Labelling People as Pre-Diabetic ‘is of Little Benefit’ Say Scientists
16 Jul 2014 --- A public health strategy is required to tackle diabetes rather than labelling millions of people as ‘pre-diabetic’, which carries huge medical and social costs, according to scientists. Writing in the British Medical Journal (BMJ), scientists state that diagnosing people is of little benefit and does not tackle the causes of diabetes, and obesity.
A public health strategy to tackle the problems in the food, health and education environment, which have led to widespread obesity and inactivity, would be far more useful, they argue.
Emeritus professor of medicine at UCL, John Yudkin, said pre-diabetes "is an artificial category with virtually zero clinical relevance .…There is no proven benefit of giving diabetes treatment drugs to people in this category before they develop diabetes, particularly since many of them would not go on to develop diabetes anyway."
The rising numbers of ‘pre-diabetic’ people is down to a new definition from the American Diabetes Association. Type 2 diabetes is confirmed when measuring average levels of haemoglobin A1c and anyone with over 6.5% indicates type 2 diabetes. The association now states anyone with 5.7% to 6.4% has pre-diabetes.
There are 3.2 million people in the UK currently diagnosed with type 2 diabetes, but 16 million would be labelled pre-diabetic and potentially be given drugs under the ADA guidelines.
At present, neither the World Health Organisation nor the National Institute for Health and Care Excellence (Nice) endorse the ADA guidelines. Nice says we should "move away from describing pre-diabetes as a separate condition".
“We need to stop looking at this as a clinical problem with pharmaceutical solutions and focus on improving public health,” stated Yudkin. “The whole population would benefit from a more healthy diet and more physical activity, so it makes no sense to single out so many people and tell them that they have a disease."
Meanwhile earlier this year campaign group, Action on Sugar, presented the UK government with a document of seven critical areas of policy to prevent childhood obesity in the UK.
With one in five 10-11 year olds now obese and one in three overweight, the plan details the following key actions to change the food environment which, the group said, is responsible for the obesity epidemic:
1. Reduce added sugars by 40% by 2020 by reformulating (similar to the CASH salt reduction programme
2. Cease all forms of targeted marketing of ultra-processed, unhealthy foods and drinks to children
3. Disassociate physical activity with obesity via banning junk food sports sponsorships
4. Reduce fat in ultra-processed foods, particularly saturated fat – 15% reduction by 2020
5. Limit the availability of ultra-processed foods and sweetened soft drinks as well as reducing portion size
6. Incentivise healthier food and discourage drinking of soft drinks by introducing a sugar tax
7. Remove responsibility for nutrition from the Department of Health and return it back to an independent agency
If these actions are followed, the UK government will be the first country in the world to halt the obesity epidemic by reducing calories by 100kcal a day per person.
At present, the costs of obesity and Type 2 Diabetes are estimated at approximately £29billion a year, and given the number of children who are now obese; this figure is predicted to rise exponentially.
The direct and indirect costs of treating Type 2 Diabetes alone are predicted to rise from £21.8billion to £35.6billion by 2035.
Professor Graham MacGregor, Chairman of Action on Sugar said: “Obesity in children leads to the premature development of cardiovascular disease, stroke, heart attacks and heart failure, which are the commonest cause of death and disability in the UK.
“Obesity predisposes to Type 2 Diabetes, which further increases the risk of cardiovascular disease and also, importantly, it can lead to severe complications i.e. the commonest cause of blindness, renal dialysis and amputation of the lower limbs. These complications are extremely expensive to manage, and will cripple the NHS if the increase in obesity and Type 2 Diabetes is not stopped immediately.”
Sonya Hook
