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Type 2 Diabetes, What is the Solution?

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Calum Howell

on 27 February 2017

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Transcript of Type 2 Diabetes, What is the Solution?

Diabetes and Diet
The Future Burden Of Childhood Diabetes!
Lifestyle Approach
Diabetes and
Physical Activity
Eating and physical activity habits are formed early in life therefore leaving a critical window to change a childs social norms (45).
Type 2 Diabetes in Children and Adolescents! What's the Solution?
What is Type 2 Diabetes Mellitus?
T2DM was discovered in
1936
, and in
2012
it diabetes
directly
accounted for
1.5 million deaths
worldwide (49). Making it
one
of the
four

priority
noncommunicable
diseases

targeted
by the
world leaders
in the
2011
Political Declaration (43).
Prevalence of T2DM
Type 2 Diabetes Mellitus (T2DM) is a
heterogeneous
disorder that derives from the
interaction
between
environmental
and
genetically
factors creating a combination of
insulin

deficiency
and
resistance
(2).
What Are The Risk Factors?
In
2010
it was estimated to affect
285 million
individuals worldwide; this figure is projected to rise to
over 400
million over the next
2 decades(
51)
.
There is
no true incidence
because up to
24%
of the world can go
undiagnosed
with T2DM (17).
T2DM in children and Adolescents
T2DM in the British youth is a relatively new disease;
2000
-
8

overweight
girls aged 9 to 16 of a Pakistani, Indian or Arab background (12).
2002
-
Four

overweight
white

adolescents (13).

31,500
British children and adolescents had diabetes in 2014, with 2% (around 630) of these being diagnosed with T2DM (10), a
7775%
increase in 14 years.
Thus meaning a child aged
15
with T2DM will
cost
the
NHS £16,750

before
they
retire
(aged 65) on medication and monitoring alone.
In a follow-up study of
51
diagnosed
children
,
9%
had died,
6%
were on
dialysis
, 1 had a toe amputation while another became blind (6).
Ten years ago, T2DM accounted for
less
than
3%
of all diagnoses of diabetes in adolescents, at present its
closer to 45%
(18; 52).
21.9%
of children aged
4-5
are overweight/obese!!
33.3%
of children aged
10-11
are overweight/obese!!
Overall
31%
of children aged
2-15
are classed as overweight/obese!! (21)
It It Only Going To Get Worse!
Excess

adiposity
at a young age is linked to
immediate
and
long-term
health risks resulting in
increased middle-age

mortality
(2).
2010/11 the cost of
treating diabetes
was
9.8bn
(9)
.
Diabetes accounts for
10%
of the
NHS budget
(9).
By
2034
this is projected to rise to
17%
(9).
80%
of these costs come through
complications
(9)
With the average outpatient cost per person per years being
£335
(28).
Figure 1 -
Prevalence of T2DM in the United Kingdom
1998/99 - 1.07 million
2012/13 - 2.7 million
2029/30 - 4.6 million
(40)
Overweight/obese -

95%
of diagnosed children are overweight or obese compared to
only 56% of adults
(17) Someone who is
obese
is
seven
times more
likely
to be diagnosed with
T2DM
(1; 51)
Sedentary lifestyles -
people with T2DM recorded a greater amount of sedentary time compared to non-diabetic counterparts (47; 50)
Physical Activity -
Data shows a steep
decline
in
physical activity
in adolescence is
associated
with
weight gain
. In fact, only
7%
of
boy
s and
0% Girls
are meeting the guidelines (41).
Family History
- Plays a significant role,
84%
of UK diagnosed adolescents have a
family history
of T2DM (20).
Ethnicity
- In the UK
43-56%
of diagnosis occur in ethnic minorities
Black ethnicity -
3.9
/100,000 persons per year
South Asian ethnicity -
1.25
/100,000 persons per year
White ethnicity -
0.35
/100,000 persons per year
(20).
T2DM is highly preventable,and all the factors have a connection to social economic status in the UK (50).
Figure 2 - Changing associations between
economic development, social economic status
and prevalence of diabetes or risk factors (50)
Only
7%
of
boy
s and
0% Girls aged 11-15
are meeting the guidelines (41).
43%
of boys and
37%
of girls aged
13-15
are sedentary for
6 hours
or more on weekend
Only
9%
of boys and
3%
of girls spend less than
2 hours
sedentary during a
weekday.
(3)
Population based Approach
Aiming interventions at the
modifiable
risk factors to
reduce
the
incidence

diabetes
and other non-communicable diseases.

