Diabetes: controlling the crisis

With cases of diabetes in the UK higher than ever before, we look at what is being done to overcome the problem and how pharmacy can help

Diabetes is the fastest growing health problem of our time, according to Diabetes UK. Recent figures released by the charity reveal there are now a record 4.05 million people living with the condition in the UK, 3.5 million of whom are officially diagnosed.

Of those with a confirmed diagnosis, 90 per cent have type 2 diabetes. A further 549,000 are thought to be undiagnosed. Some 11.9 million people are also at increased risk of getting type 2 diabetes as a result of lifestyle factors, including weight and inactivity.

In fact, obesity is one of the driving factors in the rise of diabetes. Pav Kalsi, senior clinical advisor at Diabetes UK, says: “We talk about risk factors for diabetes and the most potent risk factor for type 2 diabetes is obesity – having a large waist circumference.” This is because fat cells produce hormones which prevent insulin from working properly – known as insulin resistance.

If someone carries a lot of weight, especially around their middle, insulin resistance can develop and then progress to type 2 diabetes. And with more than two-thirds of adults in the UK classed as overweight or obese, and high sugar and calorie diets dominating, it’s no wonder diabetes is on the up.

Some 11.9 million people are at increased risk of getting type 2 diabetes as a result of lifestyle factors including weight and inactivity

What’s being done?

Tackling the obesity crisis is high on the agenda for reducing cases of type 2 diabetes, and this includes putting measures in place that can help people lead healthier lives. But as Pav explains: “There’s no one single intervention – no silver bullet – to solve the problem. The Government needs to have a range of interventions to put in place.”

As such, there have been many calls to action to the Government from organisations such as Diabetes UK and Action on Sugar to address the issues of sugar consumption and obesity. These have included clearer labelling on food, making healthy food cheaper, eliminating offers on unhealthy foods – that is foods which are high in saturated fat, salt and sugar – and restricting advertising of such foods to children, especially before the 9pm watershed.

In recent months, a potential sugar tax has also dominated the headlines which, if implemented, would initially see a 20 per cent tax on sugar sweetened beverages.

“The sugar tax could be one way to reduce calorie intake, especially with sugary drinks, but the Government also needs to work to reduce consumption of excess unhealthy fats such as unsaturated fat,” says Pav. “We’re pushing for them to introduce what we call reformulation – making more foods available that are healthy,low in sugar and fat and have gone through the appropriate checks.”

These proposed legislative changes are just part of the war on obesity and some positive courses of action have already been announced and implemented. Just last month, the NHS announced it was taking steps to impose its own 20 per cent sugar tax on sugary drinks and food in hospital cafés and eventually in local health centres.

This measure, which NHS England chief executive Simon Stevens hopes to be in place by 2020, makes the NHS the first public body in England to impose a sugar tax. It is estimated that this could raise as much as £20-£40 million a year, which will be used to improve the health of the NHS workforce.

To tackle excessive sugar consumption among children, the Change4Life ‘Sugar Smart’ campaign was launched in January following revelations that children aged between four and 10 consume over 22kg of sugar a year – the average weight of a five-year-old.

The campaign aims to make parents more aware of the sugar content in different foods and drinks using a ‘Sugar Smart’ app, which works by scanning the barcode of products to show the total sugar content in cubes or grams. It is hoped this will encourage parents to take control of the amount of sugar their children consume. According to Public Health England, the app has been downloaded more than a million times and was the number one free app on the iTunes store at various points throughout its launch day.

This is encouraging as onefifth of children are overweight or obese when they begin school, and this figure increases to one-third by the time they leave primary school. Few obese children become adults of normal weight and therefore reducing their intake of high sugar foods early on could help in preventing major health problems, like type 2 diabetes, later in life.

Education is key

Without further positive change, the number of people with diabetes in the UK is expected to reach five million by 2025, which will require 17 per cent of the total NHS budget. Currently, diabetes costs £10 billion a year, or 10 per cent of the overall budget, which is crippling the NHS. A staggering 80 per cent of this spending goes on complications – i.e. treating health problems such as blindness, amputation, kidney failure and stroke, which largely occur as a result of mismanaging the condition.

