“Understanding of both type 1 and type 2 diabetes has reached the point where innovations are emerging to tackle the growing diabetes crisis,” Dr Elizabeth Robertson, director of research at Diabetes UK said during the 2019 Royal Pharmaceutical Society and UCL School of Pharmacy new year lecture. Meanwhile, a new report highlights community pharmacy’s role in preventing and treating diabetes.

During the lecture, Dr Robertson highlighted that weight loss can prevent type 2 diabetes and, in about half of cases, induce remission. “Building understanding of how fat in the liver and pancreas causes type 2 diabetes and how its removal can restore normal glucose control will transform diabetes prevention and allow many remissions,” she said.

Dr Robertson welcomed NHS innovations, such as the National Diabetes Prevention Programme in England. However, about 500,000 people in Britain have undiagnosed diabetes and more than 5 million have ‘pre-diabetes’.

“If long-term savings are to be achieved and healthy life expectancy extended, the NHS must increase its spending on both diabetes prevention and treatment,” added Professor David Taylor, author of a new UCL School of Pharmacy report on diabetes.

“In the case of type 2 diabetes, there remain, despite provisions like NHS Health Checks, several million people in England alone who could benefit from knowing that their blood sugar levels are at hazardous levels. Arguably, everyone over 40 should know their HbA1c number, which averages blood sugar levels over three months. Yet official attitudes can still be very conservative.”

The report highlights, for example, concerns about the cost-effectiveness of systematic population-wide blood sugar monitoring. Privately purchased services through, for example, community pharmacies could improve uptake, but would “very probably” widen health inequalities.

Recommendations

The report makes numerous recommendations including sharing knowledge about the nature and causes of diabetes in ways that allow everyone to act on the information. In particular, the report stresses the importance of increasing awareness of the link between adiposity and type 2 diabetes, and how losing weight may lead to remission and other health benefits. Multiple interventions should address social determinants, such as moderating alcohol use.

The report suggests ensuring that everyone seeking to reverse type 2 diabetes can participate in a suitable programme. “Recent steps towards providing 5,000 places on rapid weight reduction courses are a welcome development, but fall a long way short of establishing a full scale ‘diabetes remission service’.”