AN INDEPENDENT SUPPLEMENT FROM MEDIAPLANET ABOUT LIVING WITH DIABETES, DISTRIBUTED IN THE TIMES

14 NOVEMBER 2007 LIVINGWITH Sharing experiences to combat a global epidemic

DIABETES

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Introduction LIVING WITH DIABETES

CONTENTS

Diet and excercise 5

Diabetes Youth Charter 6

Quality of Life 6

Discovery HealthChannel documentary 7

Research for types 1and 2 8

Patient case study 9

Lessons in diabetes 9

Awareness 11

Model Group- Encouraging open debate 11

World Diabetes Day 12

Diabetes and depression 12

Diabetes UK 14

Economic Costsof Diabetes 14

LIVING WITH DIABETESA TITLE FROM MEDIAPLANET

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As a global diabetes care leader, NovoNordisk recognises that leadershiptakes more than providing cuttingedge diabetes medicines. Our knowl-edge and position in the global dia-betes community mean we havemuch to offer as a partner in the fightagainst diabetes. We support many

Coming together to fight theglobal epidemic of diabetes

The fact you can live with diabetes isof itself a quantum leap forwardthanks to the discovery of insulin in1921, and to the ever improving effi-cacy of drugs, treatments and in-formed regimes for people with eithertype 1 or type 2 diabetes.

However, preventing diabetes hasbecome the number one priority forthose who have looked into the crys-

Health reforms neededto help diabetes battle

individual projects around the worldto combat diabetes, but our aim islarger. As a business and as a corpo-rate citizen of a world heavily bur-dened by disease, we want to changediabetes. We want to change the im-pact diabetes has on lives, change theamount of pain and suffering diabetescauses and change the burden of dia-betes on economies around theworld. Our main concern is the peo-ple with diabetes and we will fight forthese individuals so that they can livenormal lives - and live well.

The number of people affected bydiabetes is growing at such an alarm-ing rate that it threatens to over-whelm the health service. Today, onein 25 people in England and Waleshas diabetes, costing ten per cent ofNHS spending, and the costs of car-ing for the growing number of peoplewith diabetes will increase by up to25 per cent by 2040. Diabetes is morelikely to affect poorer or overweight

people, those from black and minorityethnic communities, and the elderly.

Diabetes is growing in prevalenceall over the world. The InternationalDiabetes Federation currently esti-mates that 246 million people world-wide have diabetes in 2007, which isalmost six per cent of the adult pop-ulation. This number is expected toreach 380 million by 2025, or 7.3 percent of the adult population. Many ofthese people with diabetes will de-velop serious medical complications,for which hospital treatment is costly.And as many as a third do not knowthat they have it so are not taking anyaction or receiving any treatment.

Recent reports (among others theHealth Commission report) claim thatthe state of diabetes care in the UK is in-adequate compared to other Europeancountries. In the UK diabetes is a de-clared focus area, so everybody fromgovernment to people directly affectedby the disease have a vested interest in

getting access to the best diabetes careinvolving the best education, the bestadvice and the best medical products. Inthe UK we already have some of the besthealthcare professionals, so if we do notgive them the possibility to work ac-cording to the best standards, we willnever achieve the treatment targets. Costsavings or negligence in diabetes care issomething we cannot accept and I don’tthink the UK’s health care system canafford not to put some extra effort in tochanging the current situation.

Our dedication to improving life forpeople with diabetes led Novo Nordiskto be a strong partner in the Unite forDiabetes campaign which led to theadoption of the 2006 UN Resolution ondiabetes, and as a result today 14th No-vember 2007 is the first UN recognisedWorld Diabetes Day. This however isonly one of many steps. We now needto continue to work together to put thisresolution into action, to change the fu-ture of diabetes.

tal ball and seen the implications of afuture world where diabetes contin-ues to rise at a rate well beyond theability of healthcare systems to cope.

UK policy pays lip service to pre-vention and is mainly ordered aroundthe National Service Framework (NSF)for diabetes. This is primarily a targetdriven strategy to level up standardsof care based on a programme ofchange and improvement to raise thequality of services and reduce unac-ceptable variations. For the majorityof sufferers diabetes is a conditionthey manage alone for 364 days ofthe year, and only share with thehealth service at their annual check-up or when things go wrong.

While the NSF and its concentra-tion on standards is crucial, the pri-mary aim of the National HealthService ought to be helping the pa-tient understand their condition inorder to manage, control and livewith it.

Concurrently, the primary goal forpolicy makers across government de-partments ought to be the preventionof diabetes. While this dual strategy

of self-management and prevention isnot actually opposed by decisionmakers, it does not yet lie at the heartof governmental health strategiesaround the world. This is why secur-ing a UN resolution on diabetes lastyear was so important and why eachyear on World Diabetes Day we needto proclaim the progress made andcommunicate to decision makers theenormity of the task ahead.

In the UK alone up to three millionpeople have diabetes with three quar-ters of a million of them not yet re-ceiving treatment.

The demands on a universal healthservice free at the point of use aregrowing annually and unless meas-ures are taken that address the dia-betes pandemic they may not besustainable.

Reaching a tipping point wheregovernments accept the need for ac-tion was the main conclusion of theWorld Diabetes Leadership Forum inNew York this year. That tippingpoint cannot come soon enough forthose living with the condition norfor those most at risk.

In association with:

BY VIGGO BIRCH, HEAD OF NOVONORDISK UK

BY ADRIAN SANDERS MP (LIB DEM,TORBAY) CHAIR ALL PARTY PARLIAMENTARY GROUP FOR DIABETES

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Diet and Exercise LIVING WITH DIABETES

Diet and exercise can helpkids avoid type 2 diabetesBritain is facing a ticking timebomb that is set to rapidly raiserates of chronic disease if children’s diets are not improvedand they are not encouraged to take more exercise.

That is the worrying warning fromChristine Hancock, director of the Ox-ford Health Alliance (OxHA) whichcampaigns for better awareness of howhealthy lifestyles can reduce rates ofchronic diseases, such as type 2 diabetes.

“The truly shocking thing is that wecould be raising the first generation ofchildren who don’t live longer than theirparents,” she sums up.

“If we don’t do something about en-suring children get their five portions offruit and vegetables and an hour of ex-ercise each day we are going to see hugeincreases in the proportion that go on todevelop type 2 diabetes. In fact, we’reeven starting to notice that type 2 isnow being found in children. It’s notcommon but when you think it was vir-

tually unheard of in children until veryrecently, it shows the huge problemwe’re bringing on ourselves.”

Indeed the latest government figuressuggest that 23 per cent of adults arenow obese and that childhood obesityhas trebled in the past 20 years to a pointwhere one in ten six years olds and 17per cent of 15 year olds are now obese.

Healthy adviceTo help mitigate the ‘timebomb’ of poordiet and lack of exercise Hancock hassome very straightforward messages forparents and guardians who, despite thepressures of modern living, need to takemore responsibility in ensuring their chil-dren are not tomorrow’s chronic diseasestatistics.