These should be try to
promote

healthy

food
and
beverage
consumption,
increase
physical
activity
levels.


Cuba
during a period of
economic
crisis thus levels of
diabetes

dropped
dramatically due to
reductions
in
calorific
intake and
increases
in
physical

activity
(16).



The SSB Tax in Mexico
- A 10% tax on SSB's where after the
first year
of the tax, a
6% reduction
in consumption was identified (5).



There will be a UK sugar tax in
April 2018
, as SSB are the
largest
contributor to children and adolescent free sugar intake in the UK (24).
What Policy's exist?

The average intake of
free sugars
should be
reduced to 5%
energy consumption (39).


Consumption of
sugar-sweetened beverages
(SSB) should be
minimised
as it has been associated with a higher risk of T2DM (23).


Fibre
consumption has been increased to
20-25g/day
due to the increasing evidence associating reduced T2DM risk with high fibre intake (39).



A diet
low
in
carbohydrates
might be an important strategy for reducing T2DM risk in the youth, while also suggesting foods with a
low glycemic index
being recommended (19)
UK Based

From April 2013 -
Local authorities have been paid a premium for any progression they've made against various health indicators set out in the
Public Health Outcomes Framework
for England, 2013-2016.
This includes indicators on excess weight, diabetes, diet and physical activity among adults (37).

All children and young people should
engage
in
moderate
to
vigorous
physical activity for
at least 60
minutes every day (7).


All children and young people should
minimise
the amount of time spent
sedentary
(7).
Global Aims

Voluntary global targets for prevention and control of noncommunicable disease to be attained by 2025 - World Health
Number 7 - Halt the rise in diabetes and obesity
(51)

The
ECHO
Report consist of
6 recommendations
to governments to
reduce obesity
and

thus
T2DM
in
children
(52)

Summary
No single policy or intervention can achieve changes of this magnitude. Interventions which go beyond information campaigns to simultaneously provide necessary skills, shift motivation while educating are more likely to lead to behaviour change (15)

The UK should combine both a lifestyle and population based intervention to reduce T2DM incidence, doing so by utilising various stealth techniques.

Such change calls for a 'whole-of-government approach in which all sectors systematically consider the health impact of policies (52).

Utilising group-based health educational programmes as the primary vehicle for promoting behaviour change seems to be the most cost-effective strategy.


"Until a healthier ‘eat less, move more’ environment is created for today’s children, lifestyle interventions like that in the TODAY study will fail”

The rise in diabetes risk factors has occurred the context of changing social, economic and physical environments in which we live.
Lifestyle Approaches
Healthier You: NHS DDP - Aims to identify those at high risk and refer them onto a behaviour change programme. Over 9 months patients will be offered at least 13 education and exercise sessions (36).
Adults
Finnish Diabetic Prevention Study (FDPS) -
58%
risk reduction, a 3 year follow up showed a 38% reduced relative risk (33; 34).
American Diabetic Prevention Program (DPP) -
58%
risk reduction (8).
Japan Prevention Study -
67%
risk reduction (30).
The Da Qing IGT and Diabetes Study -
43%
risk reduction after a
14 year follow-up
. 32, 38)
Children
The
TODAY
Lifestyle Program didn't show a difference between lifestyle interventions and metformin treatment. This was
fundamentally
down to the
environment
providing
more calories
and
less physical activity
(42).

Sufficient social support & cultural consideration
=
increased chance of behaviour change (22; 31).
Whole-School-Approach focusing on improving diet and physical activity - They should improve knowledge, attitudes and behaviour of children (11; 29).
Population based Approach
Campaigns such as Beat the Street (26), Lets do this and Pokemon Go are all attempting to change the social norm of society and thus changing the population's lifestyles. By using 'Health by Stealth' Techniques

Mass Media
Campaigns Change 4 Life -
Sugar Smart
App provides knowledge and guidance for British Families on how to reduce sugar intake (4; 48).



Higher intakes of
energy-dense food
are consumed
after adverts
for foods high in fats, sugars and salt (27). Thus suggesting for
policies
to implement
bans
on this.



The
Karella
Project - saw a
decline
in
cardiovascular
disease
risk

factors
through
effective education of a population.
This intervention could be developed to reduce T2DM incidence (44).
Ultimately
80-90%
of all T2DM cases are the result of an
unhealthy

lifestyle
(35)
The
Development Programme
for the Prevention and Care of
Diabetes in Finland
(2000-2010) - Resulted in an
increased knowledge
of lifestyle choices
(14; 25; 46).
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