Professor John Wilding from the University of Liverpool discusses how more effective use of treatments and greater support for healthcare professionals can make the difference in the battle against Type 2 diabetes
In the UK, there are currently over 3.5 million people living with Type 2 diabetes. Of that number, nearly 7,000 are children and young people under the age of 25 – a figure almost ten times higher than previously thought. Additionally, there are currently 6 million people at risk of Type 2 diabetes in the UK. The National Diabetes Prevention Programme, a recent initiative, is offering support to 100,000 people with diabetes or at risk of the disease to help them reduce their blood glucose levels through an intensive lifestyle change. However, with a further 5,900,000 at risk, the health service faces massive challenges in treating this growing epidemic effectively.
This growing prevalence and earlier age of onset means that healthcare professionals are also contending with increasing numbers of people with a new diagnosis of diabetes. This can create problems as it can be difficult to determine whether a young person has Type 1 diabetes (which requires insulin treatment), or Type 2 diabetes. With limited numbers of specialists and competing time pressures, there is a need for more education in primary care, where most people with diabetes are seen.
Type 2 diabetes is progressive, often leading to complications such as heart disease, kidney damage and blindness. It is, therefore, vital that people are prescribed the correct medication in parallel with lifestyle support (diet to promote weight loss and increased physical activity). Most patients will need more medications as their condition progresses and should be escalated onto new medications efficiently. This is something that we need to improve upon in the UK. Evidence has shown that when glucose rises above individual target levels, as recommended in current guidelines, the necessary escalation to a second or third medication can take up to two and a half years. To escalate patients beyond this, such as going on to insulin, can take five to six years. These delays lead to a much higher risk of serious complications.
A factor that could be driving this delayed escalation is the lack of access to diabetes specialists. People have different levels of access to expert care depending on where they live in the country. But the reality is that the existing number of diabetes specialists only have the capacity to see 5-10% of people with Type 2 diabetes. There are some local schemes helping to improve diabetes education among healthcare professionals and people with diabetes. The Liverpool Diabetes Partnership (LDP) for example, offers access to specialist teams in primary care settings. These teams are able to support the delivery of quality education, care and support to people with both newly diagnosed and established diabetes. Alongside this, they also help improve diabetes management in primary care, leading to a reduction in complications and expensive hospital admissions. Initiatives such as this, in combination with effective treatment, are vital to tackling the burden of Type 2 diabetes.
Effective treatments for Type 2 diabetes
In recent years, highly effective treatments have become available, which not only lower blood glucose levels but can also reduce the risk of the complications of Type 2 diabetes. One such class of medications, sodium-glucose co-transporter-2 inhibitors (SGLT2is), work by preventing the kidneys from reabsorbing glucose back into the blood. This has been shown to lead to weight loss and further research has demonstrated additional benefits, such as a reduction in the risk of heart and kidney failure. Another class of diabetes drugs, called glucagon-like peptide 1 receptor agonists (GLP1RAs) have also demonstrated cardiovascular benefits in patients with Type 2 diabetes.
These effective treatments can be more expensive than other Type 2 diabetes medications. However, when used as recommended – especially in those at highest risk of complications – patients using these medications are less likely to develop complications, which can result in cost savings over time. While many clinicians are waiting for NICE guidelines to catch up with the wealth of recent evidence showing the benefits of these medicines, diabetes specialists can provide advice to ensure they are used where they are most likely to be effective, ultimately leading to improvements in patient quality of life and long-term cost-effectiveness for the health system.
Type 2 diabetes is a highly manageable and preventable condition. To reduce the burden of Type 2 diabetes in the UK, education and support for both healthcare professionals and people with the condition will be key. This, together with effective prevention and treatment strategies, will ensure that the number of people living with complications from Type 2 diabetes does not continue to increase at an alarming rate.
Cello Health Communications through Napp Pharmaceuticals Limited has supported Professor John Wilding at the University of Liverpool to develop this article, in his role as Chair of the Improving Diabetes Steering Committee. This article has been solely put together by Prof John Wilding with medical writing support from Cello Health. Napp has had no involvement in the content of the publication other than to check it for factual accuracy.
Professor John Wilding (DM, FRCP)
Professor of Medicine
Honorary Consultant in Diabetes and Endocrinology
University of Liverpool
University Hospital Aintree, Liverpool, UK
