Where's the public outrage at the diabetes epidemic?

Worldwide, diabetes kills almost as many people a year as HIV/Aids, and the number of cases of Type 2 diabetes is set to increase by 50 per cent in the next decade. Why is so little being done to contain the epidemic?

Over a third of adults in England are at risk of developing Type 2 diabetes, according to a study published in the British Medical Journal earlier this week – and the number of people at risk of suffering from diabetes has trebled in just ten years.

A few more worrying figures: there are currently 3.2 million people in the UK with Type 2 diabetes. A tenth of the NHS budget goes to treating the condition, according to the charity Diabetes UK. Type 2 diabetes can cut short your life expectancy by ten years. If not properly managed, it can lead to a range of complications including heart disease, blindness, kidney damage and nerve damage.

So are we doing enough to fight the disease? The obvious answer is no. We’re not even coming close.

Let’s look at the global problem too. The World Health Organisation (WHO) reports that 1.5 million people die of diabetes a year, making it the eighth most common cause of death worldwide, and almost as deadly as HIV/Aids (which kills 1.7 million a year). Diabetes is often thought of a rich country disease, but it isn’t just that: 80 per cent of diabetes deaths are in low or middle income countries. In some Pacific Islands over a third of adults are diabetic, and in several Gulf countries over a quarter are. In American Samoa, a staggering 47 per cent of adults are diabetic.

We’re facing a global health crisis and yet there’s little sense from government that it’s being treated as one. Last year the all party parliamentary group for diabetes reported on the current state of healthcare provision and concluded, in the words of the chair Adrian Sanders, that "diabetes is one of the greatest challenges we face, yet diabetes healthcare is poor, patchy and expensive, and too many people with the condition are not getting the care or support they desperately need.”

In April, a doctor writing in the Spectator wrote that “medically speaking, I’d rather have HIV than diabetes.” His reasoning: thanks to advances in the treatment of the disease, the life expectancy of someone in the UK who is HIV positive is not all that different from someone that of someone without the condition. Those who are HIV positive and receive the right treatment (usually those in richer countries) are unlikely to suffer complications, and anti-retroviral drugs are now administered in tablet form. In contrast, most people with Type 2 diabetes face daily injections.

And, the good news is that globally, rates of HIV transmission are declining. According to the Global Fund, there were 2.3m new HIV infections registered in 2013 – which is still a lot, and the actual figure for HIV infections could be higher – but is nevertheless down 33 per cent since 2001. In contrast, WHO predicts that in the next decade, global cases of diabetes will increase by 50 per cent.

When it comes to the battle to contain the spread of HIV/Aids, it has helped that on an international scale, there are now huge multi-government funded agencies such as the Global Fund. This was set up in 2002 and by 2013 had distributed $16bn to various donors, from governments to NGOs to international development agencies, to combat the disease. UN Aids was set up almost a decade earlier, to co-ordinate the many different UN agencies working to combat the disease and tackle related problems from gender equality, to gay rights and legal protection for sex workers. The global effort to fight diabetes doesn’t come close.

Plus, long before these international co-ordinated efforts, we have to be grateful for the community activists of the 1980s who forced HIV/Aids on to national agendas, providing the initial impetus for the public awareness campaigns, charity outreach work, and medical research helping to contain the spread and impact of the illness. It’s time to get angry about diabetes in the UK, not only because at least 3.2 million people in the country are at risk of dying young, but because we know from the history of HIV/Aids how big a difference ordinary people getting angry can make.

Much like HIV, a significant proportion of new diabetes cases can be prevented. You can be unlucky, but there are ways of reducing the likelihood of developing the illness. The rise of Type 2 diabetes has been linked to rising obesity in the UK, so tackling under-nutrition and sedentary lifestyles is key.

And again, much like HIV, tackling diabetes is not just a medical issue – you need to look at the social context. There’s also a strong link between poverty and diabetes in Britain: those in the lowest income bracket are two and a half times more likely to develop diabetes than average. This is because those on lower incomes are more likely to be obese, to smoke, to lack exercise and to suffer from high blood pressure.

There will be no easy way of preventing the rise of diabetes. Just as with HIV/Aids, we have to hope for (and fund) the development of new life-lengthening and life-improving treatments. But it will also involve changing modern diets and lifestyles – and that’s not just a matter of changing behaviour, which is hard enough already, but tackling the deprivation that is so often a cause of bad health.

There’s no miracle cure, but there is one sure-fire way of ensuring that millions of people in the UK and globally die younger than they should, and that’s carrying on exactly as we are now. As things stand, the charity Diabetes UK estimate that by 2025 five million people in the country will have Type 2 diabetes. It doesn't have to be like this. Aren’t you a little bit angry?

http://www.newstatesman.com/

Graham