There are 3.8 million people living with diabetes in the UK.
The study looked at annual direct patient care costs for both types of diabetes, with Type 2 at £8.8bn being far higher than that of Type 1 at £1bn.
Both Type 1 diabetes, which tends to appear in childhood, and Type 2 diabetes, often linked to diet, lead to problems controlling the amount of sugar in the blood.
Complications occur when people with diabetes sustain high levels of glucose over a long period. This can lead to increased chances of developing disease-related complications, such as kidney failure, nerve damage, damage to the retina, stroke and cardiovascular disease.
Budget crash
Baroness Barbara Young, from Diabetes UK - one of the charities involved in the Impact Diabetes report - said: "The report shows that without urgent action, the already huge sums of money spent on treating diabetes will rise to unsustainable levels that threaten to bankrupt the NHS.
"If this rise in diabetes is allowed to continue, as is happening at the moment, it will simply be disastrous for the NHS and wreck NHS budgets. I think we have a car crash coming.
"But the most shocking part of this report is the finding that almost four-fifths of NHS diabetes spending goes on treating complications that in many cases could have been prevented.
"That's hugely wasteful - in human life, in the quality of human life, and in NHS budgets. We need to stop this now and make sure people get the right sort of care early on in their condition."
Baroness Young speculated that investing in better education and more frequent health checks to reduce the risk of complications could actually be less expensive than the current approach.
Type 2 diabetes is often linked to lifestyle and diet
She said: "We need to make sure... that we prevent people getting diabetes through good risk assessment and early diagnosis to prevent spending on avoidable complications."
A Department of Health spokeswoman said that this was something they were doing.
"We agree that diabetes is a very serious illness and one that has a big impact on the NHS.
"That's why we are tackling the disease on three fronts. First, through prevention of Type 2 diabetes - encouraging people to eat well and be more active. Second, by helping people to manage their diabetes through the nine annual health care checks performed in primary care. And by better management of the condition in hospital."
Different challenges
Karen Addington, from Juvenile Diabetes Research Foundation (JDRF) - which was also commissioned the report - said: "It's the first time that we have been able to see the cost of the unavoidable autoimmune condition Type 1 diabetes separately.
"This is important because the causes of Type 1 and the challenge it presents are very different to Type 2, and only medical research can lift this burden on families, the NHS and the economy."
The report was authored by the York Health Economic Consortium and developed in partnership between Diabetes UK, JDRF and Sanofi diabetes.
At a separate conference in Copenhagen, the cost of diabetes has also been under discussion.General Yves Leterme, from the Organisation for Economic and Co-operation and Development said: "Preventing and treating diabetes and its complications costs about 90bn euros (£73bn) annually in Europe alone.
"With health budgets already under great pressure and national budgets severely strained, for the sake of our health and the health of our economies we must find ways to prevent and manage diabetes in a cost-effective manner."
Up to 24,000 deaths from diabetes could be avoided in England each year, if patients and doctors better managed the condition, a report concludes.
The first-ever audit of patient deaths from the condition said basic health checks, a good diet and regular medication could prevent most of them.
Diabetes UK said it was vital the 2.3 million sufferers had top quality care.
The Department of Health in England said shocking variations in care and an unacceptable death toll were evident.
About a third of people in the UK affected do not realise they have the condition.
It means their bodies cannot use glucose properly. If they do not manage it, they can develop potentially fatal complications like heart or kidney failure.
The report, by the NHS Information Centre, compared information about people with diabetes in England with data from death records.
Around 70-75,000 diabetic patients die every year.
The study estimated that a third of them were dying from causes that could be avoided if their condition were better managed.
That includes basic health checks from doctors, and patients taking medication and keeping to a healthy diet.
For patients with Type 1, the risk of dying was 2.6 times higher than it was for the general population.
With Type 2, the risk was 1.6 times higher.
But in younger age groups, the risk was far greater. Women between the ages of 15 and 34 with diabetes were nine times more likely to die than other women of the same age.
Men in the same age group were four times more likely to die if they had the condition.
It is the first time there has been such a comprehensive assessment of the number of affected people dying.
The National Diabetes Information Service said the number of people with the condition was rising, so if nothing was done, the number of deaths would also increase.
'Shocking' variations
"Many of these deaths could be prevented," said Dr Bob Young, diabetologist and spokesman for the National Diabetes Information Service.
"Doctors, nurses and the NHS working in partnership with people who have diabetes should be able to improve these grim statistics."
