Huw Alban Davies is not given to melodrama, but last week, on the phone from his hospital consulting room in Kent, he gave warning that we are raising a generation in Britain today who will die before their parents. “They will have developed diabetes at a young age and they will die of strokes or coronary heart disease in their fifties,” he said.
Alban Davies, a diabetologist, is talking about type 2 diabetes (T2D), which accounts for 90 per cent of diabetics, is linked to diet and obesity and usually strikes after the age of 40. Ten years ago it was practically unheard of in children — if a doctor came across a case, it warranted a letter to The Lancet — now there are around 500 children with T2D in Britain and the number of new cases is rising by 40 per cent a year. In the US, where childhood obesity is officially an epidemic, research just published has found that people who develop T2D before the age of 20 are five times more likely to die in middle age than those who develop it as adults.
Meanwhile, here in the UK, we have our own epidemic of obesity — in young, fertile women — and a government inquiry into maternal and child health reveals that more and more pregnant women are diabetic, putting themselves and their babies at risk. Maggie Blott, an obstetrician, cannot recall seeing a single young woman with T2D when she started practising: “Now I’m seeing them all the time,” she says.
Tara Hickey, 22, was lucky: before she had her twin daughters, she ate her mother’s healthy home cooking, weighed 8½st (58kg) and was a size 10. But after the birth she rapidly put on weight. “I was breastfeeding and would sit munching gingernuts while I expressed milk at night,” she recalls. “I was busy with the girls, I got lazy about food and relied on easy-cook stuff such as breaded chicken and chips. We ate a lot of McDonald’s. Also, I have a sweet tooth and no willpower. I could eat a tub of ice cream at a sitting.”
Within a year Tara had swelled to 11½st. Determined to lose weight, she contacted The Diet Doctors programme on Channel Five, where she learnt that she was officially pre-diabetic. Her blood-sugar levels were way above normal and her pancreas was working overtime to deal with all the sugary stuff that she was eating. At some point soon, the doctors said, it would just not be able to cope and she would have T2D.
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Hickey has now stopped eating junk food and lost 20lb (9kg). She has an egg or a smoothie for breakfast, salad for lunch and meat or fish with vegetables for dinner. Snacks are a piece of fresh fruit or some seeds. Her blood-sugar level has dropped and she is no longer pre-diabetic.
Type 1 diabetes results when the pancreas fails completely to produce insulin: the cause is unclear, and sufferers must inject insulin several times a day for life. T2D develops when the body can still make some insulin, but not enough, or when the insulin that is produced does not work properly (this is known as insulin resistance), and in 80 per cent of cases it is linked with being overweight.
“Obesity-related diabetes is on the increase wherever people have more than enough to eat,” explains Alban Davies. “It is an early marker of affluence: people get fat before they buy a Ferrari and get fashionably thin.” In China, where obesity levels have shot up alarmingly as the economy booms, fat is seen as a mark of prosperity. There are now 31 million obese people there and the number of overweight children has risen by 28 times in 15 years. Some ethnic groups have a higher predisposition to diabetes — Asians living in Britain, for example, are more at risk than Europeans with the same Western lifestyle.
There are some two million diabetics in Britain (three people in 100) and the accepted forecast is that this figure will double between 2004 and 2014. Right now, most estimates indicate, there are another one million people with T2D unaware of the time bomb ticking away inside them. And to paraphrase Joni Mitchell, you don’t know what you’ve got till the damage is done; by the time the condition is diagnosed, 50 per cent of sufferers will already have vascular damage and 25 per cent will complain of a painful toe or problems with their waterworks — complications resulting from high blood-sugar levels. Undiagnosed or badly managed diabetes is also the commonest cause of blindness in people of working age.
Theoretically, it is possible to test everyone at risk of developing diabetes but, says Alban Davies, the result would put an intolerable strain on current services: “We all live in dread of mass screening,” he admits, “GPs and hospitals in every region would be flooded with thousands of new patients.”
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If a campaign launched by Diabetes UK early next month is successful, there will be, if not a flood, then a stream of people queueing up to be tested. Called Measure Up, the campaign proposes to put a tape measure round Britain’s waistline: men whose stomachs exceed 37in (94cm) and women who measure more than 31½in will be warned that they risk developing diabetes and should take themselves to their GP for a test.
Researchers behind the campaign have found that a person with a normal BMI (body mass index, the accepted measure of overall body fat) is still at risk if his or her gut is too big. Post-menopausal women have a raised risk if they develop what is popularly known as middle-aged spread. Until very recently doctors thought that fat was an inert tissue, merely acting as an insulating agent; now they know that it is full of active hormones that react to weight gain and, ultimately, cause insulin resistance in some people.
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When we were primitive hunter-gatherers, the ability to store fat to see us through lean times was important, and evolution favoured the genes that prospered in this way. But now that we order a takeaway on the cordless phone from the sofa rather than chasing our prey through the forest, our fat-storing genes have become a burden.
So genetics play a role — 25 per cent of diabetes is inherited — but, according to Matt Hunt, a research scientist with Diabetes UK, people are often hazy about their family history: “We don’t know how many people die of diabetes because it is under-reported on death certificates,” he says. “The cause of death may say coronary, when the underlying cause was diabetes.” Currently 7,000 deaths a year are attributed to diabetes but research by the British Heart Foundation and Diabetes UK suggests that the figure is more like 33,000. “If you ask people what disease affects every organ in the body, kills more than 30,000 people a year and has no known cure, they will usually say cancer,” says Hunt. “Diabetes isn’t taken seriously.”
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The good news for the increasing number of people with T2D is that, unlike type 1, it is possible to control blood glucose levels with lifestyle changes: losing weight, exercising and eating healthily. Since diabetics often have other problems such as hypertension (raised blood pressure) and high cholesterol counts, they need sound advice and support if they are to manage without medication.
The Diet Doctors: Inside and Out begins on Five in September.
A SPOONFUL OF MEDICINE KEEPS THE SUGAR AT BAY