'Public Health Emergency' Declared With 1 in 10 Adults Having Diabetes by 2030

Becky McCall

October 06, 2021

Nearly 1 in 10 of the UK's adult population will be living with diabetes by the end of the decade, if further action to prevent and treat both type 1 and type 2 diabetes is not taken, shows an analysis by Diabetes UK.

Further to the projected 5.5 million adults (10% projected adult population) who could be living with diabetes by 2030, an extra 17 million people could also be at increased risk of developing type 2 diabetes by 2030, adds the UK's leading diabetes charity.

By 2030, Diabetes UK estimates there could be more than 87,000 hospital admissions a year in England due to diabetes, representing an increase of 14% from 2020/21, and over 50% increase on 2006/07 numbers.

This potential scenario the charity says, means that unless the governments of the UK commit to urgent and sustainable investment in diabetes care and prevention, the UK is on course to reach a 'diabetes tipping point', with devasting consequences including the possible complications of heart attack, renal failure, stroke, diabetic foot disease, and diabetic retinopathy

Chris Askew is chief executive of Diabetes UK. "It's a sobering thought then that, if we don't act today, hundreds of thousands more will face the life-changing news that they have type 2 diabetes," he said, adding that, "We're at the tipping point of a public health emergency, and need action today to stop it in its tracks."

He emphasised that these projections could be prevented if the right support was made available. "Cases of type 2 diabetes can be put into remission or prevented altogether."

Prevention Programmes or Treatment Needed for Huge Case Backlog

The charity adds that the effects of the pandemic on diabetes care is only now starting to surface. A recent study presented at this year's virtual meeting of the European Association for the Study of Diabetes , found that over a 6 month period in 2020, in the UK, there were more than 6.6 million missed diabetes tests, including 5.2 million diagnostic and 1.4 million monitoring HbA1c tests nationally.

Diabetes UK noted that with so many 'millions of people with type 1 and type 2 diabetes not getting all their vital, recommended health checks, and thousands of type 2 diabetes diagnoses being missed or delayed last year – the need to take decisive action is more urgent now than ever."

With cases of diabetes and pre-diabetes comprising a significant proportion of the NHS case backlog, identifying those at risk or diagnosing those with the disease, is a significant area for immediate action, Emma Elvin, senior clinical advisor at Diabetes UK told Medscape News UK. She explained that after identifying those at risk, they need to be referred to prevention programmes.

"In England the NHS Health Check programme has been effective in looking for at-risk people in the 40-74 age group, but the programme has been underfunded in many areas and was suspended during the pandemic," she said.

She also emphasised the need for greater awareness in communities known to be at higher risk of type 2 diabetes. "These include people with South Asian ethnicity, who are at higher risk of type 2 diabetes from an earlier age and should be included in programmes like NHS Health Check from age 25."

Expand Access to NHS Diabetes Prevention Programme (DPP)

Diabetes UK notes that greater emphasis should be placed on the NHS Diabetes Prevention Programme (DPP) and calls for the Government to, 'Significantly expand access to interventions to help people diagnosed with type 2 diabetes go into remission where possible, such as low-calorie weight-management programmes and bariatric surgery,' and to, 'Improve access to weight management services for those living with overweight or obesity'.

Elvin, who is also a dietitian, explained the importance of lifestyle interventions. "Research has consistently shown that, for some people, combined lifestyle interventions – including diet, physical activity and sustained weight loss – can be effective in reducing the risk of type 2 diabetes by around 50%.

"The NHS Diabetes Prevention programme is one such example," she added. "While we do not yet have sufficient data since the NHS DPP launched in 2016 to know its full impact, we do know that in its first two years, reductions in weight and HbA1c compare favourably with reductions reported in international studies and suggest likely future reductions in type 2 incidence among participants."

Data from the NHS DPP show that overweight patients who routinely participated in the weight loss scheme lost an average of 3.7 kg over nine months.

Elvin explained that the long-term effects of calorie restriction were yet to be determined, but two-year data from the DiRECT study have shown that 36% of participants with type 2 diabetes who followed a low-calorie weight management programme put their condition into remission and were still in remission 2 years later.

Bariatric surgery data also suggest it is a clinically effective measure for people with type 2 diabetes who also live with obesity or overweight. "Evidence suggests that bariatric surgery can result in remission from type 2 diabetes for up to 15 years, and remission occurs in 30-60% of people with type 2 following surgery," said Elvin.

Consultant diabetologist at St Mary's Hospital, Imperial College Healthcare NHS Trust, London,
and National Clinical Director for diabetes and obesity at NHS England, Professor Jonathan Valabhji, commented: "Diabetes can have a marked effect on people’s lives, with higher risks of heart attacks, strokes, limb loss, many of the common forms of cancer, and more severe outcomes with COVID-19 but, thanks to better NHS treatment and care, the outlook for people with both type 1 and type 2 diabetes has improved considerably over the last few decades."

He added that, "As part of its Long Term Plan, the NHS is already delivering the world's largest type 2 diabetes prevention programme to support people reduce their risk of developing the condition, as well as piloting the use of low calorie diets in those who have recently had a diagnosis of type 2 diabetes in order to achieve remission."

The projected increase applies to both type 1 and type 2 diabetes, but mostly the latter given that type 2 diabetes accounts for 90% of cases. Data are based on Public Health England's 2015 report on diabetes prevalence estimates, and 2011 reports for Scotland and Wales from the Association of Public Health Observatories. Estimations of at-risk population levels come from the Health Survey for England by NHS Digital. 

Diabetes UK is also launching a new TV campaign, This Is Diabetes, to demonstrate the real impact of diabetes on the people living with it. It features real families from across the UK who live with a diagnosis of diabetes, illustrating the significant impact it has on their lives, and the challenges the misconceptions people with diabetes face.

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