Obesity, fitness trackers, and the war on diabetes

Even this figure understates the full scale of the problem. Diabetes UK estimates that there are around an additional 11,000 cases undiagnosed. If this was a disease we would be in the grip of an epidemic.  

What makes this all the more alarming is that 90% of these cases are Type 2 diabetes – a condition which is largely preventable.

The cost of our collective failure to achieve this is high. Currently treating Type 2 diabetes costs £400 million per annum – that’s 10% of the health budget. The human impact can be devastating. Complications can include blindness, kidney and cardiovascular disease, lower limb amputations, stroke and depression.

It follows that the emphasis for health authorities should be on prevention and early detection together with information and support for patients to manage their condition. This, as much as any condition is about self-management – enabling people to be at the centre of their own care.

Do that right and you reduce, or prevent altogether the misery that those with Type 2 diabetes endure and save many millions to be spent elsewhere.

However the  response of health authorities to the 71% increase in cases since 2004-2005 has been, to say the least, disappointing.

In March of last year the Northern Ireland Audit Office issued a devastating critique of Type 2 diabetes prevention and care. It concluded that opportunities addressed  by the 2003 report Blueprint for Diabetes Care in Northern Ireland in the 21st Century were not implemented.

Kieran Donnelly, the Comptroller and Auditor General, concluded: “Whilst a number of initiatives aimed at enhancing diabetes care were subsequently introduced, I was disappointed to note that there was limited implementation of the 2003 review and that the Department did not introduce a comprehensive strategy until late 2016. This was clearly a missed opportunity to slow the growing prevalence of the disease, and to reduce the numbers of serious complications which can arise, including blindness and lower limb amputations.”

He said that because the new strategy was only launched in 2016 he was not in a position to say whether any recent changes have made any difference.

Scope analysed the report here.

Things are now on the move. In April a diabetes prevention programme was launched for Northern Ireland. This is aimed at people who have been classified as “pre-diabetic”. That is to say they have a blood sugar level which is higher than normal – making them vulnerable to developing Type 2 diabetes.

The Harvard Medical School has estimated that as many as nine out of ten cases of this form of diabetes are preventable (Diabetes UK estimates a lower figure – two out of three). Being overweight is the single most important cause, followed by lack of exercise, poor diet, smoking and drinking too much alcohol. All of these are inter-related and it therefore follows that the healthier lives we lead, the less chance we have of joining the 7% of the Northern Ireland population with the condition.

Type 2 diabetes most commonly manifests itself in adults over 40. Many of these will have lived sedentary lives and lived on poor diets for many years. It is easy to say people need to change the way they live. But they do need support.

The  Diabetes Prevention Programme is operating across all five health trusts. People can be referred onto it, not just by doctors but also by pharmacists and nurses. It is delivered over a nine month period and is free of charge. It is run by health coaches who offer help and assistance to participants, helping them change their lifestyle, diet and physical activity. It is even possible for people with a diagnosis to put diabetes into remission (experts don’t like calling it reversing diabetes, because it can return).

This has been welcomed by Diabetes UK. The programme is in its early stages, so naturally the organisation wants to see what outcomes it produces and also to discover the experiences of those who have been through it.

Early this week the NHS in England went one step further. It has announced that up to 8,000 people will be given fitness trackers as part of its own prevention strategy. These will be linked with apps which give access to peer support groups, online coaches and ways and means of setting fitness and lifestyle goals.

In this context most experts agree that around 30 minutes per day of brisk walking is generally sufficient – it is not necessary for pre diabetics to transform themselves into athletes, nor is anyone suggesting that they should.

The English development followed a pilot scheme which found that seven in 10 people (68%) referred to digital schemes took part, compared with around half of those offered face-to-face support. The difference was particularly striking among younger people.

The first trackers will be provided to people who are currently unable to access face-to-face support but we can expect it to be rolled out further if it proves as successful as the pilot suggests. Diabetes UK have welcomed this and would like to see the initiative introduced in Northern Ireland.

It is an interesting and potentially highly significant step in encouraging self-care and good health.  

The critical audit report brought much-needed attention to the diabetes crisis in Northern Ireland.

Cathaoir McDermott Interim National Director, Diabetes UK Northern Ireland said: “We cannot allow the rise of Type 2 diabetes to go unnoticed and we need ongoing delivery on the ground. The recommendations in the Audit report are a great first step, but we still need to see progress being made in the delivery of the Diabetes Strategy for Northern Ireland.

“We look forward to further delivery in areas such as diabetes structured education and inpatient care which will further support people living with diabetes. We all have a role in raising awareness about Type 2 diabetes, the risk factors that can contribute to it so that people can make the necessary changes to prevent or delay the condition.”

The alarming rise in Type 2 diabetes is one of the best examples of why health authorities – and the general population – need to embrace the necessity of ensuring that all of us have the necessary education, information and tools to become experts in and drivers of our own care.