Features

Clinical: Type 2 diabetes is on the rise

20 November 2020

Type 2 diabetes is rife in the UK, even among children, but supporting people to make healthier choices could improve the situation hugely, writes journalist Julie Penfold.

Type 2 diabetes is a long‑term condition that causes a person’s blood glucose level to become too high. About 3.9 million people in the UK have diagnosed diabetes, 90% of whom have type 2. In addition, it’s thought that up to a million people are living with the disease undiagnosed (Diabetes UK, 2020a).

While type 2 diabetes is most common in adults over the age of 40, it can also affect children and young people. The latest national paediatric diabetes audit by the Royal College of Paediatrics and Child Health (RCPCH) has revealed that 790 children and young people were being managed in paediatric diabetes units (PDUs) in England and Wales in 2018 (RCPCH, 2020). Of those, 187 had been newly diagnosed that year. The report revealed that the number of young people being managed in PDUs had increased every year since 2012. It also found that there was a higher diabetes risk among girls, children of non-white ethnicity and those living in the most deprived areas.

‘Type 2 diabetes in the younger age groups is becoming more common because of our obesogenic society,’ says Karen Davies, senior clinical adviser at Diabetes UK. ‘When I was a diabetes nurse specialist in the 1990s I never saw younger cases of type 2 – it was quite unheard of then. It just demonstrates how our lives have changed. Obesity and weight gain among younger people is generally becoming more of a problem beyond other risk factors, such as ethnicity and family history.’

Karen continues: ‘The sad truth is that children and adolescents tend to have a more aggressive form of the condition. It progresses quite quickly compared with type 2 diabetes in adults – and it can move more quickly towards complications such as cardiovascular disease, kidney disease, retinopathy and neuropathy.’

No longer a novelty

The latest statistics published by the UK Government as part of its new strategy to tackle obesity illustrate the scale of the public health crisis we are facing. It reveals that 63% of adults in England are now either overweight or obese, while a third of primary school leavers are overweight or obese (Department of Health and Social Care, 2020). The figures for Scotland, Wales and Northern Ireland are similar.

A number of countermeasures have been introduced alongside Public Health England’s Better Health campaign. These include a ban on TV and online adverts for fast food before 9pm and increased calorie labelling on food and alcohol (see our cover feature on page 32 for further information about tackling obesity).

‘We don’t actually know how many children and young people are living with pre-diabetes or diabetes at the moment,’ says Aisling Pigott, a paediatric diabetes dietitian in Wales and a spokesperson for the British Dietetic Association. ‘That’s because it isn’t currently screened for as standard. My impression within clinical practice is that we’re failing these children, because those who have been diagnosed are still few and far between. Of the 220 children in our service, those with type 2 diabetes make up less than 5% of that number, but this total is growing every year.’

Aisling continues: ‘Type 2 diabetes in children and young people is relatively new, so perhaps it’s seen as a bit of a novelty. But when you’re diagnosed before the age of 25, your risk of complications is much higher. You’re living with high glucose levels during those early years. Someone who’s diagnosed with type 2 diabetes at 16 years old will have much worse outcomes than someone diagnosed with type 1 will at the same age.’

 

Diabetes UK, 2020a; RCPCH, 2020

 

The types explained

The hormone insulin, produced in our bodies by the pancreas, is responsible for controlling the amount of glucose in our blood. With type 2 diabetes, the pancreas either does not generate enough insulin or the body’s cells do not react to the insulin that is produced. With type 1 diabetes, the pancreas does not make any insulin at all. Lifestyle changes will have no impact on type 1 diabetes.

Type 1 and type 2 diabetes have common symptoms. These include:

  • Going to the toilet a lot, especially at night (to flush out extra glucose)
  • Being very thirsty and not being able to quench it (kidneys pass out excess sugar, which draws out moisture from other tissues too)
  • Feeling more tired than usual (because of glucose imbalance)
  • Weight loss (insufficient insulin prevents body using glucose efficiently).

Where the two types differ is in the speed of onset. Type 1 diabetes, which is common in children and young people, can develop quickly. Without a prompt diagnosis, diabetic ketoacidosis (the build-up of harmful acids in the blood) can prove fatal.

The 4 Ts campaign by Diabetes UK aims to increase awareness of the four key symptoms of type 1 diabetes: toilet, tired, thirsty and thinner. It encourages parents and healthcare professionals to act fast if they suspect that a child has the condition (Diabetes UK, 2020b).

By contrast, the onset of type 2 diabetes is much more stealthy. Karen explains: ‘The symptoms can be easier to miss, as the condition develops more slowly, especially during the early stages. Type 2 diabetes is harder to spot because it’s easy to ignore or explain away symptoms such as tiredness or feeling a bit run-down and prone to infection. It can be a little vague and insidious in onset.’

 

Diabetes UK, 2020d

 

Managing the condition

A person’s risk of type 2 diabetes increases with age, especially if they are white and over 40. Ethnicity is another contributing factor: people aged over 25 of Afro-Caribbean, black African or south Asian descent are two to four times more likely than average to develop type 2 diabetes (Diabetes UK, 2020c).

