1. Diabetes Mellitus Type II and its Threat to UK Health
James Shaw 12091938
Aetiology
The combination of genetics and the environment are what determine
whether a person develops DMT2. A variety of risk factors are associated with
the disease, these include:
• Genetics – risk varies according to subtype of DMT2. No single gene found
to be responsible.
• Obesity – it is believed that obesity accounts for 80-85% of the risk
associated with developing the disease (Diabetes, 2015)
• Age – Beta cell function declines as age increases. With the current aging
population in the UK an increased prevalence of DMT2 is expected.
• People of South Asian or Afro-Caribbean descent are at higher risk of
developing the disease. Onset is also more common at a younger age
(Holt, et al. 2015)
• Fat Distribution – if the body stores fat predominantly in the abdomen
then risk of developing DMT2 is elevated.
• Inactivity – activity uses up glucose as energy and makes your body more
sensitive to insulin.
References
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-Barnett, A (2015). Type 2 Diabetes. Oxford: Oxford University Press. p1.
-Bays, H. et al (2007). The relationship of body mass index to diabetes mellitus, hypertension and dyslipidaemia: comparison of data from two national surveys. International Journal of Clinicial Practice. 61 (1), P637-47
-Camber, D. (2013). Is Bariatric Surgery an Appropriate Treatment for Type 2 Diabetes?. Clinical Diabetes. 31 (3), p99-103.
-Diabetes.org.UK. (2015). Diabetes Facts and Stats. Available: https://www.diabetes.org.uk/. Last accessed 17/01/2016.
-Dunkley, A. Bodicoat, D. Greaves, C.. (2014). Diabetes Prevention in the Real World: Effectiveness of Pragmatic Lifestyle Interventions for the Prevention of Type 2 Diabetes and of the Impact of Adherenceto Guideline
Recommendations. Diabetes Care. 37 (1), p922-33.
-Gotz, A. L. M. Ittner and Y. A. Lim, Common features between diabetes mellitus and Alzheimer's disease, Cell. Mol. Life Sci., 2009, 66, 1321–1325.
-Hex, N. Bartlett, C. Wright, D. Taylor, M. Varley, D.. (2012). ---National Centre for Biotechnology Information. Estimating the current and future costs of Type 1 and Type 2 diabetes in the UK, including direct health
costs and indirect societal and productivity costs.. 7 (1), p855-62.
-Holt, T. et al (2015). ABC of Diabetes. Chichester: John Wiley & Sons. p2.
-National Diabetes Audit (2011-12). Adult Obesity and Type 2 Diabetes. Available: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/338934/Adult_obesity_and_type_2_diabetes_.pdf.
Last accessed 17/01/2016.
-NHS. (18/06/2014). Type 2 Diabetes. Available: http://www.nhs.uk/conditions/Diabetes-type2/Pages/Introduction.aspx. Last accessed 09/01/2016.
-ONS. (2014). ONS Diabetes. Available: http://www.ons.gov.uk/ons/index.html. Last accessed 17/01/2016.
-Paulweber, B. et al. (2010). A European evidence-based guideline for the prevention of type 2 diabetes.. Europe PMC. 42 (1), p3-36.
What is Diabetes Mellitus Type II?
Diabetes Mellitus Type II (DMT2) is a serious chronic metabolic disorder,
characterised by insulin resistance and relative insulin deficiency resulting
in hyperglycaemic. DMT2 has a significant impact on health, quality of life
and life expectancy of patients, as well having economic implications for the
healthcare system.
Around 3.9 million people are living with diabetes in the UK, with type II
diabetes accounting for 90% of these people (NHS, 2014). This costs the
NHS approximately £1million an hour (Hex, et al. 2012), with costs
predicted to rise rapidly over the next 10 years. Approximately 1/16
people in the UK have diabetes, including those that haven’t been
diagnosed (ONS, 2012). Typically, diabetes occurs in people over the age of
40, however it is becoming more and more common in children and
adolescents. DMT2 has strong familial incidence, meaning that if a twin
develops the disease, it is likely that the other twin will also develop type II
diabetes (Ahmed, et al. 2007).
Links have been found between obesity and DMT2 (Diabetes, 2015), shown
in the figure below.
Graph showing the prevalence of Diabetes Mellitus by body mass index
(BMI)
Diagnosis
Preliminary screening may identify the presence of urinary glucose and
these results suggest whether further tests are necessary.
Patients presenting with diabetes type II symptoms will be given a glycated
haemoglobin (A1C) test, indicating their average blood sugar levels for the
past 2-3 months by measuring the percentage of blood sugar attached to
haemoglobin. An A1C level of 6.5% or higher is an indication of diabetes.
Other tests can be performed if the patient is pregnant or has a
haemoglobin variant. A venous blood sample and the glucose
concentration is determined, if the fasting plasma glucose concentration is
equal to or greater than 7.0mmol dm⁻3 then the patient is diagnosed as a
type II diabetic (Ahmed, et al. 2007).
Prevention
Studies suggest that pragmatic diabetes prevention programmes are
effective. Modest changes to physical activity and diet reduce the
incidence of DMT2 by more than 50% in people with impaired glucose
regulation (Dunkley, et al. 2014). Even those who are considered ‘high risk’
can prevent or delay the onset of the disease by adhering to intense
lifestyle prevention programmes. Prevention plans are, when effective,
considered to be a cost efficient model of care (Paulweber, et al. 2010).
Treatment
Bariatric Surgery procedures have indicated effectiveness in improving
glycaemic control and reduced hepatic insulin sensitivity. This procedure
carries inherent risks associated with invasive surgery (Camber, 2013).
Metformin is a drug that is commonly used as a treatment, working by
improving the body’s sensitivity to insulin as well as reducing glucose
production in the liver.
Health Issues linked to Diabetes
Cardiovascular – angina, atherosclerosis, myocardial infarction, stroke,
coronary artery disease. 80% of type 2 diabetes sufferers go on to die from
cardiovascular disease (Barnett, 2015).
Nephropathy (kidney damage) – kidney failure, end stage kidney disease
(requiring dialysis or kidney transplant).
Neuropathy (nerve damage) – loss of feeling in limbs affected, nausea,
vomiting, diarrhoea, constipation and erectile dysfunction.
Retinopathy – potential blindness, cataracts and glaucoma.
Foot damage – cuts and blisters can develop serious infections leading to
need for amputations.
Skin conditions – more susceptible to bacterial and fungal infections.
Hearing impairment – more common in people with DMT2.
Alzheimer’s disease/dementia – many studies indicate that individuals with
DMT2 are at higher risk of developing dementia (Gotz et al, 2009).
Table 1 – Increased risk of diabetic complications in people with diabetes
compared to the general public of England (National Diabetes Audit, 2011-12)
Diabetic Complication Additional Risk of Complication Among People with Diabetes
Angina +76%
Myocardial Infarction +55%
Heart Failure +74%
Stroke +34%
Renal Replacement Therapy ESKD +164%
Minor Amputation (below ankle) +337%
Major Amputation (above ankle) +222%
Conclusion
Diabetes incidence is predicted to rise in the UK over the next decade. In
order to prevent this, education about the consequences of DMT2 must be
implemented alongside healthier lifestyles of the general public. This will
improve quality of life and reduce the future burden on the economy.
Figure 1: Distributions of BMI – (Bays, et al. 2007)