Diabetes Mellitus Type II and its Threat to UK HealthJames Shaw 12091938

AetiologyThe combination of genetics and the environment are what determine whether a person develops DMT2. A variety of risk factors are associated with the disease, these include:• Genetics – risk varies according to subtype of DMT2. No single gene found

to be responsible.• Obesity – it is believed that obesity accounts for 80-85% of the risk

associated with developing the disease (Diabetes, 2015)• Age – Beta cell function declines as age increases. With the current aging

population in the UK an increased prevalence of DMT2 is expected.• People of South Asian or Afro-Caribbean descent are at higher risk of

developing the disease. Onset is also more common at a younger age (Holt, et al. 2015)

• Fat Distribution – if the body stores fat predominantly in the abdomen then risk of developing DMT2 is elevated.

• Inactivity – activity uses up glucose as energy and makes your body more sensitive to insulin.

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What is Diabetes Mellitus Type II?Diabetes Mellitus Type II (DMT2) is a serious chronic metabolic disorder, characterised by insulin resistance and relative insulin deficiency resulting in hyperglycaemic. DMT2 has a significant impact on health, quality of life and life expectancy of patients, as well having economic implications for the healthcare system.Around 3.9 million people are living with diabetes in the UK, with type II diabetes accounting for 90% of these people (NHS, 2014). This costs the NHS approximately £1million an hour (Hex, et al. 2012), with costs predicted to rise rapidly over the next 10 years. Approximately 1/16 people in the UK have diabetes, including those that haven’t been diagnosed (ONS, 2012). Typically, diabetes occurs in people over the age of 40, however it is becoming more and more common in children and adolescents. DMT2 has strong familial incidence, meaning that if a twin develops the disease, it is likely that the other twin will also develop type II diabetes (Ahmed, et al. 2007).Links have been found between obesity and DMT2 (Diabetes, 2015), shown in the figure below.

Graph showing the prevalence of Diabetes Mellitus by body mass index (BMI)

DiagnosisPreliminary screening may identify the presence of urinary glucose and these results suggest whether further tests are necessary.Patients presenting with diabetes type II symptoms will be given a glycated haemoglobin (A1C) test, indicating their average blood sugar levels for the past 2-3 months by measuring the percentage of blood sugar attached to haemoglobin. An A1C level of 6.5% or higher is an indication of diabetes.Other tests can be performed if the patient is pregnant or has a haemoglobin variant. A venous blood sample and the glucose concentration is determined, if the fasting plasma glucose concentration is equal to or greater than 7.0mmol dm⁻3 then the patient is diagnosed as a type II diabetic (Ahmed, et al. 2007).

PreventionStudies suggest that pragmatic diabetes prevention programmes are effective. Modest changes to physical activity and diet reduce the incidence of DMT2 by more than 50% in people with impaired glucose regulation (Dunkley, et al. 2014). Even those who are considered ‘high risk’ can prevent or delay the onset of the disease by adhering to intense lifestyle prevention programmes. Prevention plans are, when effective, considered to be a cost efficient model of care (Paulweber, et al. 2010).

TreatmentBariatric Surgery procedures have indicated effectiveness in improving glycaemic control and reduced hepatic insulin sensitivity. This procedure carries inherent risks associated with invasive surgery (Camber, 2013).Metformin is a drug that is commonly used as a treatment, working by improving the body’s sensitivity to insulin as well as reducing glucose production in the liver.

Health Issues linked to DiabetesCardiovascular – angina, atherosclerosis, myocardial infarction, stroke, coronary artery disease. 80% of type 2 diabetes sufferers go on to die from cardiovascular disease (Barnett, 2015).Nephropathy (kidney damage) – kidney failure, end stage kidney disease (requiring dialysis or kidney transplant).Neuropathy (nerve damage) – loss of feeling in limbs affected, nausea, vomiting, diarrhoea, constipation and erectile dysfunction.Retinopathy – potential blindness, cataracts and glaucoma.Foot damage – cuts and blisters can develop serious infections leading to need for amputations.Skin conditions – more susceptible to bacterial and fungal infections.Hearing impairment – more common in people with DMT2.Alzheimer’s disease/dementia – many studies indicate that individuals with DMT2 are at higher risk of developing dementia (Gotz et al, 2009).

Table 1 – Increased risk of diabetic complications in people with diabetes compared to the general public of England (National Diabetes Audit, 2011-12)Diabetic Complication Additional Risk of Complication Among People with DiabetesAngina +76%Myocardial Infarction +55%Heart Failure +74%Stroke +34%

Renal Replacement Therapy ESKD +164%

Minor Amputation (below ankle) +337%

Major Amputation (above ankle) +222%

ConclusionDiabetes incidence is predicted to rise in the UK over the next decade. In order to prevent this, education about the consequences of DMT2 must be implemented alongside healthier lifestyles of the general public. This will improve quality of life and reduce the future burden on the economy.

Figure 1: Distributions of BMI – (Bays, et al. 2007)