Genetic factors can also increase an individual’s risk if they have a parent, sibling or child with diabetes. High blood pressure is another risk factor. Conditions such as polycystic ovary syndrome can increase a woman’s risk. But the main danger for anyone is excess bodyweight – particularly around the waist.

‘The biggest risk factor for children and young people will be sedentary behaviour and this linking with those extra risks of excess weight, ethnicity factors and/or a family history of type 2 diabetes,’ says Karen, who adds: ‘Having a strong family history of diabetes is also linked to a genetic type of diabetes called maturity onset diabetes of the young – or Mody for short. Mody, which has about six subtypes, affects only 2% of the population.’

The process of diagnosing type 2 diabetes usually starts with the GP, after a discussion about symptoms and a urine test. A glycated haemoglobin (HbA1c) test to measure average blood sugar levels over two to three months will typically also be conducted.

Lifestyle changes are an important step in terms of both prevention and treatment. These normally include dietary improvements, cessation of smoking, a reduction in alcohol consumption and an increase in physical exercise.

Living with type 2 diabetes can be a real challenge, as Karen relates: ‘We know that there’s a strong link between long-term conditions such as diabetes and emotional wellbeing. People’s emotional responses result from their fear of complications, feelings of isolation and concerns about managing their weight. Body image issues can also have an impact, particularly for children. The care that people need to put into their lives in order to manage the condition can also be quite draining.’

If medication is required over time, metformin is the first-line treatment option for adults. Sodium glucose co-transporter-2 (SGLT2) inhibitors are a new class of oral medication that will help to reduce blood glucose. There are also glucagon-like peptide 1 receptor agonist (GLP1) injections. Like SGLT2, GLP1 is an effective treatment for helping people to lose weight and reduce their blood glucose levels (NICE, 2020).

How to help

Aisling stresses how important it is for community practitioners to provide sensitive support to young people with type 2 diabetes.

‘It’s a stigmatising condition for them,’ she explains. ‘If they are overweight, they’re likely to have had negative views put to them about their lifestyles. It’s also about ensuring that the health promotion advice and support you offer is culturally appropriate. It can help to ask young people about what they like to eat and how the condition is affecting them to increase your understanding. If a young person has a diagnosis, touching base with their clinical team can also be helpful.’

Aisling adds that encouraging young people to perform physical activities they enjoy can help to make their lives less sedentary.

‘Where we’ve seen success in our clinic is through exercise,’ she explains. ‘Making changes to the diet may shift things a little, but often it’s down to very inactive lifestyles. Getting involved with local sports clubs can work well. It’s worth seeing whether there are any community projects that speak to those families and their cultures.’ 

Image credit | Alamy


Resources:


References:

Department of Health and Social Care. (2020) New obesity strategy unveiled as country urged to lose weight to beat coronavirus (COVID-19) and protect the NHS. See: gov.uk/government/news/new-obesity-strategy-unveiled-as-country-urged-to-lose-weight-to-beat-coronavirus-covid-19-and-protect-the-nhs (accessed 5 October 2020).

Diabetes UK. (2020a) Number of people with diabetes reaches 4.8 million. See: diabetes.org.uk/about_us/news/diabetes-prevalence-2019 (accessed 5 October 2020).

Diabetes UK. (2020b) Do you know the 4 Ts of type 1 diabetes? See: https://www.diabetes.org.uk/get_involved/campaigning/4-ts-campaign (accessed 5 October 2020). 

Diabetes UK. (2020c) Diabetes risk factors. See: diabetes.org.uk/preventing-type-2-diabetes/diabetes-risk-factors (accessed 5 October 2020).

Diabetes UK. (2020d) Differences between type 1 and type 2 diabetes. See: diabetes.org.uk/diabetes-the-basics/differences-between-type-1-and-type-2-diabetes (accessed 5 October 2020).

NICE. (2020) Clinical knowledge summary: diabetes – type 2. See: https://cks.nice.org.uk/topics/diabetes-type-2 (accessed 5 October 2020).

RCPCH. (2020) National Paediatric Diabetes Audit: annual report 2018-19: care processes and outcomes. See: https://www.rcpch.ac.uk/sites/default/files/2020-03/final_npda_core_report_2018-2019.pdf (accessed 5 October 2020).

 

 

 

Subscription Content

Click To Return To Homepage

Only current Unite/CPHVA members or Community Practitioner subscribers can access the Community Practitioner journals archive. Please provide your name and membership/subscriber number below to verify access:

Name
Membership number

If you are not already a member of CPHVA and wish to join please click here to JOIN TODAY

Membership of Unite gives you:

  • legal and industrial support on all workplace issues 
  • professional guidance on clinical and professional issues 
  • online information, training and support 
  • advice and support for all health professionals and health support workers
  • access to our membership communities 
  • CPHVA contribution rate is the Unite contribution rate plus £1.25 per month 

Join here https://www.unitetheunion.org/join-unite/

If you are not a member of Unite/CPHVA but would like to purchase an annual print or digital access subscription, please click here

Top