Diabetes

Luke Graham Excerpts

Wednesday 9th January 2019 Westminster Hall

[Sir John Hayes]

My right hon. Friend makes a very shrewd point about cause and effect. In Scotland, for example, both the processes leading to allocation and the actual allocation of technology are much more routine, as he suggests should be the case. I hope the Minister will tell us today or subsequently how he will ensure that that becomes true for the whole of our kingdom—that the very principles set out by my right hon. Friend become embedded in the way in which we approach technology, ensuring that it is allocated according to need.

We all agree that the resources should be targeted to secure optimal outcomes for the 4.6 million people who have been diagnosed with the condition. In addition to those diagnosed, however, one in three adults in the UK has pre-diabetes and might be at risk of developing type 2 diabetes if they do not change their lifestyle—a point made by a number of Members in interventions. About three in five cases of type 2 diabetes can be prevented or delayed. A focus on preventing the onset of diabetes should be of paramount importance. G. K. Chesterton said:

“It isn’t that they can’t see the solution. It is that they can’t see the problem.”

By seeing the problem, the solution will be implicit, because many more people will never develop type 2 diabetes if they make those adjustments to their lifestyle.

There is a dilemma, though: is it better that 50,000 people get a perfect solution and are prevented from having diabetes, or that 5 million people reduce their risk marginally? Let me set that out more clearly. Is it better that a small number of people achieve what the deputy leader of the Labour party, the hon. Member for West Bromwich East, has done—losing immense amounts of weight, changing their lifestyle and completely revising their diet? Or is it better that a very much larger number of people make a smaller change, lose less weight and change their lifestyle more marginally, but by so doing significantly reduce their risk of developing type 2 diabetes?

That is a challenge in health education; it affects many aspects of the health service’s work. It probably means that, rather than seeing this issue purely from a clinical perspective, we have to democratise the diabetes debate, spread the word much more widely and get many more people to lose a couple of inches off their waist, to lose a stone or half a stone. That effect would be immense in reducing the risk of diabetes, not for tens of thousands but for millions of people.

If the figures I have brought forward are so—I have cited them only because I have learnt them from Diabetes UK and others who have helped me to prepare for this debate—we would change the lives of very large numbers of constituents in a way they would be able to manage, understand, comprehend and act upon reasonably quickly. I want the Minister to reflect on the dilemma I have described; it may not be quite so much of an either/or as I have painted it, but we need a democratic debate about that, which is part of the reason I have brought this debate to the House. Certainly we need an open and grown-up conversation about some of those measures and how we go about tackling what I have described as a crisis.

I do not want to speak forever, Mr Robertson—I know you and others in the Chamber will be disappointed to hear me say that. That will cause disappointment and even alarm among some, but I want others to contribute the debate. However, I have a couple of other points to make so I will move on—having taken a number of interventions already, I hope colleagues will bear with me.

I have been fascinated to read about research funded by Diabetes UK that proves that remission is possible. I would like to take the time to congratulate the hon. Member for West Bromwich East once again and to say that I hope many more people will recognise that remission is a real possibility for them by making changes in what they do.

Part of the issue is how lives more generally have changed. My father cycled five miles to work and five miles home every day, but now most people do not do that. Once many more people worked in manual jobs—my father had a physique like Charles Atlas, but the nearest I have come to Charles Atlas is reading an atlas. Part of the problem is the way we live now; far fewer people exercise implicitly in the way he did, and it seems that junk food is more appealing to many people than eating fresh, healthy produce—indeed, that has been recognised by successive Governments as significant for health outcomes.

Evidence shows the best way to reduce the risk of diabetes is through a healthy diet, being physically active and reducing weight. That can be facilitated through societal approaches and targeted individual interventions. Technology, including digital services to support lifestyle changes, is increasingly critical in diabetes prevention. To be sustainable, methods to prevent type 2 diabetes should focus on individual behaviour change, not just short-term activity levels.

We recently learned that, by their 10th birthday, the average child in the UK has consumed 18 years’ worth of sugar. That means they consume 2,800 more sugar cubes per year than recommended levels. The current food chain has become badly distorted. Basic knowledge that my parents’ generation took for granted about how to buy, cook, prepare and store food has steadily but alarming declined.

We have allowed soulless supermarkets to drive needless overconsumption of packaged, processed, passive, perturbing products, and it is time that the greed and carelessness of corporate multinational food retailers gave way to a better model. It is not a coincidence, it is something considerably more than that; as local food retailers have declined—people knew from whom they were buying, understood what they were buying and where it came from—the consumption of processed, packaged ready meals has grown. We need to rebalance the food chain in favour of locally produced, healthy produce and to re-educate people about how to buy, cook, eat and enjoy it.

[Luke Graham (Ochil and South Perthshire) (Con)]

I will certainly give no lectures on buying and cooking food, but will my right hon. Friend join me in supporting Diabetes UK’s Food Upfront campaign, which calls for a front-of-pack traffic light system to ensure that the content and nutritional value of processed foods are much clearer for people who are suffering from diabetes, and for a whole other range of dietary and nutritional needs?