Diabetes UK described the figures as alarming.
"We know that half of people with Type 2 and more than two thirds of people with Type 1 diabetes are not receiving the care they need to stay healthy," said Barbara Young, Diabetes UK chief executive.
"It is imperative we take action now to stop even more lives being needlessly cut short.
"We will be holding the NHS to account wherever it fails to deliver high-quality care."
The Department of Health in England said the audit had revealed shocking variations in care, and an unacceptable death toll.
Care services Minister Paul Burstow said: "I expect the NHS to learn from the best. It's not rocket science - integrated health care can help people manage their diabetes, and stay well and out of hospital.
A drug that could save the sight of people with diabetes will not be made available on the NHS in England and Wales, an advisory body has concluded.
The National Institute for Health and Clinical Excellence (NICE) says ranibizumab, sold under the brand name Lucentis, is too expensive to use in people with diabetic macular oedema.
Charities say they will continue to campaign for the drug to be used.
At least 50,000 people in the UK are affected by this eye condition.
Sight saver
Macular oedema occurs when fluid leaks from the small blood vessels in the eye.
The fluid collects in the central part of the retina at the back of the eye, called the macular area, which can lead to severe visual impairment.
Straight lines may appear wavy and people can have blurred central vision or sensitivity to light.Sight can become so impaired that the person can no longer read, work or drive.Laser treatment has been the standard treatment for diabetic macular oedema on the NHS, but this only stops vision from deteriorating further.
An injection of Lucentis in the eye, however, can improve vision.
NICE already recommends Lucentis to the NHS for a different eye condition called wet age-related macular degeneration.
An eye examination can reveal the problem
Four UK charities - Diabetes UK, the Juvenile Diabetes Research Foundation, the Macular Disease Society and the Royal National Institute of Blind People (RNIB) - are urging government to rapidly agree a Patient Access Scheme with the manufacturer of Lucentis, Novartis, in order to bring down the cost of the drug to the NHS for treating diabetic macular oedema.
Currently, the drug costs £742.17 per injection.
Steve Winyard from the RNIB said: "We now hope that a patient access scheme can be agreed swiftly, so that patients with diabetic macular oedema are not left to needlessly lose their sight."
A spokeswoman for Novartis said the company would continue to work with NICE and the Department of Health to "ensure appropriate patients are able to receive this very important treatment, which in clinical trials has been shown to double the likelihood of gaining vision and reduce the chance of losing vision by up to three-fold compared to laser treatment".
Novartis believes that NICE did not consult sufficiently with clinical and patient experts on the data it submitted to the appraisal committee.
But Sir Andrew Dillon, Chief Executive at NICE, said the manufacturer significantly underestimated the cost of treatment.
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Sugar in the blood is monitored by pancreatic beta cells. If sugar levels are too high then the cells release the hormone insulin, which tells the body to bring the levels back down.
Key to this is the enzyme GnT-4a. It allows the cells to absorb glucose and therefore know how much is in the blood.
“Start Quote
The identification of the molecular players in this pathway to diabetes suggests new therapeutic targets and approaches towards developing an effective preventative or perhaps curative treatment”
End QuoteDr Jamey MarthLead researcher
Researchers at the University of California and the Sanford-Burnham Medical Research Institute say they have shown how fat disrupts the enzyme's production.
Experiments on mice showed that those on a high-fat diet had elevated levels of free fatty acids in the blood.
These fatty acids interfered with two proteins - FOXA2 and HNF1A - involved in the production of GnT-4a.
The result: fat effectively blinded cells to sugar levels in the blood and the mice showed several symptoms of type 2 diabetes.
The same process also took place in samples of human pancreatic cells.
Lead researcher Dr Jamey Marth said: "The observation that beta cell malfunction significantly contributes to multiple disease signs, including insulin resistance, was unexpected."
He suggested that boosting GnT-4a levels could prevent the onset of type 2 diabetes: "The identification of the molecular players in this pathway to diabetes suggests new therapeutic targets and approaches towards developing an effective preventative or perhaps curative treatment.
"This may be accomplished by beta cell gene therapy or by drugs that interfere with this pathway in order to maintain normal beta cell function."
Dr Iain Frame, Director of Research at Diabetes UK, said: "This is a well-executed study into possible factors responsible for the events that lead to type 2 diabetes.
