Recently there has been a scurry of worrying statistics about a diabetes epidemic. Headlines suggest that diabetes is threatening to bankrupt the NHS, that there has been a 60% rise in cases in the past 10 years. Amazingly 3.3 million apparently are diagnosed with the disease, up 1.2 million in the last 10 years. Some predict further huge increases in the coming decades.
So yes we should be worried. When things go badly in diabetes we see risks of strokes, amputations and myriad other side-effects. We should partly be worried because some of these effects would be avoidable if the right medical help was offered swiftly and appropriately.
We also know how obesity is profoundly linked to diabetes, particularly type 2 which is the kind considered to be caused by and preventable by lifestyle ‘choices’. We know now just how pernicious are the effects of the food industry’s successful campaign to get us to eat more fats, sugars and other unhealthy foods. As George Monbiot recently wrote, we get addicted to these foods, which fire similarly neurobiological pathways as other addictions, link drugs and alcohol or pornography for example, all linked to the dopaminergic system.
Of course the British government is now threatening to punish the victims (addicts?) and not the corporate peddlers and dealers. Threats include that benefits will be cut and health treatment refused.
Yet equally important and often missed is that diabetes is not just a ’fat’ issue. For example one study that followed over 49,000 women for 22 years found that those suffering post-traumatic stress symptoms had at least two times the likelihood of contracting type 2 diabetes as women who had not suffered trauma. Researchers think it is very likely that extreme stress will cause change in our immune system, hormones and biomarkers such as inflammation. Another study found that young men who had suffered sexual abuse were far more likely to become diabetic, and this was irrespective of body mass index.
A British study of nearly 10,000 found that people exposed to childhood emotional adversity such as abuse and neglect had a hugely increased chanced of contracting type 2 diabetes by mid-adulthood. Risk factors included physical, verbal, or witnessed abuse; humiliation; neglect; strict upbringing; physical punishment; conflict or tension.
Studies from other countries show similar results, and also that depressive and other symptoms lead to poorer diabetes self-management. Not surprisingly research shows that there is a link between low income, adverse childhood experiences and the onset of type 2 diabetes in adulthood.
Maybe the real shock is that stress is not just linked fundamentally with type 2 diabetes, but also with type 1, the kind that was thought to be not preventable and as inherited. A huge Swedish study recently found clear links between serious life-events in childhood and type 1 diabetes. This is a very worrying and extraordinary finding.
The take-home lessons from such research are many. We cannot afford to neglect the early years and we should be stepping up our efforts to support parents, to enhance the quality of life in communities and to reduce stress, which is ironic given that the safety is being pulled away from so many due to austerity cuts, closure of children's's charities and the squeeze on welfare.
We certainly cannot afford to be blaming the obese, nor diabetes sufferers. They are victims already, of trauma, stress, abuse, neglect, and often shocking social conditions.
We of course need to be confronting huge companies peddling addictive fattening foods, especially to children, and maybe they should be paying for the effects of what they do in the only language they know, hard cash.
In terms of healthcare, as costs spiral, especially for diabetes care, investment is urgently needed to prevent a really major cause, Adverse Childhood Experiences such as abuse and trauma, which means taking seriously early psychological development. We can also do much more to support people in managing stress and anxiety, and research is making increasing sense of links between stress and diabetes Otherwise we will see an even worse diabetes epidemic in the future, and the risk is real, to children growing up now who will be the sufferers. This is of course about much more than psychological treatment though and also means fighting for a more compassionate society than we are moving towards now. If austerity is aiming to balance the books, then it should be obvious that in fact it is storing up huge financial debt in the form of future diabetes and other healthcare , as well as terrible psychological consequences.