“I can empathise with parents be-cause when I was brought up we did-n’t have computer games and fizzydrinks,” she says.

“Also, today’s families may be singleparent and there’s an increased likeli-hood both parents will be working andso there are time constraints and fastfood can often seem to be the answer.Nevertheless, we need to reverse thetrend for children to take in more calo-ries than they burn off or we will con-tinue to raise obesity rates which, inturn, will rocket type 2 diabetes rates.

“So, parents have simply got tomake sure children get their five perday and their hour of exercise eachday and cut down on the fizzy drinks,the crisps and the burgers and chips.”

Whilst this may sound like a daunt-ing task Hancock reveals there are sev-eral subtle ways of encouragingchildren to increase their exercise lev-els. “The main thing parents need to

bear in mind is there’s no point tellinga child to eat healthily and exercise orthey’ll fall ill in 40 years time, it’s justtoo far off,” she warns.

“There’s also no point in being unre-alistic and expecting them to go to agym five days a week. It’s all about en-couraging them to do what they like. Agood starting point is walking or cyclingto school and then encouraging them totake part in sport. There’s a particularproblem for teenage girls because theygo through a stage of not wanting torun around and getting sweaty, so whynot encourage them to take danceclasses? And if kids claim to not likefruit and vegetable why not get ablender and make smoothies?”

All round improvementOxHA is keen for this message to getthrough to schools so that the impor-tance of nutrition and exercise is taughtto children and teenagers so they im-

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prove their own health and, one couldreasonably assume, they could thenchampion the cause at home, just asyoungsters have in pressuring parentsto stop smoking.

"We have colleagues who have donesome work in schools to help teachersrealise that healthy eating and exercisewould have a massive impact beyondthe children’s health”, she says.

“All the studies indicate that whenchildren are eating healthily and aretaking regular exercise their attentionspans increase and disruptive behaviourdecreases. We really think that if teach-ers were aware of the dramatic im-provement they would readily take alead role in teaching the importance ofhealthy eating and exercise.”

A very simple first step is, when pos-sible, walk children to school and intro-duce fresh fruit and vegetables at mealand snack times. At present less thanhalf of school children walk to schooland only half will eat a single portionof fruit and vegetable in a week. Mostworryingly, less than ten per cent ofschool children eat the five portions offruit and vegetables per day and take thehour’s daily exercise which OxHA is ad-vising is necessary if the country is toavoid sky high rates of type 2 diabetesin the near future.

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Diabetes Youth CharterLIVING WITH DIABETES

Youth CharterJust ahead of World Diabetes Day, which this yearfocuses on youth, Novo Nordisk and the InternationalDiabetes Foundation (IDF) published the DiabetesYouth Charter to help raise awareness of the worryingincreases in the incidence of type 1 and type 2 diabetesamong children and adolescents around the world.

The Youth Charter is described, in part,as an ‘advocacy tool’ to help raiseawareness of how the global epidemicof diabetes is affecting young peoplearound the world, calling on decisionmakers, health professionals and gov-ernments to work together on improv-ing treatment for diabetes as well asformulating strategies to combat stag-gering increases both types of diabetesin young people.

Whilst the Charter’s authors pointout that sufficient data is not avail-able for detailed global statistics, thereport points out that diagnosis oftype 1 diabetes would appear to berising at a rate of four per cent andthat, in particular, IDF figures showthat the rate of toddlers, under the agefour, being diagnosed is increasing.

Whilst the vast majority of childrenand adolescents are diagnosed with type1 diabetes, the report points out large in-creases in the incidence of type 2, whichis being largely attributed to poor dietand lack of exercise among the young

people affected. In particular, the Charterdraws attention to Japan experiencing a30 fold increase in young people devel-oping type 2 over the past 20 years andin Western Australia the incidence oftype 2 in young people increasing by 27per cent between 1990 and 2002.

Partnership approachAs well as drawing attention to the ef-fect on young people of the current di-abetes epidemic, the Diabetes YouthCharter calls for decision makers aroundthe world to develop care strategies thatwill help ensure that young people withdiabetes receive treatment and thatmeasures to help reduce the incidenceof type 2 diabetes are put in place, suchas better education for families aboutthe need for a nutritious diet and regu-lar exercise.

One of the major rallying calls the Di-abetes Youth Charter makes, Lise Kingo,executive vice president of NovoNordisk, is for developed countries tohelp assist developing countries.

“The Charter really points out howthere is a need for partnership if weare to tackle this global problem,” sheexplains.

“The developed nations need to workalongside the developing nations to helpthem tackle the global epidemic in dia-betes.”

This is not to suggest that the devel-oped nations hold all the answers be-cause the Diabetes Youth Charter pointsout there is still much work needed tobe done to help young people with dia-betes get the best treatment.

“There is still a lot more than can bedone in every country to help reduce theincidence of type 2 diabetes by encour-

aging children to eat well and take reg-ular exercise,” Kingo adds.

“There is also a great deal more workto be done tackling the psycho-social is-sues around youth diabetes, so children,adolescents and their families are of-fered counselling and support that goesbeyond the medical treatment for the di-abetes itself.

Education keyThe IDF and Novo Nordisk hopes thatthe Diabetes Youth Charter will helpmotivate decision makers in healthcaresystems around the world to do morefor children and adolescents with dia-betes by improving access to treatment

and educating young people, and theirfamilies, on how to better manage theirlevels and how a healthy lifestyle candramatically reduce the likelihood of ayoung person developing type 2 dia-betes now and in the future.

Dr Henk-Jan Aanstoot, chair of theDiabetes Youth Charter used the launchof the document to stress how importantit is for both developed and less-devel-oped countries to do their best to react tothe effect on young people which theglobal epidemic in diabetes is having.

“More has to be done to diagnosediabetes in children in a timely man-ner and give them adequate diabetescare,” he urged.

“For many children, particularly inthe less-developed world, the diagno-sis of diabetes is still a death sentence.The family simply does not have themoney to allow their child to be treatedwith insulin and thereby save thechild’s life. Even in the developedcountries, children with diabetes inpoor control live 10-20 years shorterthan their peers.”

IDF president Martin Silink also usedthe launch of the Diabetes Youth Char-ter to stress the point that “access to di-abetes care, especially for children andadolescents, is a human right whichshould no longer be ignored. Actionmust be taken now to prevent theneedless deaths of children in both de-veloped and less developed nations.Governments should prioritise child-hood diabetes on a par with HIV/Aids,tuberculosis and malaria”.

Quality of life is usuallyabout getting back to normalRight treatment and right information top diabetes patients’ wish lists

It may come as a surprise but accordingto two patient bodies who have cometogether to determine what patients pri-oritise when they talk about quality oflife, most surveys which attempt tomeasure the term are normally drawnup by clinicians or hospital staff withoutmuch, if any, patient involvement.

