Background on the campaign
Why are we doing this campaign?
We have been calling for early identification of people with Type 2 diabetes for many years, to reduce the impact of diabetes on individuals and on NHS resources.
More than half a million people in the UK have Type 2 diabetes but are unaware of it and have the condition for 9 to 12 years before diagnosis.
The UKPDS showed that up to 50 per cent of people with Type 2 diabetes already have some of the complications such as cardiovascular disease, neuropathy, nephropathy and retinopathy by the time they are diagnosed.
Through this campaign we aim to raise awareness of diabetes, and the risk factors that increase a person's risk of developing Type 2 diabetes.
The benefits include reducing the risk of developing the long-term complications of diabetes, improving quality of life and cost savings to the NHS.
We first developed the campaign, and then went out for corporate support to help fund the advertising and other campaign activity.
What are the risk factors for diabetes?
The following people should be screened for diabetes:
a) White people aged over 40 years and people from black (including people of African-Caribbean origin), Asian and minority ethnic groups aged over 25 with one or more of the risk factors below:
- a first degree family history of diabetes and/or
- overweight/obese/morbidly obese with a BMI of 25 kg/m2 and above, with a sedentary lifestyle and/or
- waist measurement > 94cm (> 37 inches) for white and black men, and > 90cm (> 35 inches) for Asian men, and > 80cm (> 31.5 inches) for white, black and Asian women.
b) People who have ischaemic heart disease, cerebrovascular disease, peripheral vascular disease or treated hypertension.
c) Women who have had gestational diabetes, who have tested normal following delivery (screen within six weeks of delivery and then one year post-partum and then three-yearly).
d) Women with polycystic ovary syndrome who have a BMI > 30.
e) People who are known to have impaired glucose tolerance or impaired fasting glycaemia.
f) People who have severe mental health problems.
g) People who have hypertriglyceridaemia not due to alcohol excess or renal disease.
The more risk factors a person has, the more likely they are to be at risk of diabetes and the greater the sensitivity and specificity of a screening test. Evidence is not currently strong enough to weight individual risk factors.
Have the risk factors changed?
We still do not advocate random screening but targeted screening among the high-risk groups above. The risk factors of Type 2 diabetes that you will be familiar with still remain; however, we have gained a consensus of opinion, and additional risk factors that increase a person's risk of developing Type 2 diabetes have been added. These include a person's waist circumference, whether they have severe mental health problems and hypertriglyceridaemia not due to alcohol excess or renal disease.
Further details, with the waist measurements which increase a person's risk can be found in our Position Statement, Early identification of people with Type 2 diabetes (June 2006).
What is the importance of waist measurement?
Waist measurement is a very practical way to assess body fat, particularly abdominal fat, and is a good predictor of increased health risk, including risk of Type 2 diabetes.
A person's waist circumference has been shown to be an independent risk factor for people with a normal body mass index (BMI). Indeed, for older people and people of south Asian origin it has been shown to be more useful than BMI as a predictor of health risk. (Although more accurate than body weight alone, risk assessment using BMI may overestimate fat in people who are very muscular or underestimate fat in those who have lost muscle mass.)
What research was used to develop the campaign focus on waist measurement?
The following findings were used to help develop the campaign focus:
- Waist circumference may be an even better marker of Type 2 diabetes risk than either weight or BMI alone.
- Even among non-obese patients, abdominal distribution of fat and increased waist measurements are independently associated with the risk for Type 2 diabetes.
- Recent prospective studies suggest that central obesity as represented by anthropometric measurements such as waist circumference is a better predictor of the development of Type 2 diabetes than overall obesity as reflected by BMI measurements.
These findings are supported by research - you will find details and links to the relevant abstracts in our Resources section.