During Diabetes Week 2023, we have been very pleased to chat our Diabetes Nurse Practitioner, Julie Parker. With her extensive experience, she has  been able to tell us how things have changed over the years in the world of diabetes:

“When I was asked to submit an article about diabetes for the website, I started to reflect on how things have changed since I began my nursing career almost 40 years ago.

I vividly recall being taught during my nurse training about Insulin Dependent Diabetes Mellitus (IDDM) and Non-Insulin Dependent Diabetes Mellitus (NIDDM). The reference to insulin as a differentiating factor for the types of diabetes became redundant in the 1990’s when insulin became a standard treatment for around 50% of people with Type 2 diabetes. The two main classes of diabetes are now known as Type 1 and Type 2 diabetes respectively.

I recall that Type 1 diabetes (T1DM) was described by doctors as ‘serious’ and Type 2 diabetes (T2DM) was considered a much more minor complaint. We now know that this is not the case, each type of diabetes is considered serious because of the severe complications that can accompany both. Witnessing the trauma and complications diabetes has caused for some people in my care are testimony to this. This is why prevention and control of T2DM are so important.

Type 1 Diabetes

Type 1 is an autoimmune disease. Internal defence mechanisms help the body to fight infection and diseases such as cancer. A fault in this system causes a response which kills healthy cells in the pancreas making it impossible for someone with T1DM to produce insulin. This is an autoimmune response.

T1DM accounts for around 10% of people with diabetes. The figure for people affected by T1DM has remained pretty consistent. T2DM affects 90% of those with a diagnosis of diabetes, in contrast to T1DM the numbers of people with T2DM have escalated enormously.

Type 2 Diabetes

The worldwide incidence of those with diabetes has increased from 108 million people in 1980 to 422 million in 2014. By 2025 the number is likely to exceed 700 million people worldwide. In Gibraltar around 1 in ten adults have been diagnosed with diabetes. There are already over 100 million people diagnosed with diabetes in India alone. The statistics in America are very interesting. In 1958 less than 1% of the US population had diabetes compared to 7.4% in 2015. That equates to 1.58 million in 1958 compared to 23.35 million people in 2015.

T2DM is linked to obesity and sedentary lifestyles. If we reflect how the world has changed since the 1950’s we see that food is more plentiful, children’s lifestyles have changed, they enjoy much more sedentary past times such as computer gaming compared to the outdoor games children used to play. As a result of this we are seeing children diagnosed with Type 2 diabetes more frequently. When I began my nursing career Type 2 diabetes only affected adults. Statistics reveal that there are 36,000 children and young people (less than 19 years of age) with a diagnosis of diabetes in the UK. In this age group the statistics are reversed, only 10% (3600) have type 2 diabetes whilst the remainder have Type 1 diabetes.

Interestingly Type 2 diabetes has more of a genetic and inheritable component than Type 1 diabetes. Type 2 tends to ‘run in families’. Many health professionals considered this was due to people within a family sharing similar unhealthy eating and lifestyle choices. Science and research have changed that opinion as we now know there are mutated genes within families that affect heritability of T2DM. There is a 40% chance that a child with one parent with Type 2 diabetes will develop T2DM themselves in adulthood. If both parents have T2DM, the risk for each child in the family developing diabetes increases to 80%.

Clearly our parentage is a non-modifiable risk factor, but we can change our lifestyle, weight, and exercise habits to reduce our personal risk of developing T2DM.

If we focus on the changes in the incidence of diabetes the statistics are startling.

Type 2 Diabetes Prevention

Due to the challenge of escalating diabetes incidence, newer approaches towards diabetes prevention and management have occurred. Scientific research has demonstrated that Prevention of Type 2 diabetes by changing lifestyle habits and modest weight loss is possible.

In addition to this, research shows that people who lose 10% of their weight loss are able to put existing Type 2 diabetes into remission. Educating people is key to success and Diabetes Specialist Nurses are an excellent resource to assist with this aspect of diabetes care.

In recent years there has been huge scientific advances in treatments for people with Type 1 diabetes now incorporating technologies like insulin pumps, continuous glucose monitoring and new insulins. Transplants and immune therapy research areas might offer completely new treatment options in the future.

My top 5 tips for preventing Type 2 diabetes are:

1. Know your individual Use the Risk Calculator Tool available at https://www.diabetes.org.uk/ to assess your risk of developing diabetes now and in the future.
2. Try to keep an eye on your weight, if you are at your ideal weight try and maintain this by restricting treats such as chocolate, sweet, cake and alcohol.
3. If you are overweight speak to your doctor or nurse for advice.
4. Increase your daily activity levels so that you are doing 10,000 steps a day, the recommended amount to reduce diabetes and cardiac risks, will aid weight loss as well as toning the body.
5. Ask your GP for an HbA1c blood test every few years – this test will tell you if you are entering into a pre-diabetes phase, at this point you can reverse this and return to a normal glucose level if you lose weight and become more active.

Your Annual Check-up is Important

 If you already have diabetes, please ensure that you attend your annual review, to learn more about diabetes and to keep updated on new treatments and how these may help you to manage your diabetes.”