OVER THE PAST thousand years of medical progress, the human race has seen a slow but steady increase in human longevity. Although the occasional plague, famine or war will lead to a mortality peak in a generation, by and large each new wave of humanity is healthier than the last. But it seems that this encouraging trend is about to change.
A study published in 2015 revealed that middle-aged white Americans are dying at younger ages than their parents for the first time in decades, and as with all trends, where the US leads, the UK and Europe are certain to follow soon after. In fact, there are many similar studies suggesting that today’s children may go on to lead shorter lives than their parents.
To explain these trends, experts have looked at two main factors – firstly “deaths of despair” such as opioid overdoses, suicides and complications from long-term alcohol abuse. In 2015, 52 000 Americans died of drug overdoses alone, more than those who died per annum of HIV/AIDS during the epidemic’s peak years in the mid 90s. Almost half of these deaths were due to opioid-based drugs, such as heroin or the much stronger synthetic opioid fentanyl. Secondly, a more recent study has linked diabetes to the increase in American mortality. Whilst in 1958 only 0.93 per cent of the US population was diagnosed diabetic, now 7.02 per cent (nearly 30 million people) of the country live with the disease. The number has grown three-fold since the early 1990s, rising with the ever-increasing obesity rates.
Approximately 368 million people on Earth were living with the disease in 2013. Most of these cases are diabetes mellitus type 2. This is what used to be known as ‘adult onset diabetes’, to differentiate it from type 1 diabetes, which involves the autoimmune destruction of the insulin producing beta cells in the pancreas and usually begins in childhood. Type 2 diabetes now makes up 90 per cent of all diabetes diagnoses in Europe and is seen increasingly in young adults and children.
Type 2 diabetes is associated with a ten-year reduction in life expectancy, and is thought to be an under-reported cause of death, likely affecting life expectancy trends. People with diabetes often have multiple co-morbidities which can include obesity, high blood pressure, cardiovascular disease, and even cancer.
Diabetes is one of the first recognisable diseases recorded in human history, although we have only been able to treat it relatively recently. In 1936, the two types of diabetes were made distinct. In 1944 a standard insulin syringe was developed. The structure of insulin was first determined in 1951 and the first genetically engineered, synthetic human insulin for use in patients was produced using E. coli recombinant expression in 1978.
Since then, huge progress has been made in the treatment of diabetes, both type 1 and type 2, including the introduction of the blood glucose meter and the insulin pump. Short and long-acting insulin derivatives that stem from work done within the York Structural Biology Laboratory at the University of York are now the standard treatment for many type 1 diabetes patients worldwide.
Researchers at the University of Pennsylvania looked at the prevalence of type 2 diabetes in the US population and looked at the increased risk of death among adults ages 30-84. They calculated that, while diabetes was listed as the cause of death in 3.7 per cent of cases, it was more likely to be the underlying cause in almost 12 per cent of all deaths.
Amongst the obese cohort alone, the death rate from diabetes was closer to 19 per cent. Annually, the NHS currently spends £8.8bn (over 8 per cent of its budget) treating type 2 diabetes and its complications, which range from outpatient services to amputations. On a societal level, too, type 2 diabetes has a huge impact on levels of absenteeism and early retirement as the various complications of the disease affect the sufferers’ lives.
Prevention of the onset of type 2 diabetes is the ideal solution from a healthcare perspective, and it can be achieved with both lifestyle changes and medication. Patients with prediabetes who go through lifestyle changes alone can reduce their risk of developing type 2 diabetes by 50 to 60 per cent. Simple ways to combat the onset of diabetes include methods such as losing weight, substantially increasing physical activity and quitting smoking. Although it has been known for some time that obesity and its assortment of associated co-morbidities are a leading factor in reduced life expectancy, researchers are hopeful that a focus on treating diabetes, and specifically the control of blood sugar, might help both healthcare workers and policy makers combat the trends in mortality statistics