Diabetes is now a household name. Approximately 3.5 million people are living diagnosed with diabetes, a number that was just 1.4 million in 1996, and set to be over 5 million in 2025. It’s safe to say that it is not just going to go away, and is going to prove to be an even larger health burden than it already is. But what is the actual impact of diabetes?
It’s difficult to untangle actual mortality rates of diabetes. It’s a condition that won’t be found on lists of leading mortalities, but nevertheless every year thousands of people due to diabetic complications.
To reveal the true costs on the people of the UK we need to turn to the National Diabetes Audit. Every year data from almost all GPs in Britain are collated and analysed, partly to find areas of good control and partly to discover ways in which we are lacking. A side effect of these measures gives us a large body of statistical evidence about the risks of having diabetes in the UK. In 2011-2012 it was revealed that having any form of diabetes increased your risk of death by 34.4%. This means that every single year around 25,000 people die as a result of having diabetes. To put that into perspective, that’s twice the number of deaths due to breast cancer.
This adds up to a huge number of years lost all across the country, largely as a result of increasing the risk of the UK’s two leading causes of death, heart failure and stroke. According to recent numbers diabetics are twice as likely to have heart failure, making it more dangerous than smoking and obesity.
Living with diabetes is a question of management. Numerous studies have shown that well-managed diabetics have fewer complications and longer lives. The issue, as with so much in healthcare, is one of concordance. How likely are patients to stick with their drug regimens? Well we have studies for that too. It’s thought that just under 50% of patients achieve their glycaemic goals, unfortunately his translates directly into greater rates of complications, and more avoidable deaths and injuries.
It’s incredibly important to note that this isn’t the fault of the patients. That same study found that the group of patients on more than 5 prescriptions is rising dramatically. Combined with a range of different timing schedules required to manage fluctuations in blood glucose levels, this makes simply sticking to your normal regimen a complicated task. This is a clear disadvantage to the waves of new medications coming onto the market as they are often introduced to complement existing routines.
Furthermore, many of these drugs have unpleasant side effects, many of which are present is a large proportion of patients. What are patients’ options if they find they get these, well often they just have to bear with them. Metformin, a common anti-diabetic that thousands of people take, risks the following:
- Diarrhoea in 53.2% of patients
- Nausea/vomiting in 25.5%
- Flatulence in 12.1%
To compound the issue, skipping these drugs often doesn’t have an immediate physical disadvantage, like skipping a pain killer would. So in some ways nonadherence is positively reinforcing as it relieves the side effects of their medications.
Finally, it’s often bandied about that diabetes can be fixed or cured through diet or lifestyle change. While it’s true this can have a large impact on the progression of diabetes, sustainable and meaningful changes are one of the most sought after things in healthcare and also one of the most difficult to achieve.
These collective difficulties make good glycaemic control increasingly difficult, as evidenced by the complications rates reported. These add up putting a strain on health systems requiring more consultations, more beds, and more procedures, which add up to millions of bed-days a year.
How does not-diabetes become actual diabetes? Well it goes through a stage unsurprisingly called pre-diabetes. Elevated levels of glucose in the blood have a tendency to react with everyday parts of the body. One such part is haemoglobin, AKA the stuff that carries oxygen around, when glucose reacts with haemoglobin it forms glycated haemoglobin. A useful side effect from this is that we can use the amount of glycated haemoglobin to give us an indication of the average blood glucose over the last 3 months. Diabetes is usually diagnosed based on a figure of 6.5%, i.e. the amount of glycated haemoglobin is 6.5% of total haemoglobin.
In an attempt to classify those people at risk of developing diabetes the definition of prediabetes was introduced. This definition encompasses those that are greater than 5.7%, but less than 6.5%, so elevated glucose levels, but not quite enough to indicate they have full diabetes. This definition is useful because it’s been shown that every year prediabetes has a 5-10% chance of progression to actual diabetes.
Why is it useful to label people this early? Well these groups of people are the most responsive to therapeutics and intervention, the hope being that progression can be stalled and so an awful lot of pain, difficulty, and death can be prevented.
The jury is still out on whether diabetic screening programmes are efficient and effective enough, but the growing demand raised by diabetes could eventually lead to national screening, part of which may include preventative measures targeting prediabetics.
I hope I have given an introduction to the issues we must tackle in order to forestall diabetes. It truly is one of the greater concerns healthcare is going to face in future years.
If you would like to know more, or better yet would like to help, I’d like to direct you to Diabetes UK. They’re the largest diabetic charity in the UK and have a wide array of ways for people to get involved and contribute.
I’m in the process of exploring the Health Survey for England (HSE) dataset about prediabetes and undiagnosed diabetes. Part of the HSE involves taking blood samples, including glycated haemoglobin, from thousands of people across England. So watch this space.