This has prompted Alex Wyke,founder of patient body, Patient Viewand Simon Williams, director of patientgroup communications company To-gether4Health to join forces to ask pa-tients what they consider to be the mostimportant factors concerning quality oflife. The resulting QALYity report isbeing published this month with themain finding, Wyke sums up, that whatpatients regard as important to theirquality of life can vary from one condi-tion to another.

Right treatmentMost interestingly, with diabetes, ascompared to other conditions, such aschronic fatigue syndrome and multiplesclerosis, among others, patients (whowere mostly living with type 2, ratherthan type 1 diabetes) prioritised gettingthe right treatment, getting the right in-formation and leading a normal life astheir top three concerns.

“The health system is very techni-cally orientated and so it’s good atmeasuring technical things, such ashow a particular treatment works butit’s not good at finding out how pa-tients feel about their overall treat-ment,” she says.

“Priorities vary by age, region andfrom one condition to another but themajor finding for diabetes was thatalthough one would imagine that a

‘GP who listens’ would be a top pri-ority, it’s quite low down the list. Peo-ple with diabetes just want the righttreatment and the right informationso they can get on with their lives andmanage their condition to the best oftheir ability.”

Back to normalIf the research shows up one majorfailing, across all the conditions sur-veyed, it is that the patients want theone thing which Wyke believes thehealth system is not set up to provide.

“The NHS will measure satisfactionwith particular treatments and accessto treatment but the overriding thingpeople want is a return to a normallife,” she says.

“They want to rejoin society and beproductive, they want to get back to

work but they’re mainly relying on theirGP who can’t always provide that be-cause it’s not what they’re there for.

“I think people need the equivalentof a personal trainer that can helpthem get back in to work and advisethem on many social issues. Some-body might want to know if theywere legally sacked for spending toomuch time off work when they wereill or, no doubt a common one forpeople with diabetes, is whether aperson can expect an employer toallow them to spend time at the doc-tor’s and diabetes clinics or do theyneed to take that time off as leave?”

Whole processSimon Williams agrees and likensmost patient research to a speed cam-era that flashes on just one spot of a

lengthy treatment journey. He alsobelieves that the QALYity report willallow medical professionals to tailorfuture studies of patient care aroundquestions that are of the greatest im-portance to patients.

“We need to get away from treat-ment quality research just focussingon one part of a treatment and con-centrate on the patient, we need tolook at the whole patient and not thatperson at just one stage,” he says.

“We need patients to have a voicein what they get asked to ascertain iftreatment has been successful becauseGPs and hospital staff need to knowthat patients want their progress to bematched against a desire to get backto a normal life. Without this realisa-tion there could be a risk some re-search is done to ensure the rightboxes are ticked and a departmentlooks like it has done well yet the pa-tient’s whole journey through a vari-ety of treatments has not beenmeasured against how well it has al-lowed them to return to a normal lifeand get back to work.”

The research is being launched thismonth with the hope it will help in-fluence future survey of patient satis-faction.

A healthy, balanced diet plays a crucial part in avoiding type 2 diabetes

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Discovery Health Channel Documentary LIVING WITH DIABETES

Diabetes questions answered

What causes diabetes?

Type 1 diabetes, which is diagnosedin children and teenagers is heredi-tary and is the result of the body’s im-

mune system attacking the ‘islets’cells in the pancreas which create in-sulin, the hormone which helps con-vert sugar, or glucose, in the blood into energy. We do not know why the

body turns on itself in this way butthe result is to leave a person de-pendent on insulin injections for therest of their life.

Type 2 is normally diagnosed in

people in their middle ages and older(although, alarmingly, it is starting tobe seen in children too). This is wherethe pancreas’ ability to produce suffi-cient insulin decreases, requiring, inthe first instance, pills to be taken toboost insulin production and help thebody make the most of what insulinthere is available to it.

Type 2 can be genetic but it is be-lieved the majority of cases are causedby poor diet and lack of exercise.

Is being moved on to insulin a badthing?

All too often people living with type2 diabetes can feel that they have letthemselves down when a doctor de-cides to move them on to insulin in-jections, but this is wrong. Diabetes isa progressive condition and so thepancreas’ own output of insulin canonly be stretched so far before insulinis required. The good news is, al-though insulin injections can be

wrongly thought of as a failure tocontrol levels, patients may find iteasier to manage their levels oncethey are established on an insulinregime that works for them and manywill feel healthier because towards theend of oral therapy some patients canbe living on very low levels of natu-ral insulin.

Do people with diabetes need to havespecial diets?

This used to be a common belief butthe latest medical advice, from bodiessuch as Diabetes UK, is that if receiv-ing the correct medical care, a personwith diabetes need not avoid all foodcontaining sugar at all times.

What is key, however, is that a per-son with diabetes maintains a healthydiet and exercise regime and so avoidjunk foods which are high in sugarand fat content. However, this adviceis just as apt for people without dia-betes, particularly those who wish tofollow medical advice and reducetheir risk of developing type 2 dia-betes by eating five pieces of freshfruit and vegetables daily and takinghalf an hour of exercise every day.

Diabetes put in to itsglobal perspectiveWith diabetes representing a major global epidemic it may come as a surprise thatDiabetes: A Global Epidemic, to be aired on Discovery Health channel on Sunday isbelieved to be the first documentary to tell the story of the chronic condition fromevery continent (excluding the Antarctic).

The film crew wanted to ensure theycovered the effects of diabetes on cul-tures around the world to underline,what John Whyte, vice president of Dis-covery Health, claims is its overridingconclusion; a single Western approachwill not suit a global epidemic.

“The cultural differences are as-tounding even though type 2 diabetesis largely being caused by the sameproblems everywhere, too many calo-ries going in and not enough beingused up,” he explains.

“In South Africa we found thatpeople do not mind becoming over-weight because it shows they don’thave AIDS, so it’s seen as a sign ofgood health to be carrying toomuch weight. It’s similar in Indiawhere we filmed. There it’s seen asa sign of wealth to be overweightand doctors tell us when they startto get men on a healthy diet andlosing weight their wives complainthey look thin and unhealthy.”

Unhealthy aspirationsHence the Discovery Health teamfound that the first import to any In-dian village that is becoming moreaffluent is always fizzy drinks.When western doctors tell locals theeffect over consumption will haveon their health they point out thatother countries have had thesedrinks for years so now they are richenough, so too should they.

A similar message became evidentwhen the film crew visited Braziland found that people do not reactwell to North American or Europeanhealth messages.

“You just can’t say to Latin Amer-ican people go down the gym be-cause it’s just not something theydo, it’s not in their psyche, it’s notpart of their culture,” explainsWhyte.

“So, the solution is to encouragedancing, which is central to theirculture. It’s an example of how you

can’t expect a global problem to betackled by a single solution.”

The film crew found that just asdiabetes can be viewed in differentways by different cultures, the ef-fects of the epidemic can also varyfrom one country to another, partic-ularly among the young. In SouthAfrica Whyte reveals the film crewfelt incredibly touched by the plightof young people with diabetes.

