2 Public health need and practice
On average, 100,000 people in the UK are diagnosed with diabetes every year, but in 2009 this figure reached 150,000. Many more are unaware that they have the condition (Diabetes UK 2006). It can lead to long-term complications including eye problems, kidney disease, foot ulcers and cardiovascular disease. On average at age 55, the life expectancy of people with type 2 diabetes is 5 to 7 years less than for the general population (DH 2006).
In addition to the personal cost to individuals, families and communities, diabetes is estimated to account for at least 5% of UK healthcare expenditure. For example, up to 10% of hospital budgets are spent on the condition – it is estimated that drug costs alone for people with type 2 diabetes account for about 7% of the total NHS drugs budget (Waugh et al. 2007).
In 2007, 60% of primary care trusts (PCTs) reported that programmes were in place to raise public awareness of the risk factors for type 2 diabetes – and 37% were raising awareness of its signs and symptoms. However, only 42% had assessed the needs of their population in relation to type 2 diabetes – and less than 40% had developed a type 2 diabetes strategy (Innove 2008).
Individual risk factors for type 2 diabetes include:
weight (a body mass index [BMI] of 25kg/m2 or more)
a large waist circumference (more than 80 cm or 31.5 inches in women and 94 cm or 37 inches in men)
low physical activity levels
a family history of type 2 diabetes,
a history of gestational diabetes
age (being older than 40 or older than 25 for some black and minority ethnic groups).
In addition, people from the following communities are particularly at risk: those of South Asian, African-Caribbean, black African and Chinese descent and those from lower socioeconomic groups.
The more risk factors someone has, the more likely they are to develop diabetes (Harding et al. 2006).
People of South Asian family origin living in the UK are up to six times more likely to have type 2 diabetes than the white population (DH 2001). They are also likely to develop type 2 diabetes 10 years earlier (Nicholl et al. 1986). People of African and African-Caribbean descent are three times more likely to have type 2 diabetes than the white population. Type 2 diabetes is also more common among Chinese and other non-white groups than among white European populations (DH 2001).
The higher risk for South Asian people living in the UK is at least partly due to the fact that they may accumulate significantly more 'metabolically active' fat in the abdomen and around the waist than white European populations. (This is true even for those with a BMI in the 'healthy' range – that is, 18.5–24.9 kg/m2.) 'Metabolically active' fat is closely associated with insulin resistance, pre-diabetes and type 2 diabetes (McKeigue et al. 1991; 1992; 1993; Banerji et al. 1999).
Minority ethnic groups are less likely to participate in at least moderate-intensity physical activity (for 30 minutes continuously a week) than the general population. For example Bangladeshi men and women have the lowest levels of participation in physical activity when standardised for age (The NHS Information Centre 2006). Black Caribbean men are the only subgroup of an ethnic minority population that are not less physically active than the general population in England (The NHS Information Centre 2006).
In England, type 2 diabetes is 40% more common among those who are in social class V (people who are most socioeconomically deprived) compared with those in social class I (The NHS Information Centre 2010). In addition, people in social class V are three and a half times more likely than those in social class I to be ill as a result of diabetic complications (DH 2002).
People in social class V are also more likely to be obese than those in higher social classes. In 2004, 18% of men in social class I were obese compared to 28% in social class V. Similarly, 10% of women in social class I were obese compared with 25% of women in social class V (Foresight 2007).
In addition, there is also a clear link between physical activity and income level. For example, those on the lowest income are less likely to undertake more than 30 minutes of at least moderate-intensity activity a week compared with higher income groups (The NHS Information Centre 2008b).
The 'Low income diet and nutrition survey' found that, overall, people on lower incomes ate similar types and quantities of food as the general population. However, they were less likely to eat wholemeal bread, wholegrain and high fibre breakfast cereals and vegetables. They were also more likely to drink non-diet soft drinks and eat more processed meats, whole milk and sugar (Nelson et al. 2007).
There is overlap between the high-risk groups, that is, those who are disadvantaged and some black and minority ethnic communities, as some of the latter are more likely to live in areas of social and economic deprivation (Barakat et al. 2001).
People from lower socioeconomic groups and those from black and minority ethnic communities may face economic, social and cultural barriers which prevent them from being physically active and managing their weight. Barriers include, for example, lack of funds for a healthy diet or a lack of awareness and opportunity to take part in physical activities or weight management programmes that are culturally acceptable.