"The researchers have linked their results in mice to the same pathways in humans and although they did not show they could prevent or cure type 2 diabetes they have shown it is a theory worth investigating further.
"We will watch this with great interest and hope this early work will eventually lead to some benefit to people with type 2 diabetes."
could increase risk of diabetes,” theDaily Mail reported. The newspaper said that people taking intensive courses ofstatins, the cholesterol-lowering medicines, are 12% more likely to get the disease.
These findings come from a review that combined the results of previous trials to compare the effects of intensive-dose stains with moderate-dose statins. It found that the risk of diabetes was higher in people given the intensive dose, with one extra case of diabetes expected for each 498 people treated in this way for one year. However, the intensive regime would also be expected to prevent an additional three people from having a cardiovascular event, such as a heart attack or stroke.
This research provides a good illustration of the balance of benefits and risks that exists with any drug. In this case, doctors need to weigh up the circumstances of each patient, assessing whether the reduced risk of cardiovascular events with intensive statin therapy is worth the additional risk of diabetes. Overall, the results of this research suggest that the benefits are likely to outweigh the risk in people with a greater chance of cardiovascular events.
As the Mail importantly noted, people should not stop taking their statins because of this research.
Where did the story come from?
The study was carried out by researchers from the University of Glasgow and other research centres in the UK, US and Australia. No sources of funding were reported for the current study. The study was published in the peer-reviewed Journal of the American Medical Association.
Both The Daily Telegraph and Daily Mail covered this story well, noting that the cardiovascular benefits of intensive-dose statins in high-risk individuals are likely to outweigh the risks, and that people should not stop taking their statins as a result of this research. The Telegraph also helpfully provided absolute figures that allow readers to gauge the effects of these treatments, rather than just percentage increases or reductions in risk, which can be difficult to interpret.
The Daily Express took another angle, suggesting that “cheaper statins on NHS can put patients in danger”. The newspaper said the study found that the drug simvastatin “recommended by the National Institute for Health and Clinical Excellence does not protect against coronary events as effectively as the alternative drug atorvastatin among patients taking high doses” and that the researchers call for NICE “to recommend the more expensive pill instead”. This does not represent the aims or conclusions of this research paper, and the researchers did not make such as recommendation.
The study did not aim to compare atorvastatin and simvastatin. Instead, it was concerned with comparing the effects of different doses of statin. While one analysis carried out in the study did find that intensive dose simvastatin did not reduce risk of cardiovascular events compared with moderate dose statins, this was not the main aim of the paper, and therefore these results need to be treated with caution until this observation can be investigated further.
What kind of research was this?
This systematic review and meta-analysis compared the risk of developing diabetes associated with intensive-dose statin therapy and moderate-dose statin therapy.
Statins are drugs used to reduce the levels of cholesterol in the blood, with the aim of reducing the risk of cardiovascular events such as heart attacks. In 2010, the authors of this study published a similar study which found that statin therapy was associated with an increased risk of developing type 2 diabetes. In the current study, they looked at whether the risk varied depending on the dose of statin used. As statins aim to reduce the risk of cardiovascular events, the researchers also wanted to see how the dose of statin affected the risk of cardiovascular events, such as heart attacks, strokes or death from these events.
A systematic review is the best way to summarise the evidence currently available on a particular question. Pooling the results from the available studies can lead to a more robust estimate of the effects of a treatment. However, the studies included need to have sufficiently similar methods in order for the pooled results to be meaningful and valid.
What did the research involve?
The researchers searched various research databases to identify randomised controlled trials published between 1996 and 2011 that met their inclusion criteria. They also asked other researchers in the field to provide details of any additional relevant unpublished studies. To be included, the trials had to have compared intensive-dose statin therapy and moderate-dose statin therapy in over 1,000 participants, and followed them up for at least a year.
The researchers used the search terms “intensive” or “aggressive” to identify relevant trials, but did not provide a specific definition of what they considered constituted moderate- or intensive-dose therapy. All trials used statin doses that were within the licensed dosing range for the drug, with intensive doses tending to be at the maximum recommended dose (such as 80mg of simvastatin or atorvastatin daily), while moderate doses tended to be the lower starting doses (for example, 10mg or 20mg daily).
The researchers asked the people who conducted the eligible trials to provide data that could be used in their analyses. These included the number of participants in their trials who had diabetes at the start of the study, and the number of people who developed diabetes or had cardiovascular events. They also collected data on the participants’ characteristics such as body mass index (BMI) and levels of cholesterol, other blood fats and glucose.
