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TX: 21.05.04 Diabetes Reaches Epidemic Levels In The UK

PRESENTER: LIZ BARCLAY

THE ATTACHED TRANSCRIPT WAS TYPED FROM A RECORDING AND NOT COPIED FROM AN ORIGINAL SCRIPT. BECAUSE OF THE RISK OF MISHEARING AND THE DIFFICULTY IN SOME CASES OF IDENTIFYING INDIVIDUAL SPEAKERS, THE BBC CANNOT VOUCH FOR ITS COMPLETE ACCURACY

BARCLAY
Incidents of Type II diabetes has reached epidemic proportions in the UK and around the world. If current trends continue by 2010 three million people in the UK will have the condition, twice the number in 1994. Diabetes costs the NHS around 5% of its total costs. Type II used to be called late onset diabetes because it developed in the 40 and 50 year olds but it's no longer unusual for people in their 30s to have it and the early signs are being seen in teenagers.

Benet Middleton is acting chief executive of the patient group Diabetes UK and Professor Sir George Alberti is seniorresearch fellow at Imperial College and former president of the International Diabetes Federation. Professor Alberti what exactly is Type II diabetes and how does it differ from Type I.

ALBERTI
All sorts of diabetes have too much glucose, that is sugar in the blood and that can cause long term problems. In Type II diabetes the cause of that is that the insulin you still have doesn't work very well - so-called insulin resistance. Type I diabetes you don't have the insulin at all anymore. Type II diabetes where the insulin you have doesn't quite cope, if you can take measures to help reduce the resistance to insulin then that person can cope reasonably well.

BARCLAY
So what are the effects of Type II diabetes - what does it lead to ultimately?

ALBERTI
Type II diabetes leads to specific complications like kidney failure, like problems with the eyes, like nerve damage and then damage to the feet and it also has a much, much higherrisk for people to develop heart attacks, strokes and problems with blood vessels in their legs for example.

BARCLAY
But am I - I'm right in thinking that people can have it for years and not know.

ALBERTI
Yes, they can. We estimate that in this country that there are probably one million people who have it but don't know that they've got it.

BARCLAY
So the estimates could actually be out. Why has this increased so much in recent years?

ALBERTI
I think there are two main reasons for this, one is nutrition - that is people are eating too much and eating the wrong sorts of foods and becoming obese. And second, people take much less physical exercise than they used to and that doesn't have to be violent exercise it's just the simple things - running around, walking briskly - all those sorts of things and people aren't doing it anymore.

BARCLAY
Benet Middleton, people often think of Type II diabetes as being less serious than Type I and manageable, how right is that?

MIDDLETON
It's absolutely untrue and it's actually one of the myths that Diabetes UK is really keen to dispel. We've heard from George about how serious the implications of Type II diabetes can be and we really need to get that message across to people because Type II diabetes doesn't need to be serious, it can be well managed in people's lives and they can live perfectly healthy lives if they support and manage their diabetes well. But the longer people think that Type II diabetes is mild, the longer people won't necessarily face up to the need to manage it well.

BARCLAY
But isn't it partly because they do go undiagnosed for such a long time that people think oh well I've already had it for 10 years, therefore it can't be particularly serious?

MIDDLETON
One of the shocking things about late diagnosis is that it actually means that often people are diagnosed because they've already started developing one of the complications of diabetes. So they may actually be diagnosed with their diabetes because they've presented with problems with their eyes or problems with their heart. But absolutely, people may live their life for quite a number of years without showing any symptoms of their diabetes at all and it's important that people do understand when they develop diabetes they need to take it seriously and manage it. It doesn't need to be a serious condition, but they need to take it seriously.

BARCLAY
Well Tracy Whitread in Kings Lynn in Norfolk has Type II diabetes and she developed the condition in her 30s.

WHITREAD
I discovered I had Type II diabetes in September 2000. I was thirsty, I was passing a lot of water, I was at college at the time, studying an access course, so I could do my nurse training. I started work on the bank at the local hospital, which is a bank auxiliary, and one of the healthcare assistants on there was then blood glucose monitoring, which I'd never seen before. I said - Can you do mine? So she did mine and it was 17. She said - You really ought to go and see your doctor. I went down to the path. lab at the hospital and had my blood taken. When I came home from my shift I was on the next day there was a phone call from staff health telling me to go to my GP, they'd fax my results through, and my blood fasting sugar was 14. And he just looked at me and said - Well I'm sorry to tell you you've got diabetes. And that's how I found out. I was rather shocked with the diagnosis to start with but I haven't let it change my life. After I was diagnosed everything seemed to click into place - the symptoms I'd had - somebody explained to me this was nothing unusual because some people can have diabetes for up to 10 years before they realise. Type II diabetes is generally associated with more mature people, they say over 40, so 35 was relatively young.

BARCLAY
Tracy Whitread. So George, thirsty, passing a lot of water - what other symptoms might we be on the outlook for?