“They end up living in a clinicwhich basically doubles up as an or-phanage, it’s terribly sad,” he reflects.

“The problem is the parents cannotafford insulin and there’s not alwaysa way of keeping it cold so the chil-dren are just forced to stay at theclinic if they want to keep getting in-sulin.”

The timing of the UK broadcast ofthe show has been set to coincidewith the ending of Diabetes Week at8pm on 22nd November, followingWorld Diabetes Day on the 14th. Obesity is leading to alarming rises in the incidence of type 2 diabetes

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Research for types 1 & 2LIVING WITH DIABETES

There are two types of diabetes, type 1 and type 2.Type 1 is a genetic condition through which, for anunknown reason, the body’s immune system attacksthe pancreas, preventing it from producing insulin, thehormone which breaks down glucose in the blood. Thisleaves patients, who will most normally be diagnosedduring their school years, with only one treatmentoption, regular insulin injections.

Whilst there are a small, yet grow-ing, number of children who arebeing diagnosed with type 2 dia-betes, it is essentially an adult con-dition caused primarily by poor dietand exercise, leaving the pancreasstruggling to produce enough in-sulin. Initial type 2 treatment nor-mally consists of a variety of pillswhich are designed to boost theproduction of insulin and help thebody make the most of what insulinis available to it but ultimately thevast majority of people living withtype 2 will need to move on frompills to regular insulin injections.

No ‘right’ optionAs with many shifts in treatment,there is not an accepted means ofestablishing the best time ormethod through which to move apatient on to insulin and so NovoNordisk has funded research com-paring the three major insulin treat-ment regimes GPs are likely toprescribe (and which will normallybe combined with the patient’s pillsfor the first, transitional period).

The three options start off a sin-gle, daily ‘basal’ insulin injection,which acts as a background dosedesigned to last the day or three‘prandial’ injections taken beforeeach meal or, as a final option, twodaily basal injections with anamount of prandial insulin mixed.

By assessing how more than sevenhundred patients across the UK andIreland respond to one of the threetreatment options, Peter Stella, a med-ical advisor at Novo Nordisk, hopesdoctors will be provided, for the firsttime, with evidence to suggest whichmay be best for each patient’s indi-vidual needs.

“Type 2 diabetes is progressive sothe vast majority of people with thecondition will need to progress to in-sulin treatment, yet doctors have noscientific research into the relative ef-fectiveness of the three main optionsavailable to them,” he says.

“The result is that it is normallydown to each doctor’s own experi-ence, so we designed the 4T study toaid them in making the decision.”

First year feedbackThe study is one year through itsthree year course and already the ini-tial results have been released by theresearchers involved. No conclusionscan be drawn, as the study is only athird of the way through, but thereare already some clear findings whichStella has been encouraged by.

“The most important point is thatall three therapy options improve apatient’s control,” he says. “How-ever, it seems that with one singleinsulin preparation it is difficult toachieve the ideal level of blood glu-cose control.

“The prandial and the mixture ofprandial and basal therapy appears tobe having the more favourable effecton lowering blood glucose levels butthe basal only route is proving verypositive results as well. People aregenerally unhappy about having toinject themselves when they firstmove on to insulin, so the fact thatonly one injection per day as an ini-tial insulin treatment can work effi-ciently in the majority of them is animportant finding. The people onbasal therapy are also putting on lessweight and we’re also noticing that itis better at avoiding low blood sugarlevels, factors which are the majorfears for patients when insulin treat-ment is started.”

“All three therapyoptions improve apatient’s control”The next step for the research, over

years two and three, is to investigatewhich treatment options are best oncea person receives a second insulinformulation added to his initial in-sulin treatment.

Another important point to bear inmind is that throughout the first yearof the trial, physicians aimed tomimic the frequency of contacts whatpatients usually experience in pri-mary care setting. This is fundamen-tal to ensuring the researchers getresults which are realistic to achievein day-to-day clinical practice.

Due to type 2 diabetes being progressive, most patientswill need to be moved on to insulin at some stage. Ofcourse, for people living with type 1 diabetes, there is noinsulin production to be boosted and so insulin injectionsare the only treatment option.

Traditionally insulin used to be sourced from animals buttoday nearly all people taking diabetes will be offered humaninsulin which has been produced in a laboratory. The obvi-ous benefit is that human insulin is a more natural medicineto take than animal insulin, although that is not to say thatsynthetic ‘human’ insulin is without its drawbacks.

Although it may appear exactly like insulin to the body,the problem is it is not produced in the pancreas but insteadartificially injected under the skin. Due to insulin being a‘sticky’ fairly large molecule, this can lead to delays in it en-tering the blood stream and means it is not as well absorbedas insulin created normally within the pancreas.

Less ‘sticky’ Hence the latest development in insulin is what aretermed ‘modern’ insulins. These are made by severalpharmaceutical companies and, in effect, they are the

Working faster for longer: Modern insulinsFor people living with type 2 diabetes, initial treatment will normally be pillsthat are designed to boost the amount of insulin the body produces and to makesure the body gets the most from what insulin is produced.

Researchers are trying to establish how best to move type 2 patients from pills to insulin injections

same as the human insulins that are most normallyprescribed today but their make-up has been slightlyaltered to allow them to less ‘sticky’ and so fasteracting in the body.

The premise is that people taking injections of in-sulin before each meal have normally had to guesswhen their food is half an hour away but, of course,they do not always know, particularly when eatingout. With insulin that is faster-acting, the injectioncan be taken shortly before eating, taking the guesswork out of when a meal may be served.

For long lasting ‘basal’ injections, it is also be-lieved that modern insulins can be effective at asteady rate over long periods, reducing the risk ofblood sugar levels going up and down, particularlyovernight when people living with diabetes are mostprone to going hypoglycaemic through low bloodsugar levels. The one down side, for doctors pre-scribing drugs, is that modern insulins are a littlemore expensive than previous insulins because ofthe large research and development costs incurredin their development.

Research compares insulin treatment

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Patient Story LIVING WITH DIABETES

From the jungle to thepoles, diabetes neednot hold you backFor many young people diagnosed with type 1 diabetes the news can bedevastating but anybody wondering whether they can still lead a full life need lookno further than Katrina Scott. As she begins her second year studying physiotherapyat Birmingham University she is living proof there is nothing to stop a youngperson living with diabetes enjoying themself to the full and remaining active.

In fact, Katrina has been on expedi-tions to the Arctic and Antarctic, hasworked with disabled children inUganda and in her everyday life lovesto play hockey, go swimming anddance the night away. The crucialthing, she maintains, is to plan aheadand keep to a regime of regular in-sulin injections, finger prick bloodglucose checks and to ensure friends,family and colleagues are familiarwith the condition so they can offerhelp if needed.