They then used accepted statistical methods to pool these results to see if the risk of diabetes or cardiovascular events differed between intensive-dose and moderate-dose statins. They also used statistical methods to assess how similar the trial results were. If the results were very different, this would suggest that the studies might be too different to be pooled in this way.
What were the basic results?
The researchers identified five trials that included 32,752 participants without diabetes. Three of these trials compared different doses of the same statin (simvastatin or atorvastatin), while two compared an intensive dose of one statin against a moderate dose of another statin (atorvastatin versus either pravastatin or simvastatin).
During an average of 4.9 years’ follow-up, 2,749 participants (8.4%) developed diabetes. This included 1,449 (8.8%) of those receiving intensive-dose statin therapy and 1,300 (8.0%) of those receiving moderate-dose statin therapy. This represented two more cases of diabetes per 1,000 patient years in the intensive-dose statin group than in the moderate-dose group (rising from about 17 cases per 1,000 patient years to about 19 cases per 1,000 patient years). This means that 498 people would need to be treated with intensive-dose therapy for a year to lead to one additional case of diabetes over and above what would be seen with moderate-dose statins.
During follow-up, 6,684 participants had a cardiovascular event. This included 3,134 (19.1%) of those receiving intensive-dose statin therapy and 3,550 (21.7%) of those receiving moderate-dose statin therapy. This represented 6.5 fewer cases of cardiovascular events per 1,000 patient years in the intensive-dose statin group than the moderate-dose group (reduced from 51 cases per 1,000 patient years to 44.5 cases per 1,000 patient years). This means that 155 people would need to be treated with intensive-dose therapy for one year to prevent one additional person having a cardiovascular event compared to what would be seen with moderate-dose statins.
How did the researchers interpret the results?
The researchers concluded that “intensive-dose statin therapy was associated with an increased risk of new-onset diabetes compared with moderate-dose statin therapy”. However, they note that intensive-dose statin therapy does reduce the risk of cardiovascular events compared with moderate-dose statins. They say that their findings “suggest that clinicians should be vigilant for the development of diabetes in patients receiving intensive statin therapy”.
Conclusion
This systematic review and meta-analysis suggest that intensive-dose statin therapy is associated with an increased risk of diabetes compared to moderate-dose statins. However, intensive use also reduces the risk of cardiovascular events, such as heart attacks or strokes. The study used appropriate methods to investigate this question and, importantly, gives us an idea of the trade-off between benefits and harms of intensive-dose statin therapy.
There are some points to note:
The trials that were included varied in their methods of diagnosing diabetes, which could affect the reliability of the pooled results. However, the researchers performed statistical tests and applied different types of analyses to the data. This suggests that, despite these differences in method, the trials all had similar findings. This increases our confidence in the findings of this review.
The pooled trials all included people who had established coronary disease and were at high risk of having future cardiovascular events. This means that the results may not represent what might happen in groups of people with different characteristics and who might be prescribed statins. For example, this could include people with a higher risk of developing diabetes or people with certain risk factors that had not yet developed heart disease or had cardiovascular disease events (such as people with raised cholesterol due to the hereditary condition of familial hypercholesterolemia, who are often treated with high-dose statins as “primary prevention” against them developing cardiovascular disease).
Most of the trials (four out of five) did not regularly test for diabetes so some cases may have been missed. The researchers say that it is possible that people given intensive statin therapy may have had more side effects than those on moderate-dose statins, and may therefore have seen their doctors more regularly, and received medical checkups more regularly. This could have led to diabetes being picked up more often in people receiving intensive statin therapy, with those receiving moderate-dose statin therapy remaining undiagnosed.
This research provides more information about the potential link between statin treatment and the risk of developing diabetes. It provides a good illustration of the balance of benefits and risks that exists with any drug. In this case, doctors need to weigh up for each patient whether the reduction in risk of cardiovascular events seen with intensive statin therapy is worth the additional risk of diabetes.
As echoed by most newspapers, the absolute increase in the risk of diabetes was relatively low compared to the absolute reduction in risk of cardiovascular events. Therefore, overall the benefits of statins outweigh the side effects. However, it is also worth remembering that statins are used in different ways and that this balance of benefit and risk may vary in the different groups who are prescribed the drugs. These include, people at high risk of diabetes or who take the statin as “primary prevention” to stop them developing cardiovascular disease and people who are prescribed them after an event such as a heart attack.
