Epidemiological review of Type 2 Diabetes

Introduction
There are a few non communicable diseases whose incidences have grown within the recent past

in the UK. One of these is Type 2 diabetes. According to an estimate of the World Health

Organization, 10 percent of the population in the world had diabetes in 2015 and out of this

number, 90 percent had type 2 diabetes. By 2030 type 2 diabetes is projected to become the seventh

killer disease on a global scale (WHO, 2016). Diabetes has been considered as being the fastest

growing health conditions among the global population and as such, is an issue that needs urgent

attention to address. Type 2 diabetes, for instance, has grown at a quite fact rate and is considered

as being one of the most common long-term health conditions globally. There are several risk

factors that are associated with diabetes, and obesity overweight issues are among them. This

condition also has an adverse impact on life expectancy. For those with type 1 diabetes, their life

expectancy is reduced by 20 years, while for those with type 2 diabetes, it is reduced by 10 years

(Diabetes UK, 2016). This paper presents an epidemiological review of diabetes in the UK, and

focuses on its risk factors and the main implications that it has for those who have the condition.

Diabetes in UK

Public health England revealed in 2015 that an estimated 3.8 million people over the age of 16 had

diabetes in 2015 which translates to 9 percent of the adult population in United Kingdom.

Approximately 90 percent of the 3.8 million are diagnosed with type 2 diabetes which is largely

preventable as well as manageable through lifestyle changes and adoption of healthy habits that

promote wellbeing. It is also estimated that 1 out of every 4 people in the United Kingdom with

diabetes are undiagnosed. Based on the current population trends it is estimated that 4.9 million

people will have diabetes by the year 2035. Around 700 people are diagnosed with diabetes every
day in the country. The number of people diagnosed with diabetes in UK has doubled since 1996

from 1.4 million to 3.8 million. It is also estimated that there are over 1.1 million people in the

country havediabetes but have not been diagnosed. According to Diabetes UK (2016), the United

Kingdom has the world fifth highest rate of Type 1 diabetes in children under age of 14.The burden

caused by complications arising due to diabetes causing extremely high economic and social costs.

Currently around 10 percent of the National Health Service yearly budget is used in the treatment

of the diabetes and its subsequent long term complications.Type 2 diabetes currently costs the

National Health Service an estimated 8.8 billion pounds every year in cost of care of the long term

condition. Tacklingthe rise of the disease is vital in reducing the burden of care and ensuring

sustainable future for the National Health Service.

Aims and objectives

The aim of this epidemiology review is to analyze the prevalence of diabetes as a major public

health issue in the world today. To understand the relationship between type 2 diabetes and

lifestyle. The study also focuses on the risk factors for diabetes, the complications and impact of

the disease on health of the population as well economic and social costs. Diabetesis now a

common health condition in the population and the risk factors associated with developing it is

dependent on several factors and these include lifestyles, genetic factors and environmental

conditions. Approximately 12 million people in the UK are argued to be at a heightened risk of

type 2 diabetes as a direct result of their unhealthy eating that contributes towards obesity and

being overweight.

Difference between Type 1 and Type 2 diabetes

There are differences between these two forms of diabetes. For instance, type 1 diabetes occurs in

a situation where an individual’s capability to produces insulin is hampered by the destruction the

cells in the pancreas that are responsible of producing it. There is no exact knowledge of what

causes damage in these cells, but in many cases, it is attributed to abnormal reactions to the cells

by the body which could be caused by viral infections or otherwise. Type 1 diabetes is extremely

prevalent in younger children under the age of 14 in UK (WHO, 2016). Type 2 diabetes, on the

other hand, occurs in situations where the ability of the body to produce enough insulin required

by the body is hampered. It also occurs when insulin is being produced well, but is not well utilized

by the body. Type 2 diabetes tends to occur due to a complex interplay of genetics and

environmental factors, and commonly occurs among people who are middle aged older. There is

however a growing trend of prevalence among younger people with obesity and overweight issues

(Diabetes UK, 2017). People with a family history of type 2 diabetes are two to six times more

likely to develop Type 2 diabetes than those without the disease in the family. Type 2 diabetes is

more common in people of the South Asian ethnicity as well as African and African-

Caribbeanorigin. Studies have shown than people of south Asian and black ethnicities have a

higher likelihood of developing than the Caucasian people.

