We are heading towards an epidemic of diabetes that threatens to bankrupt our healthcare systems
The incidence and prevalence of type 2 diabetes is increasing worldwide. In Ireland the latest figures by the Institute of Public Health showed that in 2010 more than 10 per cent of adults aged 55 and over have diabetes. More than 41,000 (2.7 per cent) adults aged 45 years and over have undiagnosed diabetes. Diabetes is also more common among older people.
The cause of this is very clear. We are becoming increasingly obese as a population, and the relationship between obesity and diabetes is well established. In fact, the term “diabesity” has been coined to link the relationship between increasing obesity and associated type 2 diabetes.
Some 90 per cent of the world’s 285 million people with diabetes have type 2 which is directly related to obesity. Richard Schulze of the Schulze Diabetes Institute in the US said “the increasing prevalence of obesity – fuelled by excessive calorie intake, suboptimum dietary quality and sedentary lifestyles – is driving this epidemic”.
Epidemic of diabetes
Thus we are sleepwalking our way as a society into an epidemic of diabetes. This epidemic is threatening to bankrupt our healthcare systems within a generation as increasing numbers of patients are managed with increasing numbers of more expensive drugs. The diabetes drugs bill in the British National Health Service, for example, is estimated to rise from the current £9.8 billion (€7.66 billion) to £16.9 billion by 2035.
The current obesity/diabetes crisis is similar to the typhoid epidemic which pervaded in America and Europe in the late 19th century. Public health measures won the day here. As a result of the introduction of clean water, the rate of death from typhoid fever fell from 80/100,000 of population in 1890 to 7/100,000 in 1918. This population-based preventive approach treated the disease far more effectively than individual patient management.
Public health
We need a similar bold approach to the prevention of obesity to stop the onward march of diabetes. This public health approach must take precedence over the so-called medical model which concentrates on individual patients but does not adopt a community approach. In other words, we need to adopt a similar approach to the “clean water” act of the late 19th century, only in this case it is an anti-obesity act. So what can be done?
Firstly, for our patients already diagnosed with type 2 diabetes there needs to be a much greater concentration on lifestyle measures to treat the condition. There is an abundance of evidence that this approach is effective. No drugs are involved. Lifestyle measures may arrest or even reverse the progress of type 2 diabetes. Many lifestyle measures have the added advantage of not costing any money and not having any unpleasant drug side effects such as nausea or low blood sugar.
A programme of exercise and diet can also have other benefits such as reducing blood pressure and achieving weight loss.
How can we prevent obesity from occurring? We need to look at measures such as:
“Walkability” of neighbourhoods. Ensure that residential development takes place near shops, schools, churches and places of entertainment such as cinemas and theatres. This reduces reliance on cars and encourages people to walk and exercise daily as an integral part of their life.
Is it time to consider a “fat tax”? This would make high-energy, high-fat foods more expensive and would subsidise the cost of healthier foods such as fresh fruit and vegetables. The “plastic bag” tax is evident of the effect that such a judiciously placed tax can have on habits.
We need to educate our children on the benefits of a good balanced diet. This education is especially important in the lower socioeconomic groups where rates of obesity and diabetes are higher.
The alarming increase in the prevalence of obesity in children also needs to be addressed through education and urgent action in the schools.
Over 100 years ago Joseph Malines lamented this in his poem The Fence or the Ambulance: “Then an old man remarked, ‘it’s a marvel to me that people give far more attention, to repairing results than to stopping the cause, when they’d much better aim at prevention.”
Perhaps it’s time to start building a good fence and adopt a brave new radical approach to this largely preventable modern epidemic.
Dr RAY O'CONNORis a GP in Limerick city, assistant programme director of the Mid-West GP training scheme and adjunct senior clinical lecturer, UL medical school.
rocthedoc@eircom.net
