Radically upgrading diabetes prevention in England

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3 million people in England currently have type 2 diabetes. 1 Health and Social Care Information CentreQuality and outcomes framework—2012–13. http://www.hscic.gov.uk/catalogue/PUB12262 Google Scholar Estimates suggest that diabetes consumes almost 10% of the UK National Health Service (NHS) budget—about £9 billion annually—and is responsible for more than 100 amputations every week and 20 000 early deaths every year. 2 Health and Social Care Information CentreNational diabetes audit—2011–12. http://www.hscic.gov.uk/catalogue/PUB12421 Google Scholar , 3 Hex N Bartlett C Wright D Taylor M Varley D Estimating the current and future costs of type 1 and type 2 diabetes in the United Kingdom, including direct health costs and indirect societal and productivity costs. Diabetic Med. 2012; 29: 855-862 Crossref PubMed Scopus (555) Google Scholar This burden, although largely preventable, is increasing; by 2025 an estimated 4 million people will have diabetes. 4 Public Health EnglandDiabetes prevalence model (APHO). http://www.yhpho.org.uk/resource/view.aspx?RID=81090 Google Scholar The health and economic rationale for prevention is clear. Diabetes prevention in England – Authors' replyWe thank John Yudkin and Christopher Millett for their correspondence. We agree that radically upgrading prevention will require a whole-society approach, with alteration of environmental and contextual factors, supporting people in achieving improved dietary intake and increased physical activity. Supporting this societal approach, local authorities now have a statutory responsibility for improving health, and councils and elected mayors are able to make an important impact. For example, the London Borough of Barking and Dagenham are seeking to limit new junk food outlets near schools. Full-Text PDF Diabetes prevention in EnglandThe announcement of NHS England's National NHS Diabetes Prevention Programme1 (DPP) comes just weeks after Nicholas Wareham's warning2 about the “achievability gap” in attempts to roll out lifestyle approaches used in the original DPP study.3 Preventing diabetes, moreover, is qualitatively different from preventing cancer. Glycaemia is a continuous variable, with an HbA1c cutpoint of 6·5%, or a fasting glucose of 7·0mmol/L, as the diagnostic threshold. Interventions in the DPP study simply delayed crossing this threshold by 2–4 years,4 with reduction in levels of HbA1c of 0·1–0·2% over 10 years, less than one-fifth of that achieved during the UK Prospective Diabetes Study. Full-Text PDF