ALBERTI
I think non-specific things unfortunately - things like feeling a bit more tired than usual, losing weight or not gaining weight and recurrent infections are the common things - so thrush orrecurrent boils. And just to add to the point that Tracy made - this business of people developing diabetes much earlier now, in the 30s I wouldn't have seen when I was a young doctor, we're seeing people in their teens now.

BARCLAY
We'll come back to that. The Government has been so concerned about the growth in Type II diabetes that it's created a national service framework to encourage best practice nationwide in fighting the illness and in charge of helping strategic health authorities to achieve that goal is Dr Sue Roberts, national clinical director for diabetes, sometimes described as the diabetes tsar. Herrole is to ensure the Government's plan for best practice, that national service framework, leads to improvements on the ground and she's currently just over a year into the project.

ROBERTS
I think we've achieved a great deal. The aim of the national service framework is to deliver everything over a 10 year period, so I think we've done a lot in the first year. I've been out into the country, I've visited all 28 health authorities, I've met over 2,500 grass root staff clinicians, people with diabetes and the managers that support them and the thing that's turned out to be most popular and most important is sharing good practice amongst them all. There's a huge enthusiasm for delivering good diabetes services. It's quite hard though and it needs to be joined up so that specialists talk to GPs and GP teams, that GP teams get very well trained so that they can deliver the very best possible services, it's these sort of things that people are telling me.

BARCLAY
But as national clinical director you don't have any formal powers over primary care trusts, so what can you do to ensure that they do start to implement that best practice that you describe and that it isn't just all talk?

ROBERTS
Ah well I have influence both ways really. I can keep everyone informed on what is required, everybody must have their eyes screened, for instance, to check that they're healthy, everybody must be on a GP list and everybody must be recalled so that they can get checked and good services and I also have access to ministers, so that I can let them know what's going on as well.

BARCLAY
But in a way you're just prodding healthcare trusts that have to make improvements in all sorts of areas of health and not just diabetes.

ROBERTS
My role enables the profile of diabetes to be raised, we've already discovered this year that there is a number of places that this has actually got them off the ground and they're beginning to collect their local resources and their people together to be able to do things.

BARCLAY
Now you talked about the 10 year timescale, what will you have achieved and what do you hope to have achieved by the end of that time?

ROBERTS
Well by the end of that time certainly everybody will be having their eyes checked on a regular basis and also the other important things - their feet and their kidneys will be checked. One of the things that we know from people with diabetes is that they're crying out for more information and more information that's personal to them. So everybody will have a tailored plan of how to look after their diabetes in the very best possible way.

BARCLAY
That plan is all very well because of course diabetes is not normally a hospital treatment, it is that kind of self-management, but how do you monitor that?

ROBERTS
We're going to be collecting data from every primary care trust up and down the land to ensure that people are getting the education, the care plans and the important tests are being done and also that actually outcomes are being improved - that there is less problem with people's eyes and feet and with their heart and with their kidneys.

BARCLAY
This all seems to be about diabetes management but what about reduction or even just reduction simply in the rate of increase in people developing diabetes?

ROBERTS
As I've gone round the country prevention is the thing that everybody talks about, it's obviously more sensible to prevent things than to treat them. Partly this, I think, will depend on the nation grasping the issue of everybody needing to increase their physical activity and look after what they eat. But there's a huge amount that individuals can do you know themselves, they don't need to wait for national policies, people who know that they've got diabetes in the family, who are just concerned about this, can increase their physical activity, can eat a healthy diet.

BARCLAY
Dr Sue Roberts, national clinical director for diabetes. Benet Middleton, you've spoken to your members of Diabetes UK up and down the country, how do they feel about Sue Roberts and the project and how it's working?

MIDDLETON
I think we all think that Sue Roberts is doing a great job. But the NHS is a big ship to try and turn round and it does it take a while to make a difference and our members are certainly not yet experiencing any particular difference on the ground but I think we all recognise that they will and that Sue's doing good work in putting the building blocks in place to ensure that people will begin to experience improved services. We're particularly worried about things like whether people have access to education soon after diagnosis - the key to good diabetes management is the person with the diabetes being in control of the condition themselves and we're worried that research we've done amongst primary care trusts has actually shown a very mixed bag and very poor provision of things like education for people with diabetes.

BARCLAY
But the message seems to be relatively simple - both Sue Roberts and Sir George have said it's down to healthy diet, eating the wrong kinds of food and having too little exercise, so it's more exercise, more healthy diet, surely that message is the key message to get across?

MIDDLETON
That's absolutely right for prevention of diabetes but once you have diabetes you really need to understand the condition and understand the things that you can do to manage your condition. And everybody's diabetes will vary because it's about their own life and the way they live their lives and they really need to - people need to be supported, to take control of the condition and take control of management and fit that into their own lifestyles, which is why we think that education soon after diagnosis is absolutely critical.

