Diabetes “prevention” – treating the root cause

25 April 2018

Guest Blog: Dr Jennifer Logue, Senior Clinical Lecturer and Honorary Consultant in Metabolic Medicine at the University of Glasgow and Obesity Action Scotland Steering Group member.

Traditionally diabetes prevention is a programme for people who are deemed to be at risk of developing type 2 diabetes but don’t yet have it. These programmes help people to lose weight and do more physical activity, and done well they reduce the development of type 2 diabetes by 58%. Preventing the development of type 2 diabetes in this way is highly cost-effective and similar programmes are delivered across the world.

However there are also over 250,000 people who already have type 2 diabetes in Scotland and 87% of them have a BMI above the healthy range. The vast majority of these individuals have never had an opportunity to attend a structured weight management programme to help improve their condition. Research from our own service in Glasgow has shown that those who can lose 5kg over a few months can keep that weight off for at least 3 years, halving their risk of progressing to insulin and improving their diabetes control.

It is welcome that that the Scottish Government has pledged to “invest £42m over five years to establish supported weight management interventions as a core part of treatment services for people with, or at risk of, type 2”.

These services are fairly cheap to provide, especially when compared to the costs of doing nothing. We need to make sure that those most at need are able to gain access to services that are available locally, flexible for those who have work or caring commitments and attractive to people of all ages and genders.

There is also a further problem of the people who have type 2 diabetes but don’t know it, as the symptoms can be very subtle. Men and people from deprived areas are at higher risk of diabetes and also at higher risk of having undetected diabetes.  Any programme looking to prevent diabetes or offer weight management to those with diabetes, will have to invest heavily in the diagnosis of type 2 diabetes and the identification and follow-up of those at high risk of future diabetes. Our already over-stretched primary care services will struggle to deliver this without increased investment.

Type 2 diabetes is a preventable disease and this investment from the Scottish Government is very welcome. Investing in the detection of type 2 diabetes and in weight management services that are innovative and accessible will make a big difference to the health of our population.