The weight of the nation and the rise of Type 2 diabetes

The latest Scottish Diabetes Survey was published earlier this year; the story of the COVID-19 pandemic for diabetes and its consequences is beginning to appear in graphs and figures. The survey also presents the story over the last decade until the end of 2021.

The survey covering the pandemic period shows some expected glitches in the data, with a drop in diabetes diagnosis and monitoring reports, followed by a resurgence of numbers of people with the condition. There is more clarity – and more of a worry for the public’s health – in the picture over the longer period, where we have seen inexorable rises in the number of people with Type 2 diabetes, for which overweight is a prime issue.

In all, 287,551 people in Scotland were living with Type 2 diabetes in 2021 – 6% of the total population. That’s 287,551 people needing to monitor their weight, their blood pressure, check their eyes and feet each year, get blood tests for control of several risk factors - sugar levels, cholesterol, kidney function and so on – and potentially take medications too. And we have a health service that supports all these efforts, as well as treating complications and managing the extra risks that go with diabetes. More than half of those with Type 2 diabetes (56.3% or 161,925 individuals) are male, and the likelihood of having Type 2 diabetes increases with age, with the majority of cases in those age 60 and over. 

What has happened as a result of the COVID-19 pandemic? It is perhaps too early to say but we did see a drop in diagnosing Type 2 diabetes in the first year (2020) followed by a resurgence in 2021. As the survey report states: “For Type 2 diabetes, this may partly reflect the reduction in the numbers of new diagnoses in 2020 but may also reflect increases in weight and body mass index in the population.” We see a drop-off in monitoring for complications – eye and foot conditions - but also weight measurement.

But the longer-term trend is still an upward trajectory of rising numbers of people with Type 2 diabetes. 60,000 more people have Type 2 diabetes in Scotland than 10 years ago. It is predominantly a problem for older people but risks for the disease start young. Type 2 diabetes is socially patterned, that is more common in deprived areas, and the socio-economic determinants of the disease are present throughout life. As Diabetes UK states: “Research has consistently shown that for some people, combined lifestyle interventions can be effective in reducing the risk of type 2 diabetes by about 50%”. These lifestyle interventions include diet, physical activity and sustained weight loss.

Diabetes is one important disease closely related to overweight and obesity, but it is far from the only one. If we are going to reduce the burden of illness, we need to take prevention much more seriously. Over a quarter of a million people in Scotland are living with Type 2 diabetes. Tens of thousands more people in the next decade could be facing a diabetes diagnosis if this preventative action is not taken. This will impact on all areas of our lives including the NHS and social care, employers through impacts on productivity and absenteeism, and also on the UK and Scottish Governments through growing costs. Many of these costs are avoidable if we focus on prevention. Working towards creating an environment that encourages healthy weight, and the factors and determinants that help to make that inevitable, for young and old, with and without diabetes, is an urgent objective.