More than 3 million people have been diagnosed with type 2 diabetes in the UK. Photo / Getty Images
OPINION:
I’m leaving a medical clinic and feel like I’ve scored a goal, won a medal, passed “Go” and collected £200. A doctor has just given me the on-the-spot results of an HbA1C diabetes health check, as part of a preventative screening programme. My blood sugar level has fallen from 42, the first “notch” of pre-diabetic, to back within the normal range again.
A few days earlier, I had received encouraging results from the Government’s ‘Our Future Health’ initiative, for which I volunteered. My blood pressure came out as 136/86, my heart rate a steady 59, and my cholesterol 6.03mmol.
Speak to any doctor, and they will tell you that these results are not, objectively, that great. My cholesterol is still raised, my blood pressure slightly on the high side, and my HbA1C sugar reading, which has dropped a point to 41, could easily be lower.
I have made progress, however. Rewind five months, and my “numbers” - gathered in March at my routine NHS Over 40 Health Check, were significantly worse. But by taking myself in hand and losing 12lb (5.4kg) through more exercise, health(ier) eating, and drinking less alcohol, I have started to reverse the trend to poor health.
This is not just a personal issue. As we all live longer, anticipating ill health and doing something about it becomes ever more important. Indeed, “prevention” - as in preventing future sickness - has become the latest buzzword.
Research performed in 2019 showed that, of the 81 years the average person spends on this planet, 18 of them are spent in poor health. And this is projected to get worse. A July study from the University of Liverpool showed that more than 9 million people will be living with major illness in 2040 - an increase from one in six of the adult population in 2019 to nearly one in five in 17 years’ time.
The researchers earmarked six specific conditions which are set to rise. By 2040, cases of dementia are projected to go up by 45 per cent. Heart failure will rise by 92 per cent, cancer by 31 per cent, diabetes by 49 per cent, chronic pain by 32 per cent, and anxiety or depression by 16 per cent. Just reading these statistics is enough to make you panic-eat a packet of biscuits and renew your Prozac prescription.
Type 2 diabetes - which people develop later in life, usually through weight gain - presents a particular problem for the NHS. “We’ve seen a doubling of the number of people with diabetes every 15 years or so,” Professor Jonathan Valabhji, National Clinical Director for Obesity and Diabetes at NHS England, told the Telegraph in August last year.
This means that, today, more than 3 million people have been diagnosed with Type 2 diabetes - as opposed to Type 1, which you are born with. Around 8 per cent of the UK population now have Type 2 diabetes. Experts estimate that 10 per cent, or £14 billion (NZ$28.5b), of the entire NHS budget is spent on diabetes.
Dr Raghib Ali is an A&E consultant at John Radcliffe Hospital in Oxford, and a clinical epidemiologist at Cambridge University. “As an emergency doctor, I was working at the other end of the spectrum,” he says. “I saw people coming in with heart attacks, strokes, complications from diabetes and cancer. I realised many of these diseases were preventable and could have been delayed.”
Ali’s clinical observations have informed his current work as chief medical officer of Our Future Health, the UK’s largest ever health research programme, which has been designed “to help people live healthier lives for longer through the discovery and testing of more effective approaches to prevention, earlier detection and treatment of diseases”, according to the blurb.
“Volunteers will provide information about their health and lifestyles to create an incredibly detailed picture that represents the whole of the UK.”
Interested, I signed up to Our Future Health the moment I was invited, via a letter through the post. The programme involves going to a pharmacy which has signed up to the scheme - you get some of your results immediately. It also happens to be free.
Ali is passionate about his task. “The most important thing in healthcare now is for an individual to know more about their future risk of chronic disease so they can take action to reduce their risks,” he says.
It will come as no surprise to read that the rise in obesity is the biggest change in the last 20 years, Ali says. “Obesity raises the risk of many conditions, including type 2 diabetes, heart disease, and cancer.”
My sister-in-law Dr Sarah Levy is a GP, and she doesn’t pull any punches when it comes to health. This contrasts with the NHS health assistant who had given me my results at the surgery at my initial March appointment and was tactful to the point of not really saying anything. Other doctors won’t comment on blood tests you have elsewhere, so I do accept I’m pretty lucky to have this available to me.
Sarah and I are sitting at her Leicestershire home on a Sunday lunchtime, looking at my test results - the statistics of which I was so proud just a week earlier.
I’m 55, with two university-age children. While I’d say I was pretty fit - I do weekly weight training, boxing, and I walk for 45 minutes a day - there’s no doubt I have become overweight in the past decade or so. Sarah tells me I shouldn’t have ordered the full English when we went out for breakfast that morning. She had the avocado and sourdough. I knew at the time that she was raising an eyebrow.
We discuss my weight, which these days wanders between 11.5 stone (73kg) and a shade under 12 (76kg). I’m 5″2. My BMI also ranges from an ‘overweight’ 28 to an ‘obese’ (just) 30. Writing these figures down does not make me feel good. I tell myself that a lot of this is muscle, but there’s no denying the band around my waist, and after seeing the ‘back view’ in M&S changing room mirrors, I feel miserable for days.
