Diabetes test for everyone over 40 revealed by officials

Everyone over 40 should be screened to test their chance of getting diabetes, the public health watchdog says today.

Up to four million people in England already have it, and officials believe a further five million are at high risk.

In new guidance, Nice is urging all over-40s to calculate their risk either through an online questionnaire or by visiting a GP, pharmacist, optician or dentist.

Up to four million people in England already have diabetes, and officials believe a further five million are at high risk

Anyone whose score is high will be offered further tests to measure their blood sugar level. 

Patients whose level is very high will be sent on a 13-step intensive behavioural change course where they will be told to lose weight, avoid red meat and start exercising.

Nice wants at least 1.7million adults who are at the highest risk of developing diabetes to be referred on to the intensive courses by their family doctors.

But GP leaders last night warned that ‘blanket checks’ for all over-40s could lead to patients having unnecessary tests, taking up precious appointment time.

Diabetes costs the NHS almost £9billion a year and one in six hospital beds at any one time are occupied by someone with the condition. 

The number of patients diagnosed has increased by 60 per cent in a decade due to rising levels of obesity, which greatly increases the risk.

The illness can be prevented and even reversed – after patients have been diagnosed – through basic lifestyle changes which lower the blood sugar.

As a first step, Nice is encouraging all over-40s to get themselves screened. Anyone who is from an ethnic minority and aged 25 to 39 should also be screened as they are at higher risk of type 2 diabetes.

In new guidance, Nice is urging all over-40s to calculate their risk either through an online questionnaire or by visiting a GP, pharmacist, optician or dentist

In new guidance, Nice is urging all over-40s to calculate their risk either through an online questionnaire or by visiting a GP, pharmacist, optician or dentist

The online assessment, called the Know Your Risk form, is available on the Diabetes UK website and asks patients their age, weight, height, waist circumference and family history. They are given a score and told if their risk of diabetes is high, moderate, slightly increased or low.

GPs are being told to identify if patients are at risk of diabetes as part of their NHS Health Check, which is offered to those aged 40 to 74 every five years.

And dentists and opticians are being urged to assess patients’ diabetes risk during routine check-ups.

Dr Mark Baker, director of the centre for guidelines at Nice, said the aim was to identify adults who had no idea they were at risk of diabetes.

‘We know that helping someone to make simple changes to their diet and exercise levels can significantly reduce their risk of developing type 2 diabetes, and that this approach is a cost-effective way of managing an illness that currently costs the NHS around £8.8billion a year.

‘We need to make sure that the people most at risk have access to the care they need.’

Dan Howarth, head of care at the charity Diabetes UK, added: ‘Type 2 diabetes is a serious condition that can lead to harrowing complications, so preventing it from developing in those at higher risk is hugely important.

Intensive prevention courses for 1.7m

The diabetes prevention courses last at least nine months and consist of at least 13 sessions.

Some are made up of exercise classes while others teach patients to cut levels of saturated fat and lose weight.

They are run by nutritionists and fitness advisers who encourage patients to cut down on treats including cakes, cheese and red meat – but increase their intake of fruit, veg and wholegrains. They are given short-term goals –such as losing a pound a week – in the hope of eventually reaching a healthy weight.

Patients are also taught strategies to help them resist cravings for sugary foods, to prevent them relapsing and gaining weight again.

Some sessions involve motivational interviews with lifestyle coaches which help reinforce reasons for wanting to become healthier.

‘We welcome these updated guidelines, which recognise the importance of preventing the condition, and the serious harm it causes to those living with it.’

The behavioural change courses last at least nine months and patients have at least 13 one-to-one sessions with nutritionists and fitness advisers.

They are encouraged to do at least 150 minutes of exercise a week, slim down to a healthy body mass index and avoid red meat, cakes and full fat diary.

But Professor Helen Stokes-Lampard, of the Royal College of GPs, said: ‘We would advise caution in methods for targeting patients – blanket checks for all over 40s, for example, have the potential to subject healthy people to unnecessary tests, and this both deflects resources away from delivering patient care to those who really need it and could cause unintended harms.

‘Any new national screening programme would need formal evaluation by the relevant bodies.’ 

Diabetes occurs when the blood sugar becomes very high, either because patients do not produce enough of the hormone insulin or their cells don’t respond.

The raised blood sugar then damages the nerves and organs causing blindness, kidney damage, foot amputations, heart attacks and strokes.

Nice has a wide-ranging role which includes issuing public health guidelines as well as deciding which medicines are cost-effective and can been prescribed on the NHS.

But some of the watchdog’s previous advice has been criticised as patronising and overly nannying.

This includes recommendations on driving more smoothly to reduce exhaust fumes, keeping a food diary to lose weight and not spending more than ten minutes in the sun.

How eating too much salt significantly increases diabetes risk

Eating too much salt significantly increases the risk of developing diabetes, researchers have found.

For every extra 2.5g of salt people consume each day – roughly the amount found in a single rasher of bacon – the risk of developing type two diabetes increases 65 per cent.

High salt intake has long been known to increase blood pressure, with a knock-on impact on heart disease and other conditions, but the new research is the strongest yet to link it to diabetes.

Experts from the Karolinska Institute in Sweden assessed the diet of 2,800 people and analysed how much salt they consumed.

They found a strong link between salt intake and type two diabetes, with those with the highest third of salt consumption – those who ate more than 7.3g a day – displayed a 72 per cent increased risk of compared to those with the lowest third.

Crucially, most British people eat far more than this.

We are advised to consume no more than 6g a day, but although intake has dropped in recent years, the average British adult still consumes 8g a day, according to the latest official statistics.

Experts estimate 80 per cent of salt intake comes from processed food, with only 20 per cent added at the dinner table.

The researchers, presenting their findings at the European Association for the Study of Diabetes in Lisbon, calculated for every extra 2.5g of salt eaten a day, no matter the starting point, the risk of having type two diabetes increased by 65 per cent.

They believe this may be because sodium – which makes up 40 per cent of salt – makes the body resistant to insulin, the main feature of diabetes.

Alternative theories suggest the impact on blood pressure or weight could indirectly have an indirect impact on diabetes.

The researchers also found a strong link between salt intake and the development of another form of diabetes called LADA – Latent Autoimmune Diabetes in Adults – an autoimmune condition which is similar to type one diabetes.

Unlike type one diabetes, which usually is diagnosed in children, LADA is slow developing and often makes its first appearance in adulthood.

The researchers found salt intake on the risk of developing LADA was even greater than for type two diabetes, with an 82 per cent rise for each 2.5g consumed per day. Those with certain genetic make-ups were at even higher risk.

The authors said: ‘We confirm an association between sodium intake and type 2 diabetes.

‘High sodium intake may also be a risk factor for LADA, especially in carriers of high risk HLA genotypes.’

They added: ‘These findings may have important implications in the primary prevention of diabetes with adult onset.’ 

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