Early diagnosisKatrina’s mother is a nurse and sosuspected her daughter had diabeteswhen she was just four.

“I was losing weight and constantlydrinking and passing urine,” Katrinarecalls. “My mum was worried I wasdrinking too much and would say I’dhad enough to drink but then she’dfind me drinking from the tap in thebathroom. I was lucky she recognisedthe signs and had me diagnosed. It’smeant I’ve lived with diabetes formost of my life, which I think is prob-ably easier than suddenly being diag-nosed in your teens.”

For fellow students, or first-timejobbers who have, or are about to,leave home, she has some usefulwords of advice. “Never keep yourcondition to yourself, it’s not a secret,

the more your friends know about dia-betes, the more they can help you andthe less frightened they are of it,” shesays. “People often don’t realise howimportant it is for someone with dia-

betes to have a biscuit or cereal bar tohand in case their blood sugar leveldrops. It’s all too easy for housematesto come home from a night out andscoff your emergency supply – I alwayskeep biscuits and sweet drinks in myroom so they’re safe! Telling yourfriends means they know what to do ifyour blood sugar levels go awry whenyou’re out dancing. My friends aregreat and they know if I start to lookdazed or wobbly that I’m going hypo(low blood sugar) and they need to giveme a sweet drink. If they didn’t knowthe signs, they might think I’d had toomuch to drink and ignore it and I wouldbecome unconscious.”

ExpeditionsKatrina has always led an active life andhas coped with diabetes at the two ex-tremes the planet can offer – the PolarRegions and equatorial Uganda. Katrinaneeds to inject insulin four times a day.Extremes of heat or cold make insulinineffective.

“In Africa with the problem of heat Iwas lucky there was one fridge in thevillage where we working at a school fordisabled children,” she says.

“When we travelled I had to put myinsulin pens in a mini cool bag”.

In Antarctica, Katrina trekked to thebase camp used by a father and sonteam who were walking to the SouthPole to raise money for diabetes re-search.

“Here I had the opposite problem. Tostop my insulin from freezing, I had tohave it strapped to my body to keep itwarm. Because of the cold and extremeactivity, I had to eat alot more than nor-mal therefore I had to keep checking myglucose levels, which meant taking aglove off to prick my fingers, whichwere freezing! I also adapt my insulinregime significantly to cope with theconditions.”

At the age of 17, three years afterher Antarctic trip, Katrina took partin an expedition to the Arctic. “While

trekking through freezing cold, slushyglacial rivers I had to try to stop myblood glucose meter getting wet”, sherecalls. “I kept it in a dry bag, how-ever, to keep it totally dry proved im-possible, so as soon as the camp stovewent on I’d dry it out.”

She monitored the responses theharsh environment had on her bloodsugar and other physiological meas-urements and compared them withthe non-diabetics in the team. Shefound that her glucose levels couldrise and drop to far greater extremesthan her colleagues.

Keeping sportyNow back at college, embarking onthe second of a three-year degreecourse, Katrina is determined to com-bine her profession with her passionfor the outdoors and sport.

“It’s so important you don’t let di-abetes run your life for you,” shesays.“Once you understand your ownbody and how it reacts to activity youplan accordingly. For example, beforeplaying a game of hockey, I eat asnack and check my blood sugar lev-els at half time and after the match.It’s the same with going out clubbing.Although I don’t drink to excess I stillhave as much fun as my friends, theonly difference is I have to keep acheck on my blood glucose levels andstock up with bar snacks! I also makesure my friends have a key to myroom so if my blood sugar is very lowover night they can give me a sweetdrink or food to help me wake up andrecover.”

The clear message from Katrina isthat if young people living with dia-betes are careful and plan ahead tomanage their blood glucose levels andtell friends, colleagues, teachers andtutors about the condition, they neednot feel held back from living a fulland active life, even if their travellingtakes them to the icy extremes of thePoles or the heat of the African jungle.

Lessons in diabetes offered for UK schoolsStatistically most schools will have at least one pupil with type 1 diabetes yet it isunlikely most pupils will know what causes the condition and how best to help outa friend who looks like they may be about to suffer a ‘hypo’.

Hence the Juvenile Diabetes ResearchFoundation (JDRF) has recentlylaunched its Classroom Toolkit whichit hopes will improve both pupils’ andteachers’ understanding of the condi-tion and help young people livingwith diabetes to feel supported byclass mates.

“The tool kit is designed along thenational curriculum to fit in with keystages 1 and 2 and comes with lesson

plans to help explain diabetes,” ex-plains JDRF’s CEO Kate Addington.

“It’s got scenarios the children canrole play with in a classroom to helpthem understand what to do if afriend who has diabetes goes wobblyin the playground, and other situa-tions.

“It’s also packed with useful infor-mation on nutrition and has exerciseguides, with 60 different exercises, so

children are aware of how they canreduce their chances of developingtype 2 in later life.”

Artificial pancreasThe JDRF has also recently been buoyedby encouraging early results from a pro-gramme it funds to develop an artificialpancreas by linking an insulin pumpand a blood glucose monitor. The idea isthat, if future more detailed trials are

successful, a person living with diabeteswould never need to inject themselveswith insulin again. Instead the meterwould feed blood glucose readings to aninsulin pump which would inject the in-sulin via a small tube.

“In the UK we’re funding the workto come up with a computer algo-rithm which will link the two piecesof kit to act like the brain, decidinghow much insulin needs to be in-jected automatically by the pump,”Addington explains.

“We’ve only had very early feedbackon the research and it seems to be goingvery well, although obviously proper

clinical trials will need to be held beforewe know if it works. At the moment,though, it appears to be particularly use-ful in helping combat the highs andlows in blood glucose levels that canoccur when people are sleeping.

“Although we’re a foundation set upto help find a biological cure, this me-chanical cure would be a real help to alot of people, if it is proven to work.”

This will rely on clinical trials as well,Addington points out, as researchersmanaging to combine the glucose meterand insulin pump into a small unit thatcan be more comfortably worn by itseventual users.

Katrina has not allowed diabetes to get in the way of polar expeditions

Aprt

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Awareness LIVING WITH DIABETES

World Diabetes DayWorld Diabetes Day is a poignant reminder that diabetes is a global epidemic thatcan hit hardest in developing countries who may not yet have rolled outcomprehensive education programmes to raise awareness of the condition and, fortype 2 diabetes, pass on health tips to aid prevention.

Among many campaigns around theworld, the World Diabetes Foundationhas been working in China and India tohelp raise awareness how changinglifestyles can lead to people becomingoverweight and dramatically increasetheir risk of developing type 2 diabetes.

In keeping with the youth theme ofthis year’s World Diabetes Day much ofthe work has involved working withyoung people so they realise that theless healthy diets that often accompanyrising economic prosperity can raise thelikelihood of developing type 2 diabetes.

By preventing diabetes (and other re-lated risk factors such as obesity andhypertension) complications such as

heart attacks, paralytic strokes, blind-ness, kidney failure and limb amputa-tions can also be prevented.