Type 2 Diabetes Risk Factors

Obesity and Diabetes

Obesity is one of the biggest risk factors for Type 2 diabetes because it is estimated to account for

over 80% of the overall risk of developing the condition and has been attributed for the current

global rise in Diabetes. UK is currently ranked in Europe as the country with the highest level of

obesity (Diabetes.co.uk, 2017). In UK almost every two out of three people are overweight or

obese with 57 percent of this number being women and 67 percent men. In England most of the
population are either overweight which includes approximately 63 percent of adults and 30 percent

children between the ages of 2 and 15 years.

The main risk factor for diabetes type 2 is obesity and being overweight. The majority cases of

type 2 diabetes in the world are directly linked to the increasing cases of obesity in the world. In

the United Kingdom, adults with obesity are to get a positive diagnosis of type 2 diabetes than

those who are of a normal weight. It is estimated that 90 percent of adults diagnosed with type 2

diabetes in the UK are obese or overweight. It is important for people to adopt active lifestyles in

order to reduce the occurrence of obesity and overweight (Diabetes UK, 2016).

Age

There is a clear association between increased age and the prevalence of diabetes. Statistics show

that those who are above the age of 40 have a higher risk of developing type 2 diabetes than in

younger populations (Great Britain, 2012). However this age lowers in some black and minority

ethnic groups to 25 years.

Deprivation

Deprivation is another risk factor that is associated with type 2 diabetes. The reason for this is its

association with unhealthy diets, high levels of obesity, poor blood pressure control and smoking.

These factors cumulatively increase an individual’s risks of developing diabetes, or more serious

conditions for individuals who have been already diagnosed with diabetes (Thomas, 2017).

According to a health survey that was carried out in England, it was established that men in lower

income households have twice a higher likelihood of developing diabetes that those who come

from households that have a higher income. Women from low income households are 1.6 times

more likely to develop diabetes. This clearly indicates that deprivation increases the risk of
developing type 2 diabetes as it is directly affected by lifestyle. Peoplefrom poor households in

England are at a higher risk of diabetes than those from better households (NHS, 2017).

Gestational Diabetes.

This is a form of diabetes that develops during the second and third trimesters of a pregnancy. The

occurrence of this form of diabetes is attributed to the fact that some women have the inability to

secrete sufficient insulin that can enable them to meet its extra demand in the course of the

pregnancy. This form of diabetes affects close to 5% of all the pregnancies in the United Kingdom.

Women who are obese or overweight are at a higher risk of developing this condition than those

with normal BMI (Grant, 2016).Women who develop gestational diabetes are at a greater risk of

developing Type 2 diabetes later in life especially if they add weight. The odds of developing Type

2 diabetes increase to 40 percent for every 1 kilogram gain over their pre-pregnancyweight. Other

factors that can increase risk of developing Type 2 diabetes include the avoidance of breastfeeding

and pre-pregnancy weight.

Diabetes impact

Health impacts

Diabetes, if not well managed, can cause a variety of health complications, which increase the tress

involved in the management of the condition. Good management of the condition has is vital in

the reduction of the risk of several health complications. For instance, people with diabetes have a

double risk of developing cardiovascular diseases and diabetic retinopathy (Diabetes UK). Some

of the conditions that are related to diabetes are discussed below.