Ironically, it was treatment for one of the “top six” conditions - depression and anxiety - that made me overweight in the first place. For my whole adult life, I had never weighed more than eight stone. The fallout from my marriage break-up in the 2010s led to a period of insomnia and depression: in an attempt to treat me, doctors put me on a succession of unsuccessful psychiatric medications which led me to almost double my body weight (this isn’t an exaggeration).
Whatever the reason, there’s no such thing as “fair” or “unfair” weight gain. The pounds have to come off if you want to stay healthy and live longer.
I’m off those drugs now. Since my recovery in 2019, I’ve been working with some success to shift the extra weight. But then, 18 months ago, I returned to the 9 to 5. Being back in an office, with attendant snacks, lunches and wind-down glasses of wine, meant I had regained almost a stone.
My health check back in March was the first time I had stood on the scales for a year. And I nearly fell off them again when I saw the results. Your body keeps the score, as they say.
“You’re definitely still a bit overweight,” says Sarah. Sarah is blessed with super-skinny genes herself and accepts she’s probably being more direct with a family member than she’d be with a patient. “And your weight is reflected in your blood results.”
The first thing Sarah does is put my blood sugar test in perspective. An ideal reading is between 20 and 38. (Pre-diabetes starts at 42, and diabetes at 48). “It’s great that your HbA1C has dropped to 41, but the fact it’s only come down by one point shows that your weight loss needs to be more radical,” she says.
Sarah also tells me that my blood pressure is an issue for “slight concern” - as it’s the upper end of normal, normal being 135/85. My cholesterol, which should be less than five, is still “worrying”. Sadly, my lowish heart rate “isn’t indicative of good health”, which is disappointing, because I thought I’d aced that one.
“As individuals, our risk profile is based on our genetics, our demographic background, and our lifestyle,” says Dr Ali. He acknowledges that we can’t change our genes, nor the environment in which we were brought up. In my case, for example, I have a family history of type 2 diabetes, as well as high cholesterol and raised blood pressure.
“But if you are aware you’re at higher risk, you can take action earlier,” he says. “We already have screening programmes for breast and colorectal cancer, among others. Widespread screening for conditions such as high cholesterol and high blood pressure is next.
“The challenge now is to change our approach from age-based to risk-based. So it’s not about just starting to predict our health in our 40s or 50s, but in our 20s and 30s. There are also clear advantages to encouraging people to change their lifestyles rather than put them on drugs, which can have side effects.”
It’s all very British not to want to “bother the doctor”, to pretend a health issue isn’t there in the first place, or to hope it just goes away. And in my case, the blood results were only a qualified success. But since I’ve discovered them, I feel empowered. My future health is (somewhat) in my control.
Sarah tells me to further cut down on my alcohol intake, snacks between meals, and overall carbohydrate consumption. As I have a sedentary job, she suggests I consider a standing desk, and take more exercise during the day.
She finally gives me some credit. “You’ve clearly made positive changes,” says Sarah. And then: speaking to all of us who want to live to see our grandchildren, carry our own shopping and survive to 100. “But the question remains: what more can you do?”
Try a very low-calorie diet (VLCD)
There is no cure for type 2 diabetes, but studies have shown that it’s possible to put it into remission by losing weight, particularly if that weight loss is fairly dramatic and soon after diagnosis. Losing weight reduces the level of fat in the liver and pancreas, and can help the cells that release insulin and control blood sugar start working again.
Research from the Diabetes Remission Clinical Trial (Direct) of an 800-calorie-a-day soup and shake diet showed that it can reverse type 2 diabetes for at least five years, with people having lost 1st 6lbs on average.
Now, in an effort to reduce the diabetes time bomb, the NHS is rolling out the soups and shakes diet across the country by March 2024, with thousands due to be eligible.
Go on a low-carb diet
Studies have shown that a low-carb diet is more effective than a low-fat diet for reversing type 2 diabetes. Dr David Unwin, a GP from Southport, has been putting his patients on low-carb diets to help reverse their diabetes for almost a decade. In a study in the journal BMJ Nutrition, 186 of Unwin’s patients, most of whom had had diabetes for at least six years, lost an average of 1st 8lb in 33 months. As a result, nearly all - 97 per cent – saw improved control of their blood sugar levels and two, both of whom had struggled with type 2 diabetes for 15 years, were able to reverse the condition and come off all their medication.
Combine dieting with exercise
You can’t outrun a bad diet, and it’s not usually possible to reverse type 2 diabetes with exercise alone, but combined with dieting it can be effective at reducing blood sugar and improving how the body uses insulin.
Drugs and surgery
If people can’t control their type 2 diabetes through diet and exercise, their doctor may prescribe drugs including Metformin, which helps your body use insulin more effectively, and Ozempic, one of the new class of GLP-1 drugs also known for weight loss. Ozempic is a once-weekly injection that helps your body produce more insulin and lower blood sugar. It also promotes weight loss by helping you feel fuller for longer.
Gastric bypass surgery, where your stomach is made smaller by surgery, can be considered a last resort as it carries a risk of complications and necessitates a long-term change to how you eat meals.
A round-up of the best fitness advice from the experts to kick the week off well.