BARCLAY
Well the rise in the incidence of diabetes is not just a UK phenomenon, it's estimated that around 194 million people worldwide have the illness and some nations are more prone to it than others - India tops the list with 35 million diabetics. Dr Ramachandran, director of M.V. hospital for diabetes in Chennai, formerly Madras, told me why Indians are developing diabetes in such large numbers.

RAMACHANDRAN
There is sedentary lifestyle, yourrisk of diabetes increases several fold. And this has been happening in the Indian population. And I feel that along with the increased genetic susceptibility, the rapid urbanisation which is all coming into Indian cities because of the explosion of TV, cable television has led also, increase in the number of motorcars and in motorbikes being sold in the cities have made people more susceptible to more metabolic disorders and one of them is diabetes.

BARCLAY
Are Indians - do they have a more sedentary lifestyle than other countries, such as our own or the States?

RAMACHANDRAN
We have actually compared the physical activity level of the average Indian in the Madras population to that of an average British man living in London, England and we have found that the average physical activity level of the middle class and the upper middle class Indian is actually lower than the average British person living in London. The average Indian, especially living in urban areas, the physical activity level has substantially come down and that is one of the reasons for an increase in the prevalence of diabetes.

BARCLAY
What about diabetes in children - is that increasing too? Your surveys have been dealing with people of 20 years old or thereabouts, what about younger than that?

RAMACHANDRAN
We have now seen cases of Type II diabetes, which is related to obesity and sedentary lifestyle, occurring in children below the age of 15 years. I will not say that that is happening as an epidemic in India, it is an epidemic in certain parts of the world such as children in America, especially the black American children and also certain other parts of the world, like for example Japan, it is increasingly being seen as a clinical problem and we have to recognise that.

BARCLAY
So far we have talked about urban areas but what is the situation in rural populations?

RAMACHANDRAN
Last year we went to a rural population where we had done a survey about 14 years ago and to our surprise we found that the prevalence of diabetes in that 14 years had increased from 2.2 to 6.3 in an identical population. So there has been an increase in the prevalence of diabetes even in the rural population in India.

BARCLAY
What is being done then to tackle this situation in India?

RAMACHANDRAN
There has been a national diabetes control programme but at this point of time the Government of India has handed over this national diabetes control programme to the Indian Council of Medical Research. We have actually initiated a programme giving training for 3,000 medical doctors from seven states as a workshop programme in order to train them in handling diabetes. We're also trying to sensitise the media, especially the TV media, to see whether they will be able to help us to actually disseminate the knowledge regarding the risk of diabetes among the urban population.

BARCLAY
Dr Ramachandran. Professor Alberti you've been quoted as saying that this could be one of the biggest health catastrophes the world has ever seen.

ALBERTI
I agree with that completely of course. We are heading for 300 million people with diabetes, we already know there are 300 million with the pre-diabetic, early diabetic, state as well and if we don't take immediate action it will be an unaffordable, economic and health problem.

BARCLAY
Well you yourself said in the 30s - you wouldn't have seen people in their 30s or children with early signs of Type II diabetes, where do we start?

ALBERTI
We start in the schools, we start with better physical activity, we start with better nutritional advice and we go right through the community - this is a whole population thing. They are very simple messages, as you yourself said earlier, and the one that I keep using is - eat less, walk more - or buy a dog or have a jog. Either way we've got to get people out more and give them the facilities to get out more and eat sensibly.

BARCLAY
Now Benet Middleton, we heard earlier Tracy say that when she was diagnosed it came as a huge shock and to be told you have any illness can be a shock, but for those people where it can't be prevented because it's already there how do you advise them - newly diagnosed?

MIDDLETON
Come to Diabetes UK, we can provide people with information and support but also talk to your healthcare professionals, sit down and actually take time to listen to what they have to say and work with them to think about how you can fit the management of your diabetes into your life.

BARCLAY
But it is about management of that diabetes, it's about monitoring, presumably, as well of your own management of that diabetes.

MIDDLETON
It's about monitoring your diabetes, it's about making sure that you're living a healthy lifestyle with it, it's about understanding the medication that you might need to take, it's about all those things and thinking about how you can carry on to achieve your own life goals, diabetes doesn't need to be a death sentence, you actually can live a perfectly healthy life with diabetes if you take control of it.

BARCLAY
Well I'm glad we're not - we're not saying anything that would scare our listeners but there may be listeners out there who are thinking - I don't want to get myself in this situation in the first place - what is the advice?

ALBERTI
I think the advice is very much to watch what you eat, eat sensibly and to take exercise. And when people say take exercise they immediately think of running the London Marathon, which would probably have a deleterious effect on all of us, but just walking briskly half an hour a day, that's all - walking up the escalator, rather than just standing there gawping at people. Lots of things you can do.

BARCLAY
Professor Sir George Alberti and Benet Middleton from Diabetes UK, thank you both.

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