Should the Government intervene to prevent a Diabetes epidemic?
Diabetes cases are escalating, and new research suggests catching COVID-19 could be creating new cases. Dr Quinton Fivelman asks what the Government can do to stop diabetes replacing Coronavirus as the UK's next health crisis.
Diabetes is escalating rapidly in the UK population, usually linked to factors such as weight, lifestyle, age and family history. One in ten people will have diabetes by the end of the next decade, and one in three will be at much increased risk of developing it. Now, to add to the problem, in the last year evidence has been building that there could also be a link between increased cases and COVID-19.
Until the COVID pandemic reached the UK, lifestyle and diet was by far the primary cause of Type 2 diabetes, the most common form. Evidence has grown over the past year that the recent acceleration in new cases could, in some cases, be linked to COVID. New research has revealed COVID could be triggering the disease in previously healthy people, and potentially significantly worsening cases for some pre-existing diabetics.
Diabetes is a disease in which people's blood sugar levels become too high due to the body not producing enough insulin. If not treated quickly, it can lead to heart attacks, kidney failure, strokes, amputation, and blindness. There are two types of the disease: Type 1 is not linked to diet or age but is the most severe and presents early in life with symptoms that can develop over weeks or even days; Type 2 is by far the most common, and symptoms develop more slowly and may not be as obvious.
It is already acknowledged in the UK that, as patients with pre-existing diabetes have a higher risk of serious complications with COVID-19, they are on the UK priority vaccine list. The way the virus penetrates organs is a particular concern. The virus interacts with a receptor called ACE-2 to infiltrate cells in organs, including the pancreas. It is likely that this disrupts sugar metabolism.
The virus can spread beyond patient's respiratory tract and lungs. Two American studies, from Weill Cornell Medicine and Stanford University School of Medicine, released this summer, have shown COVID-19 in pancreatic cells from patients who died from the virus. These pancreatic cells are responsible for making insulin to control the body's blood sugar. This suggests that COVID-19 infection of the pancreatic cells can, in some cases, lead to diabetes similar to Type 1 diabetes in previously healthy patients.
What should Government do?
Given that the link between the two diseases looks increasingly possible, what can the Government do to avoid the risk of a COVID-19 and diabetes "perfect storm"? We know that, following double vaccination, antibody levels decline over time. The Government must get on top, and keep on top, of its top-up jab campaign. There are reports that it has had a relatively slow start, and it's vital the third shot is rolled out more quickly.
It was also perhaps a mistake to relax so many measures on so-called Freedom Day. Some relatively unobtrusive precautions, such as the compulsory wearing masks on public transport and in stores, could have helped keep cases down whilst still ensuring businesses remained open. The UK's COVID case rate has remained currently much higher than in other western European countries throughout 2021 and there are concerns that it may increase further towards winter.
We don't yet know how much the increase in diabetes in COVID patients could be the impact of the virus on people's bodies and how much is it because we were all a lot more sedentary during lockdown, and perhaps ate and drank more than usual. Obesity and alcohol consumption are known triggers for diabetes.
Blood sugar levels are also known to rise in the bodies of some people fighting COVID. As yet, we have no clear idea of how long these remain at a high level, but this may certainly be a contributing factor.
Simple steps, including reducing weight, not eating too many sugary products, and staying within Government alcohol guidelines can help UK citizens reduce the risk of developing diabetes.
In terms of supporting these dietary measures the Government is finally introducing some long-promised regulations, dubbed the 'snack tax'. Over the next two years we will see new laws introducing calorie counts on pub menus for larger chains, and ending "2 for 1" style promotions and unlimited top-ups on fizzy drinks. There will also be a partial ban on pre 9pm watershed junk food ads.
However, the Prime Minister has seemingly rejected the finding of a report, commissioned by the Government itself, that a National Food Strategy should include a new sugar and salt tax. The report, drawn up by the restaurateur Henry Dimbleby, proposed a tax of £3 a kilo on sugar and £6 a kilo on salt sold for use in processed foods or in restaurants and catering businesses. It could encourage manufacturers to reformulate their recipes or reduce their portion sizes. However, Mr Johnson has reportedly responded by saying "I am not, I must say, attracted to the idea of extra taxes on hard-working people." He may want to reconsider that ideological view in this particular case.
Some scientists are speculating we may even be looking at a new type of diabetes, triggered by the effects of COVID-19, which is reportedly affecting over 1 million people living in the UK. This may be linked to longer term high blood sugar levels in Long Covid patients. Double vaccinations have reduced the number of patients being admitted to hospital and dying of COVID-19, but the wider risks from catching the disease are perhaps yet to be known.
The Government would do well to consider relatively simple measures now to halt the rise of COVID-linked diabetes, rather than face a new wave of the disease, and its concomitant cost to the NHS, later.
