DIAGNOSIS The steady advance of diabetes is unrelenting and, if unchecked, threatens to devastate an already distressed National Health Service, as Jane Kirby discovers
Diabetes is often a silent assassin lying undetected for years before it is finally revealed.
While people with type 1 come to the attention of medical staff quite quickly, those with type 2 can remain undiagnosed for a decade or more. Experts think at least a million people in the UK are living with diabetes without knowing they have it.
But the longer it takes to get a diagnosis, the more chance there is for complications to set in, including kidney failure and heart disease.
Dr Gerry Rayman, head of the diabetes and endocrine centre at Ipswich Hospital NHS Trust, says some undiagnosed people appear fairly healthy, while others are overweight or have nagging health concerns.
“There is a group of people who will not have any symptoms and who can tolerate high blood sugar levels without knowing anything about it,” he explains. “They might eventually present with an ulcer on their foot or visual problems and only then do we discover they have diabetes, which is a tragedy because damage has already been done.
“But quite a few other people will have symptoms they brush off or ignore. For example, they may suffer fatigue and put it down to hard work or think, ‘Oh, I’m just getting older’. Some might be very thirsty or go to the toilet more frequently, especially at night, which does happen as you get older, but which is also a symptom of diabetes.”
The human cost of failing to identify people with diabetes is immense. There’s no question that the longer type 2 is left undiagnosed and the less it has been controlled, the more damage it does to people’s health.
By the time of diagnosis, around half of those with type 2 are showing signs of complications. These affect the eyes, heart, kidneys, nerves and lower limbs, and often occur as a result of poorly controlled blood sugar levels.
Evidence suggests that people with diabetes are between two and four times more likely to suffer heart disease and have a similarly higher risk for stroke. One in ten hospital admissions in the UK is linked with diabetes, alongside almost one in eight of all deaths in England.
Shockingly, one in five people going into hospital with coronary heart disease, kidney disease and foot ulcers has diabetes. Not only that, but the condition is the biggest single cause of blindness among people of working age in the UK. Almost everyone with type 1 diabetes suffers some sort of eye damage within 20 years of diagnosis, alongside 60 per cent of those with type 2.
“Data suggests that most people will have had type 2 diabetes for seven to ten years before they are diagnosed,” Dr Rayman says. “One of the commonest ways we find that people have diabetes is when they are admitted to hospital after a heart attack. If people run into complications, it’s devastating.”
Tragically, people with diabetes also die younger. On average, those with type 1 diabetes live 20 years less, while people with type 2 die around a decade earlier. In addition, the condition is the biggest cause of lower-limb loss. More than 5,700 people with diabetes in England had a lower limb, or part of a limb, amputated in 2008-09.
While the risk of diabetes increases with age, the condition also affects a higher proportion of people from Asian and black ethnic groups. Some 6.9 per cent of white and mixed groups in England have diabetes but this rises to 9.8 per cent for black people. For Asian ethnic groups, the figure is 14 per cent.
Then there’s the link between diabetes and social deprivation. While type 1 affects people from all backgrounds, type 2 is twice as common in deprived communities compared to those with higher incomes.
But why? Two of the strongest risk factors for type 2 diabetes are obesity and a lack of physical activity; issues that are more likely to affect people from poorer backgrounds.
“If you don’t take frequent exercise and you continue to consume the wrong foods such as junk food then you have a higher risk of developing diabetes,” Dr Rayman says. “This is because type 2 diabetes is very closely associated with obesity which we all know is linked to diet and exercise.”
Up to 80 per cent of type 2 cases could be prevented or delayed if people led healthier lifestyles, kept to a healthy weight and took regular exercise. However, in 2010, more than 60 per cent of adults in the UK were overweight or obese and the number is growing at an alarming rate.
Experts agree that more needs to be done to reach all those people who may be undiagnosed, but particularly those who are overweight or obese. “If the obesity epidemic continues at the rate which it has been occurring over the last ten to fifteen years, then the implications for those with type 2 diabetes are significant,” says Lorraine Oldridge, from the Yorkshire and Humber Public Health Observatory. “I don’t think people are appreciating that, or thinking about the implications for wider society.”
