Diabetes: health crisis of the 21st century

Diabetes could bring first cut in life expectancy for 200 years

Unlike other health threats, the death of tens of thousands of people is inevitable. The World Health Organisation warned in a report yesterday that the number of lives claimed by diabetes in the UK is set to grow by a quarter over the next decade, driven by rising obesity and inactivity.

In the UK, about two million people have been diagnosed with the condition, which shortens lives by a decade, is the leading cause of blindness and increases by 15 times the risk of amputation of the legs.

The numbers affected have grown by 500,000 in the past nine years - an increase of a third - and are set to rise to three million by 2010. Up to a further million people remain undiagnosed.

Professor Sir George Alberti, the immediate past president of the International Diabetes Federation and Britain's foremost expert on the disease, said: "The explosion of diabetes is with us and we will see a great increase in heart disease and strokes. It is a catastrophe waiting to happen. Much stronger government action is needed.

"This is one of the biggest health catastrophes the world has seen. The financial and social burden of the disease will be intolerable if governments do not wake up and take notice now."

Diabetes affects 150 million people globally and causes five million deaths a year. The numbers affected have almost tripled in 50 years, from 55 million in 1955, and will rise to 300 million by 2025. The WHO predicted diabetes deaths in the UK would rise from 33,000 this year to 41,000 by 2015. More than 80 per cent of sufferers will die of heart attacks or strokes and more than 1,000 a year have kidney failure and have to start dialysis.

Professor Alberti said: "The WHO may well be grossly underestimating the deaths associated with diabetes in the UK. If you take all the avoidable deaths from heart disease and stroke, their figure looks very conservative."

Douglas Smallwood, chief executive of Diabetes UK, said: "What people do not recognise is that diabetes is a killer. The numbers are going up by 100,000 every year and the Department of Health's own statistics show £4bn a year is spent treating diabetes. That is 5 per cent of the entire NHS budget. There is a danger it will overwhelm the NHS unless something is done to curb the growth in cases."

Writing in the New England Journal of Medicine last year, a team of academics, led by Jay Olshansky from the University of Illinois, warned that the increase in diabetes and other chronic diseases as a result of growing obesity could lead to a fall in life expectancy. They calculated that life expectancy would already be up to a year longer if there was no obesity and that it could be reduced by five years or more over the coming decades if obesity continues to increase.

The main cause of the rise in Type II diabetes, which now numbers 1.8 million cases, is the growth in overweight and obese people. The risk is 10 times higher in those with a body mass index over 30. In Type II diabetes, the body loses its capacity to make insulin, a hormone which helps glucose enter the cells, or becomes resistant to insulin. It usually affects older people but as Britain has grown fatter, the disease has begun to affect younger people. According to Diabetes UK, 91,000 people aged 15 to 44 have been diagnosed and the first cases have been detected in overweight and obese children.

David Haslam, chair of the National Obesity Forum, said the impact of diabetes was unavoidable. "This is not like a comet that might or might not hit the Earth. The scary thing is that even if from tomorrow we prevented anyone becoming obese with 100 per cent success, we still have enough people with diabetes to create an epidemic of heart disease, stroke and cancer to come. It is inevitable that it will happen."

Nikki Caton, IT trainer, 34: 'I was run down and felt permanently tired'

With hindsight, Nikki Caton, had the classic signs of diabetes. She had felt unwell for more than a year, she kept getting infections and she was overweight.

"I put it down to stress. I was run-down and felt permanently tired. I thought it was to do with the job I had at the time."

Then, aged 28, she went to her GP in Camberley, Surrey, who could find nothing wrong. The penny did not drop until her symptoms worsened suddenly. "I found myself drinking a lot of water and soft drinks. I lost weight which was great, but surprising. My nan is diabetic and my mother suggested I should be tested."

When she finally had a blood test, her blood sugar level was off the scale. She was referred to a specialist who suggested she could control her condition - Type II diabetes - with a combination of a restricted diet and exercise. "I did that for a year. Then I had to have tablets and I was on them for a few years. Then I got an infection because my blood sugar was too high and I had to go on to insulin."

Now aged 34, she lives with her husband, Steve and 11-month-old daughter Ellen, and works as an IT trainer. She has four insulin injections a day but hopes to switch back to tablets and eventually to control her condition with diet alone. "I am about four stone overweight. The aim is to get back to my ideal weight but it is difficult when your life is turned upside down. My last test showed my blood sugar was not well controlled.I have not been matching my diet and exercise with the medication so I am going back for another test soon.

"I am not a shining example ... I am not the sportiest person but I do go through phases of playing netball, swimming and walking. But since I went back to work after my baby I just haven't had time."

BY THE NUMBERS

1.8m people in the UK have diabetes - a 450% rise on 1960

3m will be confirmed sufferers within six years - an increase of 67% on today's figure

1m more are estimated to have diabetes - but don't even know it

10% Within six years, one pound in every 10 spent on the NHS will go on treating diabetes

100,000 people in the UK are diagnosed with Type II diabetes - which is linked to obesity - each year.

50% More than 50% of British children could be obese by 2020, according to the Royal College of Physicians

37" A waist this size puts men at high risk of developing diabetes

31.5" A waist this size puts women at high risk of developing diabetes

30 A Body Mass Index above 30 means a 10 times greater chance of developing diabetes

1-in-6 of six to 15-year-olds in Britain is obese - a rise of 300 per cent in 11 years.

80% The ratio of men over 30 who will be overweight by 2015 in the UK, according to the World Health Organisation

The UK has the fastest growing rate of diabetes in the developed world. Britain also has the fastest growing rate of obesity

The World Globally, cases of diabetes have risen from 55 million in 1955 to 150 million in 2004, projected to grow to 300 million by 2025

41,000 people in the UK will die from diabetes in 2015. This marks a 25% increase on today's annual death rate

1/2 or more of all diabetes cases would be eliminated if weight gain in adults could be prevented.

Sources: World Health Organisation, Diabetes UK, and the Royal College of Physicians