Cardiovascular disease
Cardiovascular disease is a term used to refer to conditions such as heart diseases, strokes and

other complication that may impact circulation and the heart. These include peripheral vascular

diseases which are characterized by the hardening and narrowing of arteries that are responsible

for the supply of blood to the patient’s legs. This condition accounts for 52 percent of fatalities

among type 2 diabetes patients and 44 percent of those having type 1 diabetes (Edelman, 2011).

Research shows that changes in lifestyle such as managing weight, keepingactive, improving

dietary habits and using medication can help control different risk factors which include as high

cholesterol and blood pressure. Heart failure is considered as being the most common and as well,

most fatal cardiovascular complication associated with diabetes. Data from the National diabetes

audit show that people with type 2 diabetes are at an increased risk of stroke than the general

population within the first five years of diagnosis.

Diabetic Nephropathy

Another major health complication of diabetes is diabetic nephropathy. Three out of four people

diagnosed with diabetes are likely to develop kidney diseases in the course of their lifetimes with

the condition. According the a report by NHS England (2017), diabetes is considered as being one

of the most common causes of end-stage renal diseases that require renal replacement surgery,

dialysis or even kidney transplants. For people suffering from type 1 diabetes, there 11% of the

associated deaths are related to kidney diseases. For those with type 2 diabetes, kidney disease

contributes towards 21% of deaths. One of the ways in which this can be addressed is through

putting efforts in place to keep blood glucose levels and blood pressure normal as possible.

Retinopathy
People with diabetes also have a high likelihood of having retinopathy, or eye disease. It affects

the supply of blood to retina as the blood vessels in the retina become blocked and leaky (Cunha-

vaz, 2013). This damages the passage of light through the retina and if the condition is left without

prompt treatment, it may further damage a person’s vision and even lead to blindness. It is

estimated that 10% of the UK population that is registered as being blind have diabetic retinopathy.

Nearly all people with Type 1 diabetes, as well as more than 60 per cent of people with Type e

diabetes, have a high likelihood of developing a certain degree of retinopathy in 20 years after the

first diagnosis. People with diabetes are at 50 percent higher risk of developing glaucoma and

cataracts than the general population.

Depression

Depression is another complication associated with diagnosis of diabetes. People with diabetes

have emotional and psychological issues with coming in terms with diagnosis, development of

complications, burden of self-care while managing the disease and this can take a toll on emotional

wellbeing leading to conditions such as depression, eating disorders and anxiety (Barnett, 2013).

Studies show that people with lifelong conditions such as diabetes have twice the likelihood of

suffering from depressive episodes more frequently than the general population.

Financial impacts.

It is estimated that the current financial cost on the National Health Service associated with

diabetes and its resulting complications is estimated about 23 billion poundsyearly. This translates

to 10 percent of the total National Health Service total budget. When the direct and indirect costs

of this condition are combined, the costs incurred in addressing and managing this condition shall

be over £39.8 billion by the year 20135. One out of every seven beds in hospital is likely to be
occupied by someone with diabetes as they have twice the likelihood of being admitted to hospitals

than the general population has (NHS,2016). Data from National diabetes UK shows that

approximately 41.5 million prescription items associated with diabetes care were dispensed to

primary care units in England in the year 2015/16.This accounted for 10 percent of the total cost

of prescribing England (Diabetes UK).

Study Methods:

This study utilized the cohort studies that have been documented on type 2 diabetes in the United

Kingdom. This epidemiology also used two basic study designs which included prevalence and

incidence studies. Incidence refers to the number of new people that have been diagnosed with a

certain condition in a specific population within a certain time period. Prevalence on the other hand

refers to the number of people in a specific population with the condition at a given point in time

(Krentz, 2015). The study population used in the epidemiology review was population in England

over the age of 16. The study made use of statistics and figure that were obtained from the estimates

made by the Diabetes Prevalence Model 2016 from the Public Health England. It shows that there

are about 4.5 million people with diabetes in the United Kingdom, and this and this figure includes

the 1 million undiagnosed Type 2 diabetes cases (NHS, 2016).Cohortstudies are used in medical

research to investigate the causes of disease as well as establishing the complex links between

known risk factors and health outcomes. The study established the risk factors that increase the

prevalence of diabetes type 2 in the population. These include

age,gender,obesity,genes,depravation and ethnicity.The study also established the relationship

between lifestyle and the occurrence of diabetes. The study focused on a retrospective cohort study

by looking at the data on diabetes that already exists on diabetes and use this to identify the risk
factors associated with diabetes. However the contemporary data on the prevalence of type 2

diabetes, incidence and mortality are limited in the UK.