“WDF has funded several projectsthat are directed at raising communityawareness and health promotion as partof the prevention strategy. A strong pre-ventive approach targeting young peo-ple and the general population willincrease the chances of slowing the di-abetes pandemic, particularly in soci-eties such as India and China that areundergoing rapid economic transition”,explains Dr Anil Kapur, managing di-rector of the WDF

“The WDF currently supports twomajor health promotion and preven-

tion projects in India. These projectsaim to develop a comprehensive sus-tainable model involving lay people,school children, parents, healthcareworkers, primary healthcare centres,NGOs and development groups in acollaborative effort to promotehealthy living and to pass on knowl-edge through the school curriculum toencourage change in the living be-haviour at home and in the schools.”

The projected outcome of these proj-ects will have an estimated impact ofeducating 160,000 school children,8,000 school teachers and 8,500 parents.

Work in ChinaA similar health promotion projectin China aims to provide advocacythrough school interventions,media communication and trainingof healthcare professionals andlifestyle consultants. The projectedoutcome of the media awarenesscampaign will reach out to 1.94million people. Approximately2,000 healthcare professionals from690 primary care units will betrained in identifying high risk in-dividuals and providing properguidance on behavioural modifica-tion to prevent type 2 diabetes.

Raising awareness of diabetes is cru-cially important because the WDF hasfound that in the Qingdao area in China,where it is working, only one in fiveurban people and one in ten ruraldwellers are aware of the chronic con-dition. Raising the level of awareness,

Facts• 1.6 billion people in the worldare overweight or obese• Obesity and being over-weight are major risk factorsfor type 2 diabetes• By 2015, it is estimated 2.3billion adults will be over-weight and more than 700mwill be obese• Ten per cent of childrenaround the world are estimatedto be overweight or obese• People are eating food that ishigh in saturated fats and sug-ars at the same time as increas-ing urbanisation and sedentarylifestyles mean people burnfewer calories each day

Model GroupAny groups concerned by the current thinking on anyparticular medical issue can sometimes be accused ofrepresenting a minority interest, no matter how validthe issues they raise.

It was for this reason that the ModelGroup was formed to give the generalpublic and health decision makers aguide to diabetes which also called fora more open debates on treating thechronic condition.

The group included representa-tives from diabetes specialists, pri-mary and secondary healthcaredecision makers, GPs, nurses andpatients groups, among many oth-ers. Whilst the report the groupproduced this year Diabetes: Find-ing Excellence? can be used as aguide for anybody who wishes toknow more about the condition, thechairman of the Model Group, Pro-fessor David Matthews, chairman ofthe Oxford Centre for Diabetes, En-docrinology and Metabolism(OCDEM), points out it also call for anopen debates on diabetes treatment.

“When I launched the report at theHouse of Commons I joked that one el-ement of it was to be like a Rupert Bearannual in that anyone could pick it upat any time and look at the graphs andthe captions to get a quick view of di-abetes and its effects,” he reflects.

“Further to that though there is alot of heavily researched text whichraises some very serious issuesabout how we treat diabetes.”

Better fundingThe major concern Matthews and hisfellow Model Group’s representativeshave with current NHS thinking isthat the treatment of diabetes is beingunderfunded because it is a ‘quiet’area which will not generate negativepublicity.

“The problem with diabetes is it’s asilent disease, you don’t get people onlong surgery waiting lists or dying ontrolleys in A&E,” he says.

“The problem withdiabetes is it’s a

silent disease, youdon’t get people onlong surgery waiting

lists or dying ontrolleys in A&E”

“It means it’s an area where sec-ond healthcare decision makers cancut costs by pushing patients to pri-mary care and nobody in the gen-eral public really notices becausethere’s no surgery target that eitheris or isn’t being met.

“We agree that nine in ten diabetespatients can be treated perfectly well bya GP but the problem is that the one inten who do need access to a top qualityclinic at a hospital is not always thesame one in ten, it varies as peoplemanage their levels and then at anotherstage may need extra support.”

Ultimately Matthews and the ModelGroup argue that diabetes funding insecond care can be cut because the ef-fects are not immediately noticeable.

“You could close every diabetesclinic in the country tomorrow andyou wouldn’t see an immediate ef-fect,” Matthews adds.

“Give it four or five years thoughand then there would be a massivecost as people turn up at hospital withstrokes, heart attacks, renal failure,going blind and needing amputations.So it’s an easy short term view to takeand we think that there needs to be amore open debate. I’m not totallyagainst targets but one has to balancethis with the simple fact that if wespent money early on with diabetesyou can save alot of money furtherdown the road by preventing the as-sociated complications that arisewhen it’s not properly dealt with.”

Model youthAs far as treatment of diabetes amongchildren and teenagers Professor DavidDunger, Professor of Paediatrics at Uni-versity of Cambridge, Addenbrooke’sHospital believes the government islargely on the right wavelength.

“I think there is a lot more concernamong Model Group members fortreatment of adults than there is forthe youth,” he says.

“The government is suggesting thatregional centres of excellence should beset up to help treat children andteenagers who, of course, are totally in-sulin dependent, unlike many adult,type 2 patients. The idea is that peoplefrom a regional centre of excellencecould help train people in their localityand they would be there for the morechallenging young patients who arenormally the minority but they can takeup the majority of work, particularly ifthere are complications, such as avoid-ing insulin for fear of putting on weight.

“So I think the government islargely thinking in the right way, the

obvious questions now are whichcentres will be the areas of excellenceand how will they be funded.”

Whilst these questions remain to beanswered it is the hope of the ModelGroup that the Diabetes: Finding Excel-lence? report will serve as a guide to thechronic condition and help the public,politicians and healthcare professionalsgarner a better understanding of thechronic condition and open up a thor-ough debate as to whether today’s sav-ings on medical treatments, such asdiabetes clinics in secondary healthcare,could lead to major problems andgreater expense further down the line.

The Model Group gives all those involved in diabetes care a voice

the foundation believes, can only helpreduce the growing prevalence of dia-betes in an area where 7.5 per cent ofthe population has diabetes.

changing diabetes

change diabetes – unite on 14.11.07 www.diabetesbus.novonordisk.com

change

Diabetes can affect anyone, anywhere at anytime.

At present, there are some 246 million people around

the world with the condition. That number is expected

to grow to more than 380 million people by 2025.

We must act now to defeat this silent killer.

unite

On 14 November 2007, the world will unite and address

the devastating consequences of diabetes. It can be

controlled and even prevented. Learn how and what you

can do to change the future of diabetes. Join Novo Nordisk

in supporting and implementing the United Nations

Resolution on diabetes and in creating awareness this

World Diabetes Day.

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World Diabetes Day LIVING WITH DIABETES

World Diabetes Dayis marked aroundthe world

The first World Diabetes Day will be marked around the world today by a widevariety of events, including the London Eye and the Empire State building beingilluminated to appear blue, the colour synonymous with the campaign to get a dayfor diabetes recognised by the UN.

