14 million with diet related type 2 diabetes

Last week, a report published by Diabetes UK estimated that 5 million people are currently living with the condition in this country. 90% of diabetes cases are type 2, which is mainly lifestyle related and, you guessed it, obesity is one of the leading causes. And it’s not just here in the UK that this is a problem. A study has been published this week from Tufts University linking poor diet to 14 million cases of type 2 diabetes globally. To break down what all this means, Chris Smith spoke to first author on the paper, Meghan O’Hearn…

Meghan - Broadly, we're seeing this increase. In the context of obesity and overweight, poor diet is really one of the major drivers. And when I say poor diet, that means a lot of different things; it means low intake of healthy foods as well as high intake or excess intake of unhealthy foods. It's complicated because that can mean different things for different people but, at a population level, we're really seeing problems related to carbohydrate quality, so the types of grains that people are consuming, as well as excess intake of things like red and processed meats. These are two major areas that we see as primary dietary drivers of problems like obesity, as well as type 2 diabetes, which are very closely linked and related.

Chris - Who is affected, principally? Are there any groups that are particularly vulnerable or is this across the social scale and across the world economies?

Meghan - Obesity has increased to about 764 million adults and, similarly, with type 2 diabetes, an increase to about 500 million. This is really a global phenomenon. There is not a single nation around the world that has experienced a decline in either diabetes or obesity in the last 40 years. There are no countries that are untouched by this problem, although there are definitely disparities and inequities in terms of this health burden. We see that individuals from lower economic status, lower education tend to have the highest burden of these types of health issues.

Chris - Why do you think that is? Because people have always been poor and people have also always been poorly educated through not necessarily any fault of their own, through the effects of society, but those people weren't always poor and overweight. So what has changed?

Meghan - We've seen massive changes in the food environment that we live in, and I think that the food policies that we see, social safety nets, they're really designed to make sure people have sufficient calories, but not necessarily nutritious calories. So I think there's a policy side to it. And then I also think that there's a kind of a private sector, food environment side as well. We see that there's increased availability and desirability of unhealthy foods, ultra processed foods that are high in sugar, refined grains, saturated fat and salt that are really heavily marketed, particularly in low income populations, and they are, in some ways, addictive.

Chris - What are the consequences of this?

Meghan - At an individual level, it has a significant impact on people's risk for diet related diseases. Think diabetes, cardiovascular disease, also infectious diseases like Covid 19. But at a population level, it really has significant implications for a nation's overall stability, healthcare system capacity, and even economic productivity, both at a business level if all the workers, employees are unable to work and they have a lot of healthcare issues, that's going to have a significant financial burden on that business. But also on economic welfare and GDP and things like that.

Chris - Tell us about the study that you've just published on this.

Meghan - We recently published an analysis that looked at the primary dietary drivers of type 2 diabetes around the world. So we estimated the proportion or the percentage, as well as absolute number, of cases of diabetes in 184 different countries that are due to poor diet as well as low intake or insufficient intake of healthy foods. We did our modeling analysis in 1990 and 2018. In 2018, poor diet contributed to 14 million cases, which represents about 70% of the newly diagnosed type 2 diabetes cases globally.

Chris - Obesity is the biggest risk factor for diabetes. This is a massive health cost, isn't it? Looking at the figures for the United Kingdom's National Health Service, the cost of diabetes is measured in the billions every year.

Meghan - Absolutely. It's an enormous healthcare cost, but it also increases individuals' risk of developing other conditions like cardiovascular disease, renal decline, fatty liver disease, cancer. Diabetes is a healthcare burden in and of itself, but also is a very significant risk factor for these other conditions.