Pre-diabetes - just another media panic?
As if type 2 diabetes wasn't enough, now we have pre-diabetes to worry about. A new report in the British Medical Journal shows a sharp rise in the number of Britons with pre-diabetes - a condition in which your blood sugar levels hover above the normal range but below the level at which a diagnosis of type 2 diabetes is made. But many of my patients seem supremely unimpressed when I give them the news that they have pre-diabetes - they feel entirely well and they're not being told they need to take medicine for it. Is it just another media scare tactic?
I only wish it were. Pre-diabetes is a warning sign that without taking steps to change your risks, you're well on the way to developing type 2 diabetes - in one study 10% of people with this condition went on to develop type 2 diabetes every year. (1) It means you're drinking in the last chance saloon if you want to avoid a condition which increases your risk of heart attack, kidney damage, blindness and amputation. But it also carries risks in its own right, even if you feel perfectly healthy.
Type 2 diabetes is a condition in which either your body doesn't produce enough insulin to meet your body's needs, or your body doesn't respond properly to insulin, or more commonly both. The earliest change is usually ' impaired glucose tolerance' - your blood sugar levels are normal when you're fasting, but rise higher than usual after a meal. Next comes ' impaired fasting glycaemia' - your fasting blood sugar levels are high, but not high enough to be diagnosed with diabetes.
Even before you're diagnosed with type 2 diabetes, your risk of heart attack begins to rise. Pre-diabetes is associated with high blood pressure and raised cholesterol levels. You can also start to develop 'microvascular complications' of diabetes - damage to your kidneys, eyes and nervous system - in the pre-diabetes period.
The implications for the NHS and the British economy of these findings are potentially devastating. The researchers looked at Health Survey for England data between 2003 and 2011. These showed that in just eight years, the number of adults with pre-diabetes had trebled from 11.6% to 35.3%. Without drastic action, most of these will go on to develop type 2 diabetes within a few years. With 10% of the NHS budget already spent on treating diabetes (up from 5% a decade ago)(2), the stakes are high. That's before we even start to think about the estimated indirect costs to society (from work absenteeism, early retirement and social benefits) of £14 billion pounds a year in the UK. (3) The tragedy is that while most of the NHS cost of diabetes goes on hospital admissions, it's estimated that 80% of complications of type 2 diabetes are avoidable with good control of weight, diet, blood sugar, blood pressure and cholesterol, as well as regular attendance for screening. (2)
But there's good news too. Unlike type 1 diabetes, which has nothing to do with lifestyle, healthy changes can dramatically cut your risk of going on to develop type 2 diabetes, even if you've reached the stage of pre-diabetes. A combination of regular exercise, modest weight loss and a heart-healthy diet can reduce your chance of being diagnosed with type 2 diabetes by as much as 58% (1). Just the sort of changes, of course, you can make if you log on to MyHealth, and take practical steps tailored just for you.
There's no doubt that certain ethnic groups - particularly people of South Asian origin - are at higher risk of type 2 diabetes. Type 2 diabetes is linked with deprivation, too. Nationally, 6% of British adults have type 2 diabetes today, but the figure drops to under 5% in some affluent Southern counties and rises to over 8% in inner city hotspots such as Leicester, Birmingham, Bradford and parts of London. But lifestyle measures work regardless of your ethnicity - you can defeat the odds.
The national Vascular Screening Programme targets all those aged between 40 and 75 for health checks for their risk of heart attack and diabetes. If you have a family history of type 2 diabetes or are in a high-risk ethnic group, and particularly if you're overweight, the National Institute for Health and Care Excellence (NICE) recommends getting checked out from your mid-twenties. If getting pre-diabetes gives you the impetus you need to turn your life around and avoid complications, it could be the best diagnosis you've ever had.
1) Diabetes Prevention Program. N Engl J Med 2002; 346: 393-403
2) Hex N et al. Diabet Med 2012;29: 855-862
3) Diabetes UK. State of the Nation 2013 England. Available at http://www.diabetes.org.uk/Documents/Reports/State-of-the-Nation-20123pdf Last accessed January 2014
4) NHS England. Quality and Outcomes Framework, 2012-2013