In 1980 about 6% of men, and 8% of women were obese1 , but now about half of the UK population is overweight, and combined obesity levels have risen to 17%2.
Past president of the American Diabetes Association, endocrinologist Dr. Gerald Bernstein3, has commented that diabetes is built into the genes of too many people, and that in the days when food was scarce, those people who genetically got the most energy from food were best able to survive. Now, with an overabundance of food, those genes turn calories into fat with what is now distressing efficiency.

"You take this gene pool and a bunch of people sitting around and watching TV, or working at computers, and you have obesity," he says.

The remedy is simple: physical exercise and low calorie, low fat and high-fibre diet. Some 80% of Britons with type 2 diabetes are overweight and estimates point to diseases caused by obesity costing the NHS over £2 billion each year1.

A 3 year study, reported in the May 3rd 2001 edition of the New England Journal of Medicine, which was conducted by the National Public Health Institute, in Helsinki, and involving more than 500 middle-aged and overweight individuals, showed that during the trial, the risk of diabetes was reduced by 58% in an intervention group that was given detailed advice on weight reduction, diet, and exercise.

Through the introduction of initiatives such as NHS Direct the government is actively attempting to encourage people to take more responsibility for their health, but there still remains a continuing challenge to get higher risk individuals to seek medical advice. Additional research by the Royal College of Physicians has also revealed that men, in particular, are less willing to come forward, either because of inadequate knowledge, or for fear of being diagnosed with a serious disease - or they are just too busy! Men are still one-and-a-half times more likely to get diabetes than women6.

Concern has been voiced about people self-testing themselves for potentially serious disorders at home, without professional support on hand to provide guidance on the interpretation of results, or assistance with emotional responses to positive outcomes. Whilst self-assessment tests have not been encouraged it can be argued that if simple and easy to use home tests encourage people to take more responsibility for their health, there is an increased probability that they will contact their GPs to discuss their results. Anything that gets them to visit a doctor is beneficial, rather than having them present themselves, either when it is too late, or when complications have set in and expensive treatment has become necessary. An average type 2 diabetic is generally diagnosed between 9 - 12 years after onset3, by which time as many as half of them will have developed costly associated complications.

The tests are symptomatic of potential abnormalities within the context of the accepted biological ranges covered by the technologies used, but are not meant to replace either medical consultation, or the need for pathology investigations, where appropriate. If conducted at an early stage, and if used to focus on early detection, or the exclusion of negative results, the tests could be useful in the freeing of limited GP time to investigate the abnormal and positive cases.

Being simple urine tests, their ease of use is not dissimilar to that of the now universally used pregnancy test kits, the fundamental difference being that one might be bringing good news.2

Albeit the tests cannot fully exclude diabetes, they can highlight the need for further investigation. False positive or negative results are also found in the clinical environment, and most home tests comply with current standards, and follow the results, reliability and performance values that are found in the laboratory. A caution, though, is that false positive results may follow as a consequence of abnormal dietary intake, but careful adherence to the product instructions mitigates against this occurring.

Education is key to the success of tackling diabetes. Whilst only about 60% of current sufferers have actually been diagnosed, it may already be costing the NHS over £5 billion per annum2, with associated conditions, and it may be using up as much as 9% of the total NHS budget.

Yet the cost of NHS prescriptions for people with diabetes, in 1996, was £123.7 million1, just a small proportion of the total related costs. 

Patient numbers are forecast to double by as early as 2010, by which time the drain on resources could become unsustainable. The government, though, is expected to introduce its National Framework for Diabetes initiative sometime during 2003, and whilst it is too early to anticipate the contents, addressing the short to mid-term growth of the disease, and its wider effects on the operational efficiency of the NHS, will be a necessary priority:  Up to 15% of coronary heart disease deaths are diabetics, who are 4 times more likely to suffer from coronary disorders2.
 Foot ulceration, resulting from neuropathy and ischemia, lead to some 40 thousand annual amputations on diabetics, who are15 times more likely to need amputations2,4.
 Diabetic nephropathy accounts for more than 25% of end-stage renal failure cases, and has been indicated as its leading cause2.
 Diabetic retinopathy is considered to be the prime cause of blindness in the country2.
 The effect of prolonged raised blood glucose on the blood vessels serving the brain make diabetics significantly more likely to have a stroke2.

Educational literature can readily be modified to concentrate on specific issues such as obesity, overweight and lifestyle, as part of a wider education, training and awareness programme, and could also cover additional elements such as family history and ethnic predisposition to the disease. The incorporated expertise of retail pharmacists, and clinics, can offset much of the screening burden placed on general practitioners. Advice on the calculation of a Body Mass Index - confusing for those who may have difficulty in thinking in metric terms - as well as recommendations to perform a urine test, could necessarily spread the net wider than it reaches now.

Diabetics are required to assume considerable self-management responsibility, after diagnosis, as they and their families come to grips with diet, lifestyle and the monitoring of insulin. Yet, they are discouraged from taking responsibility and self-testing beforehand, when it may be of great value - patient education is easier to impart after diagnosis, but the greater need is to deliver it beforehand, where simple home testing may have a role to play

As the level of diabetes is forecast to double by 2010, and as the population ages, and people live longer, radical innovations will become necessary if diseases are to be detected at an earlier, less costly and more easily treatable stage.

The average age of diagnosis for Type 2 diabetes is about 526. Research undertaken by charity, Diabetics UK, and the Nuffield Institute of Health, has revealed significant shortfalls in both diabetic screening resources, and its treatment at all levels of the NHS2,5 . It has led the charity to conclude that possibly 2 in every 3 diabetics may needlessly be dying from complications that could be prevented, or delayed2. 

Reference:  1. Target Diabetes - ABPI Feb 1999
 2. Diabetes UK - diabetes.org.uk
 3. health24.co.za
 4. Dr T Maguire, head of N Ireland Centre for Pharmacy - Chemex 2000 Symposium
 5. Association of Clinical Diabetologists - 11 June 2001
 6. Malehealth.com