Diabetes and the risks of being undiagnosed
4.6 million people in the UK have now been diagnosed with diabetes, an increase of 200,000 from last year. Of these, 90% have Type 2 diabetes.
An estimated 6.3 million people have pre-diabetes, a condition where blood glucose levels are elevated but not high enough for a Type 2 diabetes diagnosis. Many remain unaware of their risk.
Diabetes UK estimates that 1.3 million people are living with undiagnosed diabetes, stressing the need for more effort in detecting those with diabetes and those at risk.
Early detection of pre-diabetes is crucial to preventing Type 2 diabetes and its complications. Meanwhile, those unknowingly living with diabetes may not show symptoms for years, but left untreated diabetes can lead to severe health issues affecting the heart, eyes, feet, nerves, and kidneys.
What is Diabetes?
Diabetes is a condition caused by persistently high blood glucose (sugar) levels. It occurs when the body either doesn’t produce enough insulin, doesn’t produce any at all, or cannot use insulin effectively.
Insulin, a hormone made by the pancreas, allows body cells to absorb glucose from the bloodstream for energy. It also helps with storing excess glucose. Glucose is derived from carbohydrates in our diet.
Types of Diabetes
Type 1 Diabetes: An autoimmune condition where the body’s immune system destroys insulin-producing cells in the pancreas, preventing insulin production. It is influenced by genetic and environmental factors (such as obesity and diet), it often develops before 40 years old, normally in childhood, and requires lifelong insulin therapy.
Type 2 Diabetes: The pancreas produces insufficient insulin, or the body’s cells become resistant to it. Blood sugar levels gradually rise over months or years. This type can be linked to genetics, age, diet, and lifestyle. Unlike Type 1, Type 2 diabetes can often be reversed through lifestyle changes.
Symptoms of Diabetes
- Fatigue
- Blurred vision
- Increased urination and thirst
- Unexplained weight loss
- Slow-healing wounds
- Confusion
Long-Term Health Risks
Untreated high blood sugar damages blood vessels, leading to:
- Heart disease and strokes
- Diabetic retinopathy, which can cause blindness
- Foot problems, including circulation issues and slow-healing sores, potentially leading to amputation
- Kidney disease (Nephropathy), where diabetes and high blood pressure reduce kidney function
- Nerve damage (Neuropathy), affecting movement, sensation, and hearing
Diabetes treatment costs the NHS £10 billion per year, around 10% of its total budget, with 80% of spending going toward treating complications. In some hospitals, over a quarter of beds are occupied by diabetes patients.
Diagnosis & Screening
Currently, there is no national diabetes screening programme.
The HbA1c test is the primary diagnostic tool, measuring average blood sugar levels over 2-3 months:
- 48 mmol/mol or more = Diabetes
- Under 42 mmol/mol = Normal
A study of 1,388 random patients attending A&E, who had no known diabetes diagnosis, found, using the HbA1c test, that 30% had pre-diabetes and 120 patients had Type 2 diabetes.
Who is at Risk?
The National Institute for Health and Care Excellence (NICE) classifies at-risk groups as:
- Anyone over 40 (except pregnant women)
- Ethnic minorities over 25, including South Asian, Chinese, African-Caribbean, and Black African populations
See list of those at risk below
(The Times, The Guardian, Diabetes UK, NICE.org.uk)