Perspectives: Preventing type 2 diabetes
Dr Neel Basudev, GP Principal at Springfield Medical Centre, Diabetes Lead for Lambeth CCG and Clinical Director Diabetes at Health Innovation Network — South London AHSN shares his thoughts on preventing type 2 diabetes.
I often get asked by patients why they have diabetes. I think the answer to that question is quite simple really. In essence, we are all born with a certain level of risk that we mainly inherit from our family tree and also our ethnic background. Whether that risk becomes reality depends to a large extent on what we then do throughout our lives in terms of diet and exercise. Putting on weight in early/mid adult years is the single biggest risk factor for developing type 2 diabetes. This is the most common type of diabetes and the one I am going to talk about here in terms of prevention. Of course, there are other risks involved and not everyone with type 2 diabetes is overweight, but most will be.
What you see on the outside of your body in terms of weight is a snapshot of what is going on inside. It’s not exact, but what we refer to as “central adiposity” i.e. your central weight/love handles is an indicator of “visceral adiposity” i.e. fat around your internal organs. It is this fat which is crucial to the development of type 2 diabetes as this fat is linked to features of type 2 diabetes such as resistance to insulin. We often measure Body Mass Index (BMI) and waist circumference to help get a more accurate perspective on weight. BMI is a measure of both your height and weight. Generally, depending on your ethnic background, numbers of 25 and above indicate being overweight and numbers of 30 and above indicate various levels of obesity. To give you a perspective, I could count the number of patients I have with type 2 diabetes who have a BMI of less than 25 on one hand. Waist measurement is interesting as almost everyone gets it wrong. Your waist is accurately measured just above your belly button, not where your trousers sit as most people would naturally think- that is technically your hip measurement. A waist size of greater than 31.5 inches for women and 35 inches for men can increase your diabetes risk.
If we could as individuals or indeed as a society reduce the central fat, then maybe we could reduce the incidence of type 2 diabetes.
That is why there is currently so much work going on with regards to diabetes prevention both locally and nationally. We know that people tend to follow a path whereby they go from being considered normal risk, to high risk and then onto diabetes itself. It is the high risk phase that we are interested in tackling and it goes under various names including pre-diabetes.
Once you are on the path, the interesting thing is that you can go backwards. In other words, you can reduce the likelihood that you develop type 2 diabetes in later life.
How often can you say that you have the potential to influence your health and prevent a disease like diabetes?
There is a huge amount of very good research which shows this. The main way to prevent diabetes is through (yes, you guessed it!)…diet and exercise. These two words are probably the most used in the field of diabetes and conjure up various images for people. I often explain to my patients that when we talk about weight loss here, we are referring to around 5%. So, if you weigh 80Kg, reducing your weight by 4Kg will help to significantly reduce your chances of developing diabetes.
The trouble is that this is harder to achieve and maintain than it sounds in today’s obesogenic society. That is where the NHS Diabetes Prevention Programme comes in. It is being rolled out nationally; locally in South London, we have been working on what the programme will look like, how will people be able to access it and how do we ensure it does what it is supposed to do. It is a huge undertaking. Nothing like this has ever been done before and at a time of austerity, it is perhaps priceless that we have the financial backing to make a real difference for people and give them the support they often need to prevent diabetes.
Dr Neel Basudev
GP Principal (Springfield Medical Centre);
Diabetes Lead (Lambeth CCG);
Clinical Director Diabetes (Health Innovation Network- South London AHSN)
