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The number of adults with diabetes has risen spectacularly – between 6-8% of adults are known to have diabetes, with the true incidence probably closer to 10%, when undiagnosed diabetes is also taken into consideration (Harris et al '98, Mokdad et al '00).

By 2050 as many as 1 person in 5 is projected to have the disease.

Even more worryingly, the disease has begun to affect growing numbers of children. In the US, experts predict that on current trends, one out of every three children born in 2000 will develop Type 2 diabetes.

The global increase in Type 2 diabetes parallels the increasing tides of overweight, obesity and physical inactivity that are known to drive the disease.

The human and economic costs are vast, and predicted to increase dramatically over the next decade (Must et al '99, Engelgau et al '04, Ford et al '04). If we include people with Impaired Glucose Tolerance, a pre-diabetic condition, the projected costs in the UK will rise to the point that diabetes will represent over 50% of the National Health budget which would have to be expanded to consume 12% of our entire GDP! It’s totally unsustainable.

It also represents a near future, where 1 in 6 of us will be chronically ill and where life expectancy will go into a sharp decline. It’s the catastrophic failure of the pharmaceutical model of health ie. treat the symptoms of the disease when they surface, rather than prevent the disease from happening.

   Health costs, Pharma profits

Diabetes accelerates the ageing process. It increases the risk of ill health and shortens life, doubling or trebling the risk of dying prematurely (Panzram '87). The diabetic is up to 4 times more likely to die of heart disease, up to 6 times more likely to die of stroke (Panzram '87); at increased risk of kidney failure, blindness and lower limb amputation (Stephenson et al '95).

Some of this increased risk can be reduced by stringent blood sugar control through a restricted diet (UKPDS '98), but in practical terms this is a difficult target and one which most diabetics are unable to achieve (Lusignan et al '05). So we are left on the whole with drugs such as metformin, and on current trends 1 in 6 of us can expect to be dependent on metformin and related drugs for the rest of our lives! A bitter pill for us to swallow – and sweet profits for Big Pharma.

Is there an alternative? According to the drugs industry literature there is, but I’m deeply sceptical. ‘Glittering’ new drugs such as the glitazones carry such adverse effects as weight gain, fluid retention, liver damage (NPS ’05). There is also a possible increased risk of heart failure (Anon '02), although this is disputed (Karter et al '05).

Pharmaceutical ‘puffs’ about gene therapy are wide of the mark. The epidemic of diabetes that has been gathering momentum over the last few decades is nothing to do with genes – which have not altered in such a short period of time – and everything to do with our lifestyle.

   The Lifestyle Case

The most important risk factors for developing Type 2 diabetes are obesity and physical inactivity (Sullivan et al '05). Evidence from randomised controlled trials on three continents has clearly demonstrated that maintenance of modest weight loss through diet, combined with physical activity, reduces the incidence of Type 2 diabetes in high-risk individuals by between 40-60% over 3-4 years (Pan et al '97, Tuomilheto et al '01, Knowler et al '02, Williamson et al '04).

Would you rather take pills? In one crucial study (Knowler et al '02), a lifestyle-modification program with the goals of at least a 7 percent weight loss and at least 150 minutes of physical activity per week reduced the incidence of diabetes in high-risk patients by 58 percent. This was approximately TWICE as effective as taking prophylactic metformin, which reduced the incidence of diabetes by 31%.

Since the diabetic is at significantly increased risk of heart attacks and stroke, you could also, if you wanted, take pills for that. Step forward one of the drug industry’s biggest earners, the statins. They lower cholesterol, and the risk of heart attack and stroke. But not by much … In a number of large-scale trials the statins reduced the risk of heart attacks and stroke by 1.4%! (Shepherd et al '95,  Downs et al '98, ALLHAT '02, Shepherd et al '02, Sever et al '03)

In contrast, a group of patients at high risk of heart attack was given dietary advice, which over a period of 4 years, reduced the incidence of heart attack by 67% – and also the risk of cancer (de Lorgeril et al '99, Leaf '99). In other words improved diet can be many times more effective than drugs.
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