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Home » EU Health, Europe, Health

Viewpoint on an EU-Wide Diabetes Strategy

Submitted by on 05 Mar 2014 – 11:02

Andrew Boulton

By Andrew JM Boulton, President, European Association for the Study of Diabetes 

Diabetes, particularly type 2, is reaching epidemic proportions across the world including European countries. Indeed if all those with diabetes across the world were put into one country, this would be the third largest country after China and India. There is a need in Europe to raise the profile and importance of diabetes amongst not only the general public but also health care providers and professionals. In my particular area of diabetic complications, the outlook in terms of morbidity and mortality for those patients on dialysis as a consequence of end-stage diabetic kidney disease, who also have foot problems, is worse than for most malignant diseases with the potential exception of lung and pancreas. It is therefore essential in Europe that the seriousness and consequences of having diabetes be widely appreciated: no longer can this be regarded as “a touch of sugar” or “mild diabetes”. All patients with diabetes are at risk of later complications which can have devastating effects on health and quality of life.

It is not my view that national screening programmes will be helpful: rather it is important to focus screening on high risk groups which might include for example those from certain ethnic minorities, those with morbid obesity, those with a strong family history of diabetes, those with a history of gestational diabetes and so on. Another high risk group is hospital inpatients who are not known to have diabetes: in most UK hospitals between one in four and one in five of the total inpatient population has diabetes whether they know it or not. In other chronic diseases, for example heart disease, diabetes is also very common: only one out of five patients with established chronic cardiac failure will have normal glucose tolerance, the remainder having frank diabetes or impaired glucose tolerance.

There are a number of existing therapies for people with diabetes with proven efficacy and safety and many have been introduced in recent years: moreover there are a number of innovative new developments in the pipeline. Europe should try and focus on prevention by not only education on healthy eating and physical activity, but also by taking action in areas such as advertising of fast foods, sponsorship of sports events and so on. It was certainly rather ironic that just prior to the Olympics held in London in 2012, McDonalds opened their largest ever store on site.

In many ways if one looks in 2014 at the food and beverage industries, we are now where tobacco promotion and advertising was 50 years ago. At that time it was emphasized that smoking may well be bad for you and you should not smoke if at all possible. Similarly the UK Secretary of State for Health recently announced that all individuals should be involved in “national soul searching” and be more responsible with their diet. Some 50 years later, the banning of all advertising of tobacco products, restriction of sponsorship of sporting events and further legislation soon to come, has resulted in a significant reduction in smoking in the UK. As pointed out in a letter to The Times on January 11 by Professor Sever from London, are we going to have to wait 50 years for similar activities to be taken on potentially harmful and obesity generating foods? Recent examples of promotion of supposedly “healthy” foods by manufacturers for example promoting cereals and other similar items as being healthy when they contain significant quantities of sugar and even salt, are not difficult to find. We can look west to the United States and the example of New York City where reducing the volume of “super-sized soda” drinks has had an impact and most restaurants are now compelled to reveal the calorific content of every item on the menu.

Much can be done across Europe and it behoves all of those involved to try and promote activities such as those listed above.

Professor Andrew JM Boulton MD, DSc (Hon), FICP, FACP, FRCP

President, European Association for the Study of Diabetes.

Professor of Medicine, University of Manchester and

Consultant Physician, Manchester Royal Infirmary, Manchester, UK.

Visiting Professor of Medicine, University of Miami, FL, USA.