[Sir John Hayes]

Entirely; in fact, I call on the Minister to do just that: will he introduce a mandatory front-of-pack traffic light labelling system, which is supported not only by my hon. Friend but by 83% of the population when asked whether that should happen? The Minister will be in tune with popular opinion; he will become something of a popular hero by responding to my hon. Friend’s request, which I amplify.

--- Later in debate ---

[Mr George Howarth (Knowsley) (Lab)]

I congratulate the right hon. Member for South Holland and The Deepings (Sir John Hayes) on giving us the opportunity to debate this subject, and on the comprehensive way he introduced it. He rightly spoke about the potential of technology—I will say more about that in a moment—and about the distinction between those who deal with type 1 diabetes and those with type 2 diabetes. It is important always to make that distinction, because type 1 diabetes is an autoimmune condition over which the person involved has no control. It is not a lifestyle-related problem; someone is born with a predisposition to diabetes and something—we do not really understand what—will trigger it at some point in their life, often at a young age. There is also increasing incidence of people developing type 1 diabetes at an older age, which is a relatively new phenomenon. I will confine my remarks to type 1 diabetes and consider what can be done to help people better to manage their condition.

The Juvenile Diabetes Research Foundation is working with Cambridge University to develop an artificial pancreas. The problem with type 1 diabetes is that the pancreas does not work to produce the required levels of insulin—indeed, in most cases it produces no insulin at all. Currently, a person can have a device for continuous blood glucose monitoring, and if it is judged that the condition is not being managed satisfactorily, they can also have an insulin pump. Those are two separate devices; the beauty of the artificial pancreas is that through an algorithm the two are linked, so while the person receives continuous blood glucose level monitoring, the algorithm also enables the insulin pump to respond to a requirement for additional insulin, depending on the blood glucose level. The potential is enormous, and I commend the Juvenile Diabetes Research Foundation for its work. The technology the right hon. Gentleman referred to is now close to being so good that type 1 diabetes will become much easier to manage, which is important.

Before Christmas, I secured an Adjournment debate on the development of the artificial pancreas in which I mentioned the fact that people are now devising their own artificial pancreases. It seems mostly to involve young people who, in some cases, are technologically savvy enough to devise their own algorithms and link a blood glucose monitoring device to a pump. They are devising those devices in their bedrooms or other normal settings. Someone who is a bit older contacted me after the debate and said, “I didn’t devise this in my bedroom. I’m an engineer and I did it on the kitchen table.” The point is that people are capable of doing such things. I am not saying that that is the way forward, because although many of those devices work and people are pleased with the results of the things they have devised, it cannot be right that they are being left to create such devices on their own without them being quality assured and tested by people who are competent to do so. It shows, however, the potential of what people can do for themselves.

We should not fool ourselves into believing that technology will resolve all the problems, because the situation is difficult, particularly for some young people. Think about when we were teenagers: no matter how well disciplined or well behaved people are, the lifestyle of a teenager does not easily lend itself to monitoring a diabetic condition. Going out with a group of friends for a meal or drink and having to adjust one’s insulin level with an injection can be awkward. Young people also face challenges with the way their condition is perceived by their peer group. In some instances, people confuse type 1 and type 2 diabetes and young people in school get bullied on the basis that they have brought their diabetes on themselves because they eat too much sugar. I have seen examples of that. An autoimmune condition is not triggered by one’s lifestyle at all, yet people get bullied on that basis and it is important that they receive the necessary support.

One of my worries—I hope the Minister will try to address this when he responds to the debate—is that there is often a need for psychological, or even in some cases psychiatric, support because the challenges of being a young diabetic are such that people need other support. Schools, by the way, need better training in supporting pupils with diabetes. There have been examples of young people becoming hypoglycaemic and, when they have tried to raise their need to deal with it with the teacher, being told off and humiliated because they happen to have that condition at that time.

[Luke Graham]

The right hon. Gentleman makes a valid point. I have friends and family members with diabetes, and there are tell-tale signs. At the moment there is a great schools initiative to encourage teachers and students to do CPR and first aid; perhaps spotting the tell-tale signs of a hypo could be included in that package, and promoted in schools. Will he join me in supporting that?

[Mr Howarth]

Yes. I will not labour the point, but the hon. Gentleman is right. I would add that quite often teachers are left with such responsibilities, although they have enough challenges in their working life, but there is a need for someone in the school to have the expertise and to be trained to deal with young people with type 1 diabetes.

I know that I assured you, Mr Robertson, that I would try to be briefer than I have been, but I am coming to the end of my remarks, and the matter is important. I join the right hon. Member for South Holland and The Deepings in saying that it would be useful to have a meeting with the Minister to discuss the matter in more depth and get his thoughts on how to move forward. There is much that we can do to make people’s lives better. I hope that the debate will inform that process, and that we will be able to move forward on the basis of consensus across the House. The Minister faces challenges, and Members of this House will want to share the burden of them.