COMMENTARY

Expert Insight: Tackling the 'Diabetes Epidemic' in the UK and Globally

Dr Andrew J.M. Boulton, DSc, FRCP

Disclosures

June 18, 2018

My name is Andrew Boulton. I'm a professor of medicine, University of Manchester, UK, and a consultant physician here at the Manchester Royal Infirmary. And today, I'm just saying a few words about diabetes and the global epidemic that we're currently facing. Every 2 years, as you know, the International Diabetes Federation produces an atlas looking at diabetes across the world.[1] But every time this is published, it's already out of date. The numbers are far greater than was published, for example, in the last one, in December of last year. Across Europe there is increasing diabetes, and across the world. I recently, for example, shared the stage with Narendra Modi, the Prime Minister of India at a meeting in Bangalore. And he got up and he said very eloquently that the biggest threat to the health of the Indian population is no longer infectious diseases like tuberculosis and malaria, but it is diabetes.

Across the world efforts are trying to be made to impact obesity, which of course is strongly related with type 2 diabetes. Many countries have brought in a sugar tax, not always successfully. If one looks, for example, at Denmark where the tax was brought in, it was widely shunned and it was not successful. Whereas other countries such as Mexico, and parts of the United States, such as Berkley in California, have been very successful and have seen reduced sales and reductions in obesity levels. So there is promise.

But what about the UK? Well, many of you will remember the time when Tony Blair was Prime Minister, he was meeting with Jamie Oliver and trying to introduce good diet, good food, healthy food into schools. What did we see a few weeks later? We saw in the daily newspaper pictures of mothers selling fish, chips, and probably mushy peas, through the railings of schools to their children who didn't like this high fibre food.

Of course, at last recently, our country on April 1st, brought in a sugar tax but it is yet to see how effective this is. But I would suggest to you, it isn't just a sugar tax, we need to look at town and country planning. If we look at the Netherlands, for example, which has a relatively low prevalence of diabetes, people tend to be more active, for example, cycling. And there is predominance of cyclists over cars, and preference is given to these cyclists. For example, when they're cycling, they have their own traffic lights and preference over cars.

And planning of cities. I work also at the University of Miami occasionally and I see there that it's safer to drive than it is to walk because crossing the road is a major challenge. So we need to think all round about addressing factors that are associated with diabetes.

Screening programmes are underway, and screening the high-risk population, for example, those who are significantly obese, those who come from certain ethnic backgrounds, and those with a strong family history of diabetes, may well be successful.

What about if you have type 2 diabetes and you are obese? Well, our friend Roy Taylor, in Newcastle of course, has recently published some excellent studies showing that reversal is actually possible with a very low calorie diet.[2] So there are things we can do in diabetes but it behoves us all to be active in trying to promote healthy eating, healthy lifestyle, setting the example - I've given up the car for example, I take the train to work and walk. These small efforts if we attract them and put them in worldwide, and certainly in our own country, will have a major impact on the huge increases we're seeing in type 2 diabetes in our country.

Thank you very much.

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