Why do people get diabetes?
We’re all judgmental bastards when it comes to health
Imagine a crumbling rock face, sitting high above the ocean. Each wave that pounds this cliff is tiny in comparison, a flea on the back of the mammoth weight of rock.
Imagine the scale of this cliff. It reaches so high that even by craning your neck back you can barely see the distant peak, grass blowing over the edge.
Imagine the massive weight of this behemoth poised above you, held back seemingly by air, a titan made immobile by its own mass.
Every so often, the waves will wear away the base enough that another fragment will fall, disturbing the endless march of the ocean for a brief moment until it sinks forever beneath the waves.
Now imagine a giant rock poised to fall at the edge of this cliff. Its foundation has been worn away almost to nothing, the waves relentlessly driving it further towards its doom. Against the scale of this cliff, the rock is tiny. It seems almost like a toy.
The giant rock teeters on the edge. Cracks appear. Ever so slowly, it starts to fall.
We look up and see it coming.
At the brink
The giant rock is diabetes, or at least type 2 which is >90% of diabetes*. We have known for decades that the world is getting fatter. The average weight in some places in the world is 50% higher than just a few generations ago. Diabetes trends are largely driven by obesity; the fatter people get, the more diabetes we see.
This is not a contentious issue.
We’ve been able to see the rock for some time now. Study its shape, see how it might fall.
There are 2 reasons its falling now. People tend to get diabetes when they are older (aside from type 1 diabetes, which initiates mostly in kids). And whilst people have been getting fatter, they have also been getting older, building slowly to a peak that we are only now seeing hit the water.
The rock is falling, and falling fast. Diabetes is currently one of the top 10 causes of ill health, and within 10 years it is going to be the leading disease of our time. Rates of diabetes have nearly doubled in the last 10 years alone, and by 2025 we expect nearly 1 in 6 Australians to have diabetes.
There will be more people with diabetes than almost any other chronic disease.
Gestational diabetes (diabetes whilst pregnant) is often seen as a warning sign for future diabetes in the population. This is because the babies of women who have gestational diabetes are 4–7x more likely to develop type 2 diabetes, with the women themselves having a similarly elevated risk of the disease. And rates of gestational diabetes in certain parts of Sydney have increased tenfold since 2002.
We’ve gone from ~40 women per year getting gestational diabetes to over 400 in Western Sydney. Gestational diabetes is (mostly) easy to treat, and relatively easy to reverse, but it has all kinds of risk factors. And there are 10 times as many women getting sick in less than 2 decades.
The rock is falling. It is almost here.
And the saddest part of it all?
Diabetes is largely preventable
The mechanism for obesity causing diabetes is relatively complex, but the treatment is not; decreasing the weight of a population by as little as 2kg can reduce the number of people getting diabetes by 30%.
Not only that, but with bariatric surgery we can reverse diabetes in >90% of adults. The vast majority of diabetes can be either prevented or reversed. We can stop this epidemic in its tracks.
So why don’t we do it?
Social determinants of diabetes
I’ve written before about how our environment affects our health, and for diabetes this is more true than ever. People living in Sydney’s less affluent western suburbs are almost 3x as likely to have diabetes than those living in the richer east.
This ties in very well with what we already know. There is an almost linear relationship between our postcode and our health. Living in a poorer area means less access to parks, less fresh food, less ability to move around, and a myriad of other problems.
Its the same old chronic disease story. We are all idiots living in a basket of stupidity. We tell fat people that it is all their fault, blame diabetics for losing their feet, and feel good about our new gym shoes.
The rock falls, and we’re too busy telling each other how ashamed they should be of their double-chin than doing something about it.
So why do people get diabetes?
Mostly it is because we live in a diabetogenic society (because health nerds love adding ‘ogenic’ to the end of a word to make it sound scary; i.e. Trumpogenic). Basically, our environment encourages diabetes, particularly in poorer areas.
We tend not to walk. We rarely cycle. In many places, fast food is the most accessible form of nourishment.
And our answer to this problem, too often, is to blame people. “You wouldn’t have diabetes if you weren’t so fat”, we sneer, ignoring the social inequities that have led to this condition. “If you ate some more quinoa, or drank an acai smoothie every once in a while, you’d be fit like me”. It’s not about how to really help people. It’s about judging them as not worthy.
In the end, the solutions are right in front of us, and have been for decades. Stop building roads, and invest in more active transport like cycleways and buses. Use regulatory measures to encourage consumption of healthy foods and limit their intake of unhealthy ones. Provide evidence-based treatments for obesity that we know can have an effect.
We can stop the rock falling, or at least slow it down.
It’s time that we stopped judging people and actually help them instead.
*Type 2 is largely caused by obesity and so follows the same trends, Type 1 is mostly genetic but is also increasing. However, Type 1 only makes up ~10% of diabetes, and the proportion is falling because Type 2 is rising so fast.
