the good news and the bad news – and what else for the future

Alarming stories about the diabetes epidemic that threatens millions of lives – and the NHS itself – have become commonplace and with good reason. About 4.6 million people in the UK are living with diabetes while another 12.3 million are at increased risk of developing it. The NHS spends about 14 billion pounds a year on treating diabetes and its complications.

But there is some positive news in the midst of gloom. I chaired the 2018 World Congress on the Prevention of Diabetes and its Complications, in which experts from around the world came together to discuss progress in science and prevention programs

. Type 1: avoidable?

age of patients is normally diagnosed, type 1 is an autoimmune disease that attacks insulin-producing cells, leaving patients facing a life of injections and deterioration of health. Improved care has focused on how insulin is administered and on reducing the impact of health complications on daily life. Scientists are now more convinced than ever that this type of diabetes can be avoided. Although type 1 diabetes represents only 5% of all diabetes, it still represents tens of thousands of patients who face health problems every day and who require lifelong medical support. The impact of type 1 diabetes prevention would be significant.

The two breakthroughs underpinning this new optimism are early detection and prevention. The genetic risk of type 1 diabetes is becoming clearer, and we now have the ability to measure a range of blood factors that appear in the early stages of the disease. Which means that we are developing tools to identify those who are most likely to develop diabetes.

From here we now have a real hope that immunotherapy can stop the destruction of insulin-producing cells. This covers a range of treatments – including vaccination – designed to change the functioning of a person's immune system. The important thing is to find a therapy that specifically stops the part of the immune system that attacks the insulin-producing cells, leaving the rest of the defense system intact. Fears that immunotherapy would be too toxic and nonspecific for children are challenged by evidence in clinical trials. These have shown that therapy can be safe, and encouraging, have shown signs of slowing the progression of the disease.

Type 2: devastating

It is the most common form of the disease, directly related to obesity and other lifestyle factors. Type 2 diabetes is devastating; In the next five to ten years, patients could lose their kidneys, eyes or legs. They can suffer from cardiovascular diseases and other deadly diseases related to diabetes.

As about four in five people with diabetes are overweight, the most effective way to prevent the disease is to avoid gaining weight. For 20 years, Finland, the United States and Australia have implemented diabetes prevention programs to encourage lifestyle changes and positive health outcomes for their countries.

This involves "encouraging" people to accept changing lifestyle habits, and then providing years of support to maintain physical activity and improve their diet.

However, this can only reach half of all type 2 diabetes, so these countries are increasingly targeting the obesogenic environment that makes it easy to gain weight and hard to lose. It starts with talking to the food industry, but we also need to include legislation to reduce the impact of the most damaging aspects of our diet. A tax on sugar has already been introduced in many countries and we will soon learn how effective it is in reducing diabetes and its health problems.

and recent plans for 2-for-1 pizza and "everything you can eat" buffets. These measures are never popular but they are more and more necessary. Taxes and subsidies can help rebalance the cost of healthy and unhealthy foods. Making higher-fat and high-sugar foods more expensive could help to increase the demand for healthy alternatives and, as a result, lower prices.

Prevention of Complications

People do not fall dead because they develop diabetes. They can live for decades with the condition, but the quality of life is another matter. Type 2 diabetes prevention programs should also include people who already have the disease.

Changes in lifestyle can slow progress and reduce serious health problems and, in some cases, reverse the disease. For many, strictly following a low-calorie diet immediately after diagnosis can put Type 2 in remission. But its success depends on individual commitment, so support is needed to help each person reach that difficult goal and then maintain the lifestyle to prevent the return of the disease.

The possibility of developing immunotherapy to prevent type 1 and prove that type 2 can be put into remission are the two most exciting developments in diabetes research.

If it was possible to prevent at least half of type 2 cases – what we think we could do by changing lifestyle and environmental factors – the amount of diabetes and its complications could be reduced by half. That's billions released for the NHS. More importantly, it would improve the quality of life of patients and life expectancy.

The link between cheap, sugary and fatty foods and obesity and type 2 diabetes is indisputable. The cost ratio of healthy / unhealthy food has to change because the proof is that education – while valuable – is not enough on its own. Evidence from many countries shows that in most lifestyle-related chronic diseases, legislation is faster and often more effective.

The often described apocalyptic scenarios are not inevitable, but they are likely if we continue as we do. People must accept certain truths about their way of life, and bold political leadership is needed to make unpopular decisions for the health of the nation.