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Avoiding diabetes

Diabetes is on the rise, Dr Mark Vanderpump, of Express Medicals, reports.

Type 2 diabetes is the form of diabetes that usually occurs in middle-aged and older persons. It is characterised by elevated blood glucose due to deficiency in the action (i.e. insulin resistance) and secretion of the hormone insulin. It is usually treated by diet, exercise and tablets and may eventually require insulin therapy in some cases. In up to 80% of cases it is associated with obesity.

Increase in obesity

The number of people classified as obese has trebled since the 1980s and the projection is we should expect a 10% increase in the number of men who are obese and a 7% increase in the number of women, taking the population estimates up to 1 in 4 being obese in 2012.

The increase in obesity has already caused an increase in type 2 diabetes which is expected to also rise significantly in the next 5 to 10 years. The prevalence of type 2 diabetes is approximately 7% in London and by 2020 it is estimated to be nearer 10%. Even higher rates may be seen among people from South Asian origin.

Body Mass Index (BMI)

The metabolic syndrome describes a collection of abnormalities including abdominal or central obesity, high blood pressure, high cholesterol and fat levels and high blood sugars all of which increase risk of cardiovascular disease.

Obesity is usually defined by the body mass index (BMI). This marker of obesity is calculated from the weight in kg divided by height in metres squared. A BMI greater than 30-35kg/m2 is thought to be significantly obese.

However the key issue is where you have collected your weight not your total weight.

Many patients with type 2 diabetes have a BMI in the slightly overweight range but who have collected significant fat centrally within the abdomen. European men are defined as being centrally obese once their weight circumference is above 37 inches (94cm) and their risk of diabetes is significantly raised once their waist circumference is greater than 40 inches (102cm). The equivalent figures for women are 31.5inches (80cm) and 34.5inches (88cm).

Waist circumference

There is now strong evidence that your waist circumference is the first sign of an increased risk of developing type 2 diabetes. The waist circumference is measured around the abdomen at the level of the

belly button (umbilicus) and reflects the fat that collects inside the abdomen around the gut.

Fat collects here if the insulin hormone which controls carbohydrate metabolism is not working effectively. Most patients assume the fat is collected under the skin (so called “love handles”) but in reality this subcutaneous fat does not differ as much as you might expect between thin and overweight people.

This is the reason why the fat removed by liposuction usually re- accumulates within a year. Most men believe that their waist circumference is at least 3 inches less than measured as men are used to wearing their trousers around their hips and clothes manufacturers pamper their egos.


The measurement of the waist circumference therefore allows us to identify people at risk of type 2 diabetes. It allows you the chance to stop or slow the progression to type 2 diabetes.

Lifestyle modification is key with regular cardiovascular exercise (at least three 45 minute sessions per week) and grabbing every opportunity for exercise in your daily life such as avoiding lifts and walking up stairs etc.

There is no doubt that we are eating too much carbohydrate which encourages insulin production so make the majority of your diet foods such as chicken, fish, fruit and vegetables and cut back significantly or your portion sizes of bread, pasta, rice and potatoes.

If you manage to lose 10kg then you know you will have significantly reduced your blood pressure and cholesterol as well as your risk of developing type 2 diabetes.

As there is a strong inheritance in type 2 diabetes (ie if your mother or father has type 2 diabetes then your risk is almost 50%) then there is also the opportunity to encourage the younger members of your family regarding the benefit of keeping their waist circumference as low as possible as well.

Dr Mark Vanderpump is a London-based consultant physician and senior lecturer in diabetes and endocrinology. See www.markvanderpump.co.uk. His email address is [email protected] Dr Vanderpump has provided some training to the medical staff at Express Medicals.

See our website: www.expressmedicals.co.uk or call 020 7500 6900.


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