Prevention and cure of type 2 diabetes

doi:10.1136/bmj.325.7358.232

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Weight loss is the key to controlling the diabetes epidemic

Jonathan Pinkney, senior lecturer (jpinkney@liverpool.ac.uk)

University Department of Medicine, Diabetes and Endocrinology Research Group, Clinical Sciences Centre, University Hospital Aintree, Liverpool L9 7AL

The Department of Health has published the first part of the national service framework defining standards of care for people with diabetes. The substance—how these standards will be achieved—is now awaited. Type 2 diabetes, however, is reaching epidemic proportions, and epidemics are seldom controlled unless their causes are addressed. Obesity is strongly and causally linked to type 2 diabetes. Recent data suggest that the prevention of diabetes is feasible if weight management is addressed adequately in individuals at high risk. More controversially, weight management also has the potential to make a significant impact in those with established type 2 diabetes.

The most common definition of obesity is a body mass index greater than 30 kg/m². In the nurses' health study the risk of type 2 diabetes in women with an index of 29-31 was 28-fold increased compared with women with an index lower than 22, and an index greater than 35 carried a 93-fold increased risk.1

The overall prevalence of self …