Links to the headlines
High-dose statins 'increase Type 2 diabetes risk'. The Daily Telegraph, June 22 2011
High doses of statins could increase risk of diabetes. Daily Mail, June 22 2011
Cheaper statins on NHS can put patients in danger. Daily Express, June 22 2011
Links to the science
Preiss D, Kondapally Seshasai SR, Welsh P et al. Risk of Incident Diabetes With Intensive-Dose Compared With Moderate-Dose Statin Therapy. A Meta-analysis. Journal of the American Medical Association. 2011;305(24):2556-2564
Further reading
Taylor F, Ward K, Moore THM, Burke M, Davey Smith G, Casas JP, Ebrahim S. Statins for the primary prevention of cardiovascular disease. Cochrane Database of Systematic Reviews 2011, Issue 1
Vale N, Nordmann AJ, Schwartz GG, de Lemos J, Colivicchi F, den Hartog F, Ostadal P, Macin SM, Liem AH, Mills E, Bhatnagar N, Bucher HC, Briel M. Statins for acute coronary syndrome. Cochrane Database of Systematic Reviews 2011, Issue 6
Newcastle University researchers found the low-calorie diet reduced fat levels in the pancreas and liver, which helped insulin production return to normal.
Seven out of 11 people studied were free of diabetes three months later, say findings published in the journal.
More research is needed to see whether the reversal is permanent, say experts.
Type 2 diabetes affects 2.5m people in the UK. It develops when not enough insulin is produced in the body or the insulin that is made by the body doesn't work properly.
When this happens, glucose - a type of sugar - builds up in the blood instead of being broken down into energy or fuel which the body needs.
The 11 participants in the study were all diagnosed with Type 2 diabetes within the previous four years.
They cut their food intake drastically for two months, eating only liquid diet drinks and non-starchy vegetables. Fat loss
After one week of the diet, researchers found that the pre-breakfast blood sugar levels of all participants had returned to normal.
MRI scans of their pancreases also revealed that the fat levels in the organ had decreased from around 8% - an elevated level - to a more normal 6%.
Three months after the end of the diet, when participants had returned to eating normally and received advice on healthy eating and portion size, most no longer suffered from the condition.
“Start Quote
It offers great hope for many people with diabetes.”
End QuoteProf Keith FraynUniversity of Oxford
Professor Roy Taylor, director of Newcastle Magnetic Resonance Centre at Newcastle University and lead study author, said he was not suggesting that people should follow the diet.
"This diet was only used to test the hypothesis that if people lose substantial weight they will lose their diabetes.
"Although this study involved people diagnosed with diabetes within the last four years, there is potential for people with longer-standing diabetes to turn things around too." Susceptibility question
Dr Ee Lin Lim, also from Newcastle University's research team, said that although dietary factors were already known to have an impact on Type 2 diabetes, the research showed that the disease did not have to be a life sentence.
"It's easy to take a pill, but harder to change lifestyle for good. Asking people to shift weight does actually work," she said.
However, not everyone in the study managed to stay free of diabetes.
"It all depends on how much individuals are susceptible to diabetes. We need to find out why some people are more susceptible than others, then target these obese people. We can't know the reasons for that in this study," Dr Lim said.
Professor Edwin Gale, a diabetes expert from the University of Bristol, said the study did not reveal anything new.
"We have known that starvation is a good cure for diabetes. If we introduced rationing tomorrow, then we could get rid of diabetes in this country.
"If you can catch people with diabetes in the early stages while beta cells are still functioning, then you can delay its onset for years, but you will get it sooner or later because it's in the system."
But Keith Frayn, professor of human metabolism at the University of Oxford, said the Newcastle study was important.
"People who lose large amounts of weight following surgery to alter their stomach size or the plumbing of their intestines often lose their diabetes and no longer need treatment.
"This study shows that a period of marked weight loss can produce the same reversal of Type 2 diabetes.
"It offers great hope for many people with diabetes, although it must be said that not everyone will find it possible to stick to the extremely low-calorie diet used in this study."
Dr Iain Frame, director of research at Diabetes UK, which funded the study, said the diet was not an easy fix.
"Such a drastic diet should only be undertaken under medical supervision. Despite being a very small trial, we look forward to future results particularly to see whether the reversal would remain in the long term."
More frequent health checks and risk assessments could reduce the cost of diabetes
Type 2 diabetes is often linked to lifestyle and diet