The first World Diabetes Day will bemarked around the world today by awide variety of events, including theLondon Eye and the Empire Statebuilding being illuminated to appearblue, the colour synonymous with thesuccessful campaign to get a day fordiabetes recognised by the UN.

Celebrations will be centred on NewYork, home of the United Nations whichagreed with campaigners that diabetesis a chronic condition that places strain,not just on people living with the dis-ease, but also society as a whole.

Hence the Novo Nordisk ChangingDiabetes bus will be in New York as partof its five continent tour, helping to raiseawareness of diabetes, its symptoms, itstreatment and, with type 2, the stepsthat can be taken to avoid it.

Keeping momentumWhilst these will be very public actdrawing attention to the global epi-demic of diabetes, medical healthprofessionals have been workinghard to ensure that now there is aWorld Diabetes Day the central rea-son for it being officially recog-nised by the UN is acted on.

“The support for this Resolutiondemonstrates that all nations haverecognised the severity of the world-wide diabetes pandemic and havecommitted to urgently dealing withthis. In this way, nations have ac-knowledged that the access to diag-nosis, prevention and proper care ofdiabetes constitutes a human rightwhich should no longer be violated,”says Lars Rebien Sørensen, CEO andpresident of Novo Nordisk.

It was for this reason that the phar-maceutical company helped to organ-ise, in March, the first GlobalChanging Diabetes Leadership Forumwhere 185 medical health profession-als from more than 20 countries con-gregated to discuss ways forward intackling the alarming worldwide risein diabetes through better diagnosis,treatment and prevention strategies.

Barometer of changeAt the Forum, Novo Nordisk agreed thata Changing Diabetes Barometer willmeasure and share the worldwideprogress in the fight against diabetes onan annual basis around World DiabetesDay. To support the Changing Diabetes

Barometer, Novo Nordisk will, on an an-nual basis, publish a report with keyfindings from the Barometer.

“The Barometer is a tool that willprovide healthcare professionals, pa-tient organisations, politicians, institu-tions and media with valuableinformation on how to improve thequality of diabetes care, bring downdiabetes related complications, extendpatients’ life expectancy and reducecosts.” says Lise Kingo, executive vicepresident of Novo Nordisk.

In keeping with the theme for theinaugural World Diabetes Day, NovoNordisk has also recently publishedresearch from its DAWN (Diabetes At-titudes, Wishes and Needs) Youth pro-gramme which looked at thepsycho-social issues surroundingchildren and adolescents, as well astheir families. The report points outthe widely-accepted need for youngpeople, and their immediate family, tobe offered better medical support, di-abetes care at schools and, where nec-essary, counselling so the familygroup can help the family membercontrol their blood glucose levels tothe best of their ability.

This mental strain of coping with di-abetes can lead to depression, anxietyand stress as patients battle to keeptheir blood sugar levels under controlbecause, even though half of all peo-ple with diabetes admit to havingproblems controlling the condition,the majority will always blame them-selves and feel guilty they are notmanaging their condition better.

Hence studies have shown thatpeople with diabetes are two to threetimes as likely to suffer from depres-sion which, when combined with theincreased anxiety of managing theircondition, ensures the symptoms areworse that those suffered by a personwith depression but no diabetes.

Little helpHowever, very few people living withdiabetes are offered psychological as-sistance or counselling and, accord-ing to Soren Skovlund, head of theDAWN programme, which aims toraise awareness of the psycho-socialissues surrounding diabetes, this canhave a very hard impact on childrenwith the condition, and their families.

“We are working to raise awarenessthat with diabetes the whole family isthe patient and medical health pro-fessionals need to be aware of the is-sues that can cause young peoplewith diabetes to skip injections or be-come depressed,” he says.

“The classic example is where chil-dren think their parents are naggingthem and so rebel, yet the parentshave this huge anxiety every day theywave a child off for school that theycould go hypo at any time and theywouldn’t be there to help out.

“So there’s a huge role for coun-selling for the whole family, particu-larly in the UK. We’ve carried outstudies in many countries and it’s fairto say the UK suffers the most fromthis inter-family conflict that can leadto children missing injections. This isa huge problem. In recent interna-tional research 90 per cent of the chil-dren questions admitted to skippingat least one injection per month.”

When dealing with young people

Diabetes bringsincreased risk ofdepressionAlthough diabetes is a condition caused by thepancreas not producing enough, or any, insulin, someof the largest health challenges it can pose for patientsare mental as well as physical.

with diabetes DAWN is also workingto show doctors and nurses that al-though there are a lot of alarming sta-tistics surrounding the globalepidemic of diabetes, it is very impor-tant to give the youth a positive mes-sage. Young people, the project’sleaders have found, react mostfavourably to hope and positive helpin showing them that although theyhave an, as yet, incurable condition,there are effective strategies to ensurethey can lead a full life.

Not costlyOne of the problems with mentioningcounselling is that health authoritiescan be afraid that making a positivestep towards tackling psycho-socialissues will bring large demands on fi-nite resources.

However, the clear message fromSkovlund is that, at its simplest level,taking on board these extra issuesand hopefully dealing with them sothey do not develop into mentalhealth problems does not necessarilyrequire large increases in expenditure.

“Most of the time it is more aboutreorganising a clinic and offeringsome extra training to staff,” hepoints out.

“There are 12 centres across Europewhich have shown you can look atthe psycho-social side of diabetesthrough better training and use of ex-isting resources. Staff can be trainedto help work with a family to helpthem come to terms and deal with achild’s condition and they can also betrained to look out for and spot thesigns of depression.”

The alternative, Skovlund pointsout, is to ignore the tensions withinfamilies affected by diabetes and notto consider mental health issues whentreating people with diabetes. This,however, as experience is showing,simply leads to people needlessly suf-fering as their relationships arestrained and they feel guilty aboutnot managing their condition better -a destructive cycle which doubles ortrebles the likelihood of a person withdiabetes suffering from depression.

The London Eye is expected to be illuminated in blue tonight to mark World Diabetes Day

the charity that caresabout people withdiabetes

www.diabetes.org.ukRegistered charity no. 215199

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Education Packs LIVING WITH DIABETES

Diabetes UKSchool staff could prove an immense help to familieswith children living with diabetes with just a smallamount of extra training, according to Diabetes UK,which recently began distributing education packs toschools to raise awareness of the condition.

The literature is designed to encourageschools to consider having a person re-sponsible for ensuring that childrenwith diabetes are monitoring theirblood glucose levels and keeping totheir required insulin injections. For theyoungest of children, the charity alsohopes school staff could be helped tobecome confident enough to administerinsulin doses.

“Ultimately the long term aim wouldbe to get back the school nurse,” ex-plains Mike Hales, marketing director ofDiabetes UK.

