26.05.20
Pre-diabetes: a hidden healthcare problem
Dr Russell Muirhead, Clinical Director of Living Well, Taking Control
A third of adults in England have pre-diabetes, according to research published in The BMJ. The study also found that, over eight years, the number of people diagnosed with pre-diabetes tripled. By 2025, it is estimated that five million people will have diabetes in the UK – 90% of which is Type 2 diabetes.
Pre-diabetes is related to increasing rates of obesity and has grown to become one of the most prevalent health conditions in the UK. The use of the prefix ‘pre-’, which could be quite easily interpreted as ‘not quite’ a health condition, may make patients wonder if it is something they even need to worry about.
But just because a condition is widespread, and in its early stages, does not mean that it should simply be accepted. Indeed, intervention now could prevent pre-diabetes from turning into Type 2 diabetes – a lifelong condition which carries a range of associated health problems. In case we needed any more reminders of how seriously this condition must be taken, NHS England reported this month that a quarter of all Covid-19 patients who died in hospitals had diabetes.
Pre-diabetes remains a largely hidden healthcare problem, but this is a critical phase for people ‘at risk’ of Type 2 diabetes to turn things around. Early diagnosis and support will avoid complications and reduce the future burden on our health service. So, how can we make sure patients have the opportunity to take control of their own health?
Identifying and diagnosing patients at risk
According to Diabetes UK, pre-diabetes is characterised by the presence of blood glucose levels that are higher than normal, but not yet high enough to be classed as diabetes. GPs will consider a range of factors – including age, ethnicity, weight and family medical history – to assess risk and put patients forward for testing.
Early diagnosis can prevent progression to Type 2 diabetes, or delay its onset thus reducing long term complications. It is often too late if we rely on patients reporting symptoms, so it is vital health practitioners check in with patients from at risk groups to assess their risk factors. We must proactively ask the questions to lower the numbers of those with pre-diabetes.
Communicating the condition
Pre-diabetes must be taken seriously by patients to prevent future health problems, but they can be reassured that reducing their risk of developing Type 2 diabetes does not require a complete lifestyle overhaul. They can still enjoy their favourite things. It's all about small and achievable changes that get patients eating healthier and moving more. Small changes can have dramatic effects.
Encouraging lifestyle changes
New patterns of behaviour can reverse pre-diabetes. However to achieve this requires more than a short-term diet or health kick; it is a lifestyle change that needs to be maintained. Step one is to recognise unhealthy behaviours. Food and exercise diaries may sound a little elementary, but they can provide a realistic insight into how much patients are really moving and how much sugar, fat and alcohol they are consuming. These are useful benchmarks for individuals to set personal goals to make simple, but important, changes to their lifestyle.
Supporting educational initiatives
Often, patients will only be motivated to make significant lifestyle changes if they fully understand the long term detrimental effects of Type 2 diabetes and how they can prevent disease progression. A critical step is the education people need on food labelling, healthy eating and physical activity plans to make good choices. With a third of the population at risk, the healthcare sector is under pressure to deliver mass educational support. This is the key to empowering patients to take control of their own health.
Building support networks
We know that bringing people with pre-diabetes together encourages a more supportive conversation and local groups (whether that is in-person or digitally) tend to be more effective. This is because people can usually find more things in common, and build more trust, with a neighbour than with a stranger on the internet. Community programmes are also an excellent opportunity to get inspired by people who have successfully reversed the condition.
Pre-diabetes is prevalent across the UK, yet few people talk openly about having the condition. It is possible that the stigma associated with Type 2 diabetes extends to its precursor. We have a joint responsibility to bring pre-diabetes back to the fore and focus on prevention before treatment. Intervening at this stage will help more people to turn it around and halt the development of Type 2 diabetes altogether.