type one diabetes, which is also on the rise across the western world, but for reasons the experts do not quite understand yet. The rise is too steep to be attributed to genetic factors, so researchers are examining environmental changes which could precipitate such a large increase.
For further information on the conference, log on to www.eventwise.ie or tel: 01-6645409