Why is Britain turning into the diabetes capital of the under-40s world? | Devi Sridhar
TType 2 diabetes used to be a condition associated with aging. It is the most common metabolic chronic condition in older people in Britain, and the risk of developing diabetes increases dramatically after the age of 45. People of South Asian descent have a higher prevalence of type 2 diabetes, and I grew up watching my grandparents and older relatives develop it one after another. India is often called thediabetes capital of the world”, accounting for 17% of the total number of diabetes patients worldwide.
But in Britain, recent data has shown a big change in the profile of those who develop diabetes: it is now young people. The number of under-40s diagnosed with type 2 diabetes has increased by 39% in the past six years. This was particularly the case for people from disadvantaged areas and people from black and South Asian backgrounds. In 2022, Diabetes UK highlighted that the number of children being treated for type 2 diabetes in England and Wales had risen increased by more than 50% during the past five years.
The reason for these increases is no mystery to experts. They are closely associated with obesity, and especially with the carrying of fatty tissue around the internal organs and the waist. As a diabetes specialist at the Royal Infirmary in Edinburgh told me: “It is rare for someone with a normal BMI (body mass index – a rough measure of a person’s weight rating) to be diagnosed with type 2 diabetes at the age of 30, except in South Asians where genetic predisposition is so strong”. She continued that type 2 diabetes in younger people is strongly linked to overweight and obesity (81% of children with type 2 diabetes living with obesity), but occasionally there is an unexplained abnormality or genetic basis. Exploring the links between BMI and diabetes, a study on well over a million people found that diabetes is more likely with a BMI of 30 or higher if you are from a white background, 28 if you are black, 24 if you are South Asian and 21 if you are of Bangladeshi descent.
What exactly is diabetes? It is a condition in which the body develops resistance to insulin, a hormone that converts food into energy. In diabetes, fat, liver and muscle cells do not respond to insulin, so glucose does not get into these cells to be stored for energy. Because the glucose has nowhere to go and continues to circulate, the resulting high blood sugar levels cause problems such as fatigue, numbness in the feet, joint pain, increased thirst, increased urination, blurred vision and a decreased immune response. Untreated diabetes damages blood vessels and kidneys and can lead to heart attacks, strokes and even blindness. The cellular mechanism underlying the link between obesity and diabetes is complexBut simply put: fatty tissue releases substances (such as fatty acids, hormones and cytokines) that play a role in the development of insulin resistance.
As with many health problems, the real solutions to the rising rates of diabetes among young people are more political than medical. Reducing the incidence of overweight and obesity, especially in children, is an ongoing challenge for most high-income countries, and an emerging challenge in low- and middle-income countries. While awareness of symptoms is important, as is early screening to identify pre-diabetes, in the public health field we know that education has its limits. Simply telling people about the risks of being overweight has had no impact at the population level, the researchers said investigations by the World Cancer Research Fund.
The central theme here is inequality; a real solution would include making healthier diets and physical activity more accessible, affordable and available. The cost of living is rising in Britain, meaning the price of fruit and vegetables, and healthy meat and dairy products, is rising, while leisure and sports centers are closing. It is not surprising that the number of overweight and obese people is increasing are increasing in almost all age groups in Britain, and that these are highest in the most deprived areas.
Once again we see the false cuts that the British government is making when it comes to healthcare policy. It should invest in public health and prevention, including anti-obesity strategies – such as a ban on multi-buy deals and junk food TV advertising before 9 p.m., and subsidies for nutritious food – and a healthier environment for individuals, especially those from disadvantaged backgrounds. families. areas. A clear focus could be on school meals, in which ultra-processed foods play a role 72.6% and 77.8% of primary and secondary school lunches (between school-provided and packed lunches): as a result, British children have the highest intake of ultra-processed foods in Europe. Yet the UK government has delayed tackling overweight and obesity, meaning the NHS must spend more on acute and chronic care for people who develop diabetes and need treatment and support. Unless this dynamic changes, Britain may in future be called ‘the diabetes capital of the under-40s world’.