Tens of thousands of people in England living with early onset type 2 diabetes will benefit from more intensive and targeted care, thanks to a world-first initiative being rolled out by the NHS.
Around 140,000 people aged 18 to 39 years old will receive additional tailored health checks from healthcare staff, and support with diabetes management, such as blood sugar level control, weight management and cardiovascular risk minimisation.
Under the ambitious new programme, named ‘T2Day: Type 2 Diabetes in the Young', patients will benefit from extra one-to-one reviews as well as the option of new medicines and treatments where indicated, to help better manage their diabetes.
Addressing the additional risks associated with the condition during pregnancy, there will also be dedicated support available for women, including access to contraception and folic acid supplements.
Backed by £14.5 million, local health teams will be supported to roll out the new scheme to help minimise the risk of these people developing health complications and severe illness and to support a reduction in health inequalities.
Eligible individuals may also be able to access the NHS Type 2 Diabetes Path to Remission Programme - a year long programme including 12 weeks of low-calorie total diet replacement products and support to re-introduce food, with the aim of supporting participants to improve their blood sugar levels, reduce diabetes-related medication and in some cases put their type 2 diabetes into remission.
The NHS is the first health system in the world to put in place a national, targeted programme for this high-risk group of people.
Early onset type 2 diabetes is more aggressive than later onset type 2 diabetes and is more prevalent in people living within deprived areas and individuals from minority ethnic groups.
Defined as a serious disease by medical experts, early onset type diabetes is associated with premature mortality, worse long-term health outcomes, and higher risk of diabetes-related health complications, such as sight loss, kidney failure, amputation, heart attacks and strokes.
Professor Jonathan Valabhji, National Clinical Director for Diabetes and Obesity said:“Type 2 diabetes in people under 40 is a growing problem globally - England is no exception, meaning there is an ever-increasing challenge for the NHS.
“We know this age group is least likely to complete vital annual health checks but we want to ensure people are able to manage their diabetes well and reduce the risk of serious complications, which is exactly why we have embarked on an ambitious and world-first initiative called T2Day: Type 2 Diabetes in the Young.
“The programme will provide targeted intervention for each person under the age of 40 living with type 2 diabetes, including additional reviews focused on completing proven diabetes care processes, managing blood sugar levels, weight management, preparation for pregnancy, and supporting any unmet psychological or social needs.
“We are delighted to roll out this initiative, which we hope will be a big step forward to improving care in this high-risk group of individuals.”
Analysis of the National Diabetes Audit has shown that the rate at which young adults are diagnosed with early-onset type 2 diabetes has risen faster than the rate of diagnosis in over 40s' in England.
Dr Shivani Misra, a consultant in diabetes and metabolic medicine who has been part of the clinical team developing the programme, said: “This is great news for young adults living with type 2 diabetes who are at high risk of developing complications and other long-term conditions. I am delighted our research has helped to shape the T2DAY programme and look forward to supporting delivery of this innovative intervention”.
Research shows that on average someone diagnosed with type 2 diabetes at 20 years-old, will have an overall reduced life expectancy of 11 years, compared to a reduced life expectancy of two years, when diagnosed at 65 years-old.
Sarah Parsons, 45 years old from Plymouth, was diagnosed with Type 2 diabetes in her 20s. She reflects on how helpful this kind of programme could have been for her at the time of her diagnosis.
Sarah said: “My journey to a diagnosis of type 2 diabetes began as a teenager. My parents knew things weren't right as my weight gain was averaging a stone a year - by 21, I was 21 stone, and my mental health was rapidly declining because of it.
“Around this time, I finally asked for help with my comfort eating and was formally diagnosed with an eating disorder. Eventually treatment and therapy allowed me to take control of the situation, but despite this I had to start Metformin and other medications for type 2 diabetes.
“Risk factors weren't discussed at my appointments or annual checks - it was presumed I knew what was expected and that I was being proactive and reading up on what was needed and the conditions I was at higher risk of. I did have a two-day diet course in my late 20's but don't remember risks being discussed and I was very overwhelmed as everyone else was over the age of 50 and I spent most of the two days trying not to cry in front of the group.
“Now, at 45 years old, I face living with multiple complex complications. For young people living with early onset type 2 diabetes now, extra clinician time could potentially pick up signs before all this escalating.
“I think offering these additional appointments would provide some time to explain the risks and best way forward, help a patient feel listened to and enable their healthcare professional to monitor for signs of diabetes distress. Support to have a family and given goals to achieve that would also be amazing and something I wish I'd had.”
Research also shows that women living with diabetes who become pregnant without adequate preparation, including recommended blood sugar management and folic acid prescription, are at increased risk of having serious complications during pregnancy, including stillbirth.
Seema Hussain, who is in her 40s and from Leeds, said: “Receiving a diagnosis of type 2 diabetes in 2019 was quite a surprise, even though it had been prevalent in my maternal family. Over the years, I had witnessed my family members struggling with their diabetes management, and I was determined to approach things differently. However, I made the mistake of excessively researching T2, leading to feeling overwhelmed by the conflicting information.
“Fortunately, my diabetes nurse introduced me to an NHS-led programme that provided guidance on living with type 2 diabetes and it proved to be excellent. It was straightforward and relevant, enabling me to easily implement the information.
“As a result, I successfully navigated a healthy pregnancy, which included a C-section from which I quickly recovered. Knowing how to maintain a healthy HbA1C played a crucial role in my well-being and significantly contributed to both a healthy and happy pregnancy.
“From my experience, the key to effectively managing life with type 2 diabetes is to seek support from your NHS team, and I think access to enhanced support through initiatives such as T2Day is incredibly beneficial. We all face ups and downs but knowing you can turn to specialists who offer reliable and honest support is positive.”
Chris Askew OBE, Chief Executive of Diabetes UK, said: “This is a vitally important step towards improving care for people who develop type 2 diabetes at an early age.
“Type 2 diabetes is a serious, life-changing condition. It can have more severe and acute consequences in younger adults, and is more common in people from ethnic minorities and those living in the most deprived areas. Yet we know that access to vital routine diabetes care is lower in the 18-40 age group - putting those affected at a higher risk of potentially devastating complications.
“This programme is a welcome and much-needed opportunity to address these existing inequalities in type 2 diabetes care.”
The ‘T2Day: Type 2 Diabetes in the Young' initiative will run alongside, the highly effective NHS's Type 2 Diabetes Path to Remission Programme. A recent evaluation of the NHS Type 2 Diabetes Path to Remission Programme found that it has helped thousands of people living with type 2 diabetes or obesity or overweight to lose over 10kg in weight. This is expected to have helped many people put their type 2 diabetes into remission.