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We need to start viewing type 2 diabetes as a lifestyle issue

Once patients are on the medical merry-go-round, there’s virtually no way off.

Diabetes has got us in a quandary. Numbers of diabetics have more than doubled over the past two decades, with an estimated 3.5 million people currently diagnosed in the UK. Ten per cent of the entire NHS budget is spent treating it – there’s been an explosion of new, expensive pharmaceutical products capable of lowering blood sugar. And the medical profession is slowly waking up to the realisation that we are a large part of the problem.

Diabetes comes in two types. Type 1 typically presents in childhood, when an aberrant immune system destroys the pancreas’s ability to make insulin. Type 1 diabetics need insulin therapy for life, and they’re a tiny minority of all diabetic patients. For the purposes of this column, forget about them.

Type 2 diabetes is very different. It usually presents in mid- to late life, mostly as a consequence of obesity. In the early stages, the pancreas continues to make insulin, but the excess fat tissue in the body blunts its effect – so-called insulin resistance. Sugar levels rise, driving the pancreas to produce ever more insulin in a vain attempt to keep them under control. At this stage, type 2 diabetes is potentially reversible: if patients can lose weight then their insulin resistance reduces and demands on the pancreas decrease. Without weight loss, though, there comes a point when the escalating demand for insulin causes the pancreas to burn out, and insulin production begins to fail. At this stage, type 2 diabetes can no longer be reversed.

Diabetes causes serious complications: blindness, kidney failure and heart disease, to name but three. Traditionally, doctors have doled out pills and injections to help prevent its sequelae. We perform regular blood tests to monitor things, and are forever adding new treatments to tighten sugar control.

We may mention lifestyle factors such as weight, diet and exercise, but our every action conveys to patients that this is not what we’re really interested in. Patients learn that they “have” a disease called diabetes, and become passive recipients of ongoing medical care. They even become eligible for free prescriptions, such is the importance we attach to drug therapy. But many of our treatments (and our flawed dietary advice) actually cause further weight gain. Once someone gets sucked on to the medical merry-go-round, there’s virtually no way off.

The burgeoning rates of diabetes reflect the current epidemic of obesity. We’re surrounded by cheap, delicious, energy-dense foodstuffs. For too many people, “exercise” equates to the walk from the car to the supermarket door. It’s gradually dawning on the medical profession that we have to stop treating type 2 diabetes as a disease; we can’t keep turning millions of people into long-term patients.

The alternative is a cultural shift to viewing type 2 diabetes as a lifestyle issue. Around the country, the NHS is beginning to offer newly diagnosed type 2 diabetics referral on prescription for exercise, weight loss, dietary advice and cooking skills. This approach needs to be far bolder. Currently these “lifestyle prescriptions” last for up to 12 weeks, after which patients are left to get on with it. Offering free prescriptions for, say, a maximum of six months, but unlimited free access to gyms and weight-loss classes, would start to send the right signal.

As a profession, we also have to overcome an ingrained cynicism. We can all think of patients who prefer to “have” a disease and rely on medication to manage it, but we tar too many people with the same brush. Pioneering doctors are reporting high success rates from initial conversations that starkly set out the options: multiple drugs for life, or a chance to turn things round with simple lifestyle measures. Not everyone is willing or able to change. But if we offer everyone support to take a different path, we’ll be pleasantly surprised. Both patients and the NHS budget stand to gain. 

This article first appeared in the 27 July 2017 issue of the New Statesman, Summer double issue

Arsène Wenger. Credit: Getty
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My biggest regret of the Wenger era? How we, the fans, treated him at the end

Arsenal’s greatest coach deserved better treatment from the Club’s supporters. 

I have no coherent memories of Arsenal before Arsène Wenger, who will leave the Club at the end of the season. I am aware of the Club having a new manager, but my continuous memories of my team are of Wenger at the helm.

They were good years to remember: three league titles, seven FA Cups, the most of any single manager in English football. He leaves the Club as the most successful manager in its history.

I think one of the reasons why in recent years he has taken a pasting from Arsenal fans is that the world before him now seems unimaginable, and not just for those of us who can't really remember it. As he himself once said, it is hard to go back to sausages when you are used to caviar, and while the last few years cannot be seen as below par as far as the great sweep of Arsenal’s history goes, they were below par by the standards he himself had set. Not quite sausages, but not caviar either.

There was the period of financial restraint from 2005 onwards, in which the struggle to repay the cost of a new stadium meant missing out on top player. A team that combined promising young talent with the simply bang-average went nine years without a trophy. Those years had plenty of excitement: a 2-1 victory over Manchester United with late, late goals from Robin van Persie and Thierry Henry, a delicious 5-2 thumping of Tottenham Hotspur, and races for the Champions League that went to the last day. It was a time that seemed to hold the promise a second great age of Wenger once the debt was cleared. But instead of a return to the league triumphs of the past, Wenger’s second spree of trophy-winning was confined to the FA Cup. The club went from always being challenging for the league, to always finishing in the Champions League places, to struggling to finish in the top six. Again, nothing to be sniffed at, but short of his earlier triumphs.

If, as feels likely, Arsenal’s dire away form means the hunt for a Uefa Cup victory ends at Atletico Madrid, many will feel that Wenger missed a trick in not stepping down after his FA Cup triumph over Chelsea last year, in one of the most thrilling FA Cup Finals in years. (I particularly enjoyed this one as I watched it with my best man, a Chelsea fan.) 

No one could claim that this season was a good one, but the saddest thing for me was not the turgid performances away from home nor the limp exit from the FA Cup, nor even finishing below Tottenham again. It was hearing Arsenal fans, in the world-class stadium that Wenger built for us, booing and criticising him.

And I think, that, when we look back on Wenger’s transformation both of Arsenal and of English football in general, more than whether he should have called it a day a little earlier, we will wonder how Arsenal fans could have forgotten the achievements of a man who did so much for us.

Stephen Bush is special correspondent at the New Statesman and the PSA's Journalist of the Year. His daily briefing, Morning Call, provides a quick and essential guide to domestic and global politics.