Letters

Prevention and cure of type 2 diabetes

BMJ 2002; 325 doi: http://dx.doi.org/10.1136/bmj.325.7370.965 (Published 26 October 2002) Cite this as: BMJ 2002;325:965

General practitioners are treating more cases of diabetes

  1. Azeem Majeed (a.majeed{at}ucl.ac.uk), professor of primary care,
  2. Angela Newnham, senior lecturer in public health medicine,
  3. Ronan Ryan, research officer,
  4. Kamlesh Khunti, senior lecturer in general practice
  1. University College London, London WC1H 9QU
  2. Thames Cancer Registry, King's College, London SE1 3QD
  3. Office for National Statistics, London SW1V 2QQ
  4. Department of General Practice, University of Leicester, Leicester LE5 4PW
  5. 1448 Dumbarton Road, Glasgow G14 9DW

    EDITOR—Most studies measuring the prevalence of diabetes have been carried out in one locality and have generally measured point prevalences. Hence, although the prevalence of diabetes in England and Wales is increasing,1 time trend data on prevalence and future projections based on sound data are both lacking. We recently estimated the prevalence of diabetes in England and Wales between 1994 and 1998 using data from 210 general practices with a combined list size of 1.2 million.2

    We found that the overall prevalence of diabetes during this period increased from 1.99% to 2.43% in males and from 1.69% to 2.04% in females. This striking increase in the prevalence of diabetes in primary care is likely to be due to a combination of factors, including better case ascertainment, rising rates of obesity, an ageing population, and an increase in both the size and average age of the ethnic minority population. Overall, 29%, 48%, and 24% of males with diabetes and 26%, 48%, and 26% of females with diabetes were treated by diet, oral hypoglycaemic drugs alone, and insulin respectively.

    We estimated around 1.15 million people had a diagnosis of diabetes mellitus in England and Wales in 1998. If the age specific prevalence of diabetes increases by a modest 30% over the next 25 years (less than predicted by many authorities), then the number of people with diabetes will increase by 70%, to 1.96 million by 2023. If age specific prevalence increases by more than 30%, then the increase in the number of cases will be even larger.

    Our findings illustrate the potential size of the diabetes epidemic facing England and Wales. The epidemic will have major implications for the NHS, which will have to provide diabetic services for these patients, as well as deal with the clinical and psychosocial complications resulting from diabetes. We therefore reinforce the need to tackle the underlying causes of this epidemic, particularly by increasing levels of physical activity and reducing rates of obesity in our society.3

    References

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    Let's move upstream to obesogenic environments, please

    1. Colin Guthrie (grey_triker{at}hotmail.com), general practitioner
    1. University College London, London WC1H 9QU
    2. Thames Cancer Registry, King's College, London SE1 3QD
    3. Office for National Statistics, London SW1V 2QQ
    4. Department of General Practice, University of Leicester, Leicester LE5 4PW
    5. 1448 Dumbarton Road, Glasgow G14 9DW

      EDITOR—Another BMJ brings yet another editorial on obesity and associated diabetes.1 Once again there is no reference to the real cause of this problem—obesogenic environments.

      Why is it that commentators constantly shy away from digging deeper? Why do they repeatedly refuse to venture upstream? It must be blindingly obvious to everyone by now that there is, and never will be, any conventional medical treatment for obesity or diabetes. Doctors should come clean and tell patients and populations that the cure lies not with medicine but in how our societies are created.

      Children are denied vital play space because politicians favour selling play space to developers. Sixty per cent of the green space used for housing in London in the past 10 years came from the sale of playing fields (Open spaces conference, Bankside Trust, London, March 2002). We exclude children's play from our streets by permitting a 30 mph urban speed limit. If we are to encourage an extra 3 miles of walking daily to enable 4 kg weight loss, reducing the risk of developing diabetes by 58%, then we must create an environment where people are able to walk. It is facile and cruel just to tell people that they must walk more. Healthy people need healthy environments.

      Politicians have the central role in creating healthy populations. They should stop pandering to powerful lobbies such as the pharmaceutical, motoring, food, and tobacco industries. If we as doctors do not tell them that they have the prime responsibility for health then they will continue to abuse us by heaping us with impossible responsibilities for changing the health of our nation. When we inevitably fail then they will give us the blame.

      General practice in the United Kingdom is currently teetering on the brink of such stupidity in the shape of a new medical contract that will enslave us into performing the impossible tasks of reducing blood pressure/weight/glycated haemoglobin concentrations/cholesterol concentrations, etc. We will soon be shackled to tick box medical consultations stuffing irrelevant data into computers in a pointless and ever increasing spiral of ineffectual intervention while the good that we can do, but which has never been recognised or rewarded, will simply wither and die.

      Perhaps the next obesity and diabetes editorial should be commissioned from a sociologist?

      References

      1. 1.