For the most part, these complications and the subsequent strain on NHS finances could be avoided if people receive the appropriate information, advice and support in the first instance. As 95 per cent of diabetes care is down to self-management, this information could be the difference between good quality of life and potential complications or even premature death.

To this end, the gold standard for people with type 2 diabetes is a structured education programme providing the tools for them to manage their own condition and giving them a greater understanding of what their condition is, when and how to take any necessary medication and what lifestyle changes they should adopt. One such programme is DESMOND (Diabetes Education and Self Management for Ongoing and Newly Diagnosed), a six-hour programme run by the NHS which has a particular focus on providing strategies that enable people with type 2 diabetes to cope with the condition.

A lack of participation in diabetes education programmes has, however, been identified, with many people reportedly unaware of the education programmes available, or how they might be relevant to them. As such, the ‘Taking Control’ campaign by Diabetes UK was launched as a way to empower people with diabetes to ask their healthcare professional where they can access such education. The aim is to ensure everyone is given the chance to learn about their condition and, as Pav explains, “from our feedback, people who have had education about their diabetes say it’s been very valuable.”

But it’s not just tackling the existing problem that’s the focus of diabetes care programmes. In order to prevent the number of diabetes cases from skyrocketing, as is predicted over the next decade or so, the NHS Diabetes Prevention Programme (DPP) was launched in 2015 as a joint venture between NHS England, Public Health England and Diabetes UK. Pav says: “Often, the NHS has dealt with complications and problems rather than the root cause, but this is the first time prevention has been considered and focus has moved to reducing obesity and diabetes – it’s quite revolutionary.”

The NHS DPP aims to identify those at high risk of type 2 diabetes, raise awareness of the importance of them losing weight and becoming more active and support them in achieving this to reduce their risk of developing the condition. The programme will be rolled out over a three to four year period, with complete coverage across England expected by 2020.

Pharmacy support

“Pharmacy is really important for diabetes care because lots of people go to their pharmacy a lot more often than other healthcare providers – it’s the first point of contact with a healthcare professional for a lot of people,” explains Pav. She also suggests that because of this frequency of interaction, “pharmacy staff have a more informal relationship with their customers and [these customers] can often feel more comfortable in discussing their condition with someone over the counter or in a consultation room rather than with their doctor.”

Pharmacy staff also have a vital role to play in both the prevention and management of type 2 diabetes, including recognising the warning signs and identifying possible cases. “Some of the main symptoms of diabetes are that you’re going to the toilet for a wee a lot, especially at night, blurry vision, unintentionally losing weight, feeling very thirsty and being extremely tired,” says Pav.

Throwaway comments from customers, who might be in the pharmacy for another reason, about any of these issues should ring warning bells and pharmacy staff should be ready to ask follow up questions to assess whether further action is required. If diabetes is diagnosed then talking to patients about the value of diabetes education and signposting programmes in the local area is important.

For those at risk of developing type 2 diabetes, it should be highlighted that up to 80 per cent of cases can be delayed or prevented by making simple lifestyle changes. This includes eating a healthy, balanced diet, being more active and losing weight, if necessary. The same advice can be given to people with the condition as a means to stop it getting worse.

“There’s nothing revolutionary when it comes to lifestyle advice for people trying to prevent diabetes or if they have the condition and are trying to manage it. It’s just about them taking care of themselves,” says Pav. “Eating a healthy, balanced diet and regular meals, cutting down sugar intake and empty calories like fizzy drinks that have no nutritional value, keeping an eye on portion size, eating plenty of whole grains and eating two portions of oily fish a week can all be recommended.”

Pav explains that it’s important for anyone working in a pharmacy environment to be aware and up-to-date when it comes to diabetes because it’s so common. “Diabetes UK has an e-learning programme for healthcare professionals which is accredited by the Royal Pharmaceutical Society and will increase understanding of the condition, ensure accuracy of advice given and make sure people are providing information in the right context.” This e-learning programme can be accessed here.

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