“It’s such a shame they don’t existany more. For now, though, we’re try-ing to get the message out there thatschools can really help families by justmaking sure children are keeping totheir regimes and that for young chil-dren that maybe cannot inject them-selves, a member of staff is trained todo it for them.

“The alternative is parents having tostop off at school half way through theday to give an injection which is farfrom ideal and can put strain on theircareers.”

To raise awareness of the additionalfactors that affect children with dia-betes, the charity will be marking WorldDiabetes Day with not only a parlia-

mentary reception in London but willalso be sending a British child and itsmother to meet MEPs in Brussels.

Extra challengesDiabetes UK believes that many of theadditional challenges which childrenand teenagers face, along with theirfamilies, can be overlooked and so isdue to campaign heavily next year toraise awareness and understanding ofhow diabetes can have a different im-pact on the youth.

“The classic problem is family con-flict through other children resentingthe child with diabetes getting alot ofattention and maybe being the reasonwhy none of them are allowed sweetsor treats,” says Cathy Moulton, DiabetesUK’s care advisor.

“That’s why it’s so important for usto get our message over to families thatpeople with diabetes can eat a normalbalanced diet with the occasional treatso long as it is after a meal so the bodyis already digesting food.”

Teenagers also face the twin problemsof being at an age when they are liableto rebel against authority and, particu-larly with girls, can be steered by mediaand peer pressure to risk their health ina bid to avoid putting on weight.

“There’s a misperception amongteenagers that insulin makes them puton weight and so injections can beavoided” “The problem is that weightloss is a symptom of diabetes and sowhen a young person is diagnosed andput on insulin, the weight loss isstopped and they can think they’ve puton weight.

“It’s leading to a huge problem ofyoung people, particularly girls, ofwhat’s being called ‘diabulemia’ wherethey do not keep to their insulinregimes. Add to that the problem ofteenagers rebelling against the regimeof constantly having to check bloodglucose levels and taking insulin andwe’ve got a big problem on our hands.

Some young people are doing them-selves terrible damage further down theline because, unchecked, glucose issticky and so blocks up small arterieswhich leads to problems with eyesight,kidneys and sexual dysfunction as wellas increasing the risk of heart attacksand strokes.”

Gradual changePart of the solution Diabetes UK be-lieves could be to have a better handover of care when patients turn 16. Atthis age children move from paediatriccare to adult care and often they receiveless support and have to attend clinicsat a different location. Rather than havesuch a definite age limit, Diabetes UK is

advocating that patients transfer toadult care when they are ready to man-age their own blood glucose levelswithout the support of a paediatric teamand that the transfer is made easier bydoctors and nurses from adult treat-ment centres visiting paediatric clinicsso they are a familiar face when a pa-tient attends their first appointment inunfamiliar surroundings.

The Medical Conditions at School ed-ucation pack was produced by Diabetes

UK in conjunction with The Anaphy-laxis Campaign, Asthma UK, EpilepsyAction and Long-Term Conditions Al-

liance. Visit www.medicalconditionsatschool.org.uk for more information.

Economic cost of diabetes

BY ROB MITCHELL, A SENIOR EDITOR ATTHE ECONOMIST INTELLIGENCE UNIT

There is universal agreement that the problem of diabetes is growing significantly worsein both developed and developing countries. This much we know, but what is lessfrequently explored is the burden that this epidemic is placing on our economies.

For example, what are the true costs oftreating diabetes and its complications,and what is the extent of the lost pro-ductivity and earnings that arise fromillness, disability and early death causedby the condition?

It may at first appear somewhat cold-hearted to express a chronic disease thatcauses such massive human suffering inpurely economic terms but research ofthis nature is extremely important. It isonly by having a strong grasp on thetrue cost of a disease to society that pol-icy makers from a variety of back-grounds are able make informed

recommendations on which to base theefficient allocation of scarce resources.

This is not to say that such a cal-culation is easy. There are numerousbarriers that stand in the way of put-ting a figure on the economic cost ofdiabetes, including a lack of availabledata, and a tendency for deathscaused by complications of diabetes,such as heart disease and kidney fail-ure, not to be attributed to the under-lying cause on death certificates.

Varying costWorking with the data and informationthat are available, the Economist Intelli-gence Unit produced a report* earlier thisyear, sponsored by Novo Nordisk, that

explores the economic cost of diabetesto five countries: China, Denmark, India,the UK and US. All are countries thatface mounting costs from diabetes but,because they are at different stages oftheir development, the scale of the prob-lem varies considerably between them.

The research found that, out of thesefive countries, India currently carries thebiggest burden. Expressed as a percent-age of gross domestic product, the coun-try currently incurs costs equivalent to2.1 per cent of GDP in 2007. Among thedeveloped countries, the United Statesfaces the biggest burden, with an esti-mated cost equivalent to 1.2 per cent ofGDP. The UK faces costs in the region of0.4 per cent of GDP, while Denmark in-

curs costs equivalent to 0.6 per cent ofGDP. In the case of China, there were in-sufficient data to calculate healthcarecosts, but lost productivity costs aloneare equivalent to 0.6 per cent of GDP.

The five countries studied for this re-port spend significant sums of moneyevery year on treating diabetes and itscomplications. For example, the USspends $134.8bn annually, or six percent of its healthcare expenditure. Cut-ting back on treatment, however, is notan option. If countries do not invest inprevention, early diagnosis and treat-ment, the costs in future will escalatedramatically. Individuals who were notdiagnosed and treated in the early stageare far more likely to suffer from seriouscomplications, such as heart disease,and these are far more expensive to treatthan early stage diabetes.

Moving onIt is clear that a better understandingof the scale the challenge that dia-betes represents requires further con-sistent, clearly defined research, far

beyond the study that we conductedfor this report. Obtaining better dataon diabetes costs and prevalencemeans that healthcare professionalsmust be encouraged and, if appropri-ate, incentivised to diagnose diabetesand make correlations between com-plications of the condition and theirunderlying cause. Research organisa-tions must then collect and share thisdata at a national and internationallevel, and then contextualise it forkey policy-makers in government,healthcare and business.

However, a lack of data should nothold up the urgent action that is requiredto address diabetes and other chronicdiseases. We already know what to do tocounter obesity and smoking. In a simi-lar way, stakeholders must all work to-gether to make the small changes neededto create societies in which the healthychoices are the easy choices.

*The Silent Epidemic: An economicstudy of diabetes in developed and de-veloping countries is available fromwww.eiu.com/silentepidemic

Diabetes UK is helping school staff to get a better understanding of diabetes

Every 10 seconds 2 people develop diabetes around the world.

PremieresNovember 22, 8PM

Watch Diabetes: A Global Epidemicthe world premiere documentary from Discovery Home & HealthFinally, a sweeping documentary that takes you to the frontlines of diabetes around the world. Witness personal accounts from patients and doctors—and find out about the challenges ahead.

Funded by an educational grant from Novo Nordisk as part of its Changing Diabetes Leadership Initiative.

©2007 DCL