Analysis of results

UK diabetes prevalence

Recent data that has been compiled by Public Health England has shown that over 3.8 million

people in England aged 16 and above have the diabetes condition. There has been a significant

increase in the incidence of type 2 diabetes diagnosis in the United Kingdom since 1990 and there

has been a rise in the proportion of people that have been diagnosed with the condition at a

relatively early age. It is expected that the incidence rates are going to increase over the next

decade. According to Diabetes UK (2016) there has been a high increase in prevalence of diabetes

in the UK since 1996, with the prevalence in 1996 being at 1.4 million compared to the 3.8 million

in 2015.

Prevalence

Table 1: Statistics of Diabetes prevalence among adults in 2014

Country Prevalence Number of people

England 6.2% 2,913,538

Scotland 5.9% 271,312

Wales 6.9% 183,348

Northern Ireland 5.3% 84,836

Source: www.diabetes.co.uk

According to data from Public Health England the prevalence rates of type 2 diabetes saw an

increase from 3.21% in 2004 to a staggering 5.26 % in 2014.Type 2 diabetes causes around 22,000
premature mortalities in England every year. The increase in the prevalence of type 2 diabetes in

the UK over the last decades can be attributed to patients with the condition living longer rather

than by the increase in the new incidences of type 2 diabetes. Incidence rates have however

remained stable over the last few years. The increase in prevalence and incidence rates over the

last decade were mainly related to poor lifestyle choices, male gender and deprivation.It is

estimated that the number of the people who will be diagnosed with diabetes will have grown to

five million (Diabetes UK, 2016).

Future trends.

The rising prevalence of obesity among the adult population in England has brought about, and

continues to bring about, an increased prevalence of type 2 diabetes in the county. It is estimated

that the costs incurred in dealing with this condition as well as the complications brought about by

it will continue rising in the next few decades. Forecasts predict that by the year 2050 obesity will

affect 50 percent of adult women and 60 percent of adult men (WHO, 2016).

Conclusion

Being among the most serious health problems not only in the UK but across the globe, there is a

need for different stakeholders in the health sector to prioritize diabetes and devise holistic

approaches that can be used in addressing it. The numbers of cases as well as the prevalence of

diabetes have been increasing rapidly over the last few decades. While there is no known

prevention of type 1 diabetes, there are effective approaches that are available to prevent type 2

diabetes as well prevent c complications associated with the condition (WHO, 2016). The

department of health in England have come up policies and practices that contribute to promote

good health habits for the population. These practices recommended include eatinghealthy,
exercisingregularly,controlling blood pressure and avoidingsmoking. Another approach to

prevention of diabetes is screening. The NHS introduced a programme for screening populations

that are considered as being at a high in the development of type 2 diabetes. Screening is the

process through which healthy people who are at high risk of developing a certain condition are

identified. Efforts are then made to offer them information, tests as well as appropriate treatment

to reduce the risk. (UK National Screening Committee, 2016). The NHS screening programme

was started in 2016 and is expected to cover all of England by 2020.Lifestyle interventions such

as adoption of an active culture and reduction of obesity remains the major goal of the National

Health Service in its fight against the increasing prevalence and incidences of Type 2 diabetes.

Other public health measures such as introducing taxes on drinks and foods that contribute to

obesity, helping people control their weight and ensuring physical activity is accessible to the

public.
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