In a world grappling with the ever-growing burden of non-communicable diseases, Professor Nick Wareham, Director at the Medical Research Council (MRC) Epidemiology Unit at the University of Cambridge, delivered a thought-provoking presentation on ‘Developing and Evaluating Strategies for the Prevention of Type 2 Diabetes.’ This significant lecture was presented during the Sir John Monash Lecture (SJML) at Monash University Malaysia recently.
For a decade, the SJML has been a beacon of knowledge and intellectual exchange in Malaysia, serving Monash University Malaysia’s dual mission to enhance its regional standing and promote thought leadership in areas vital for 21st-century development. Covering pivotal topics like sustainability, technology, health, and more, the SJML is a platform for engaging stakeholders, featuring renowned thinkers and leaders, leaving a global impact.
Professor Adeeba Kamarulzaman, President and Pro Vice-Chancellor of Monash University Malaysia, emphasised the significance of Professor Wareham’s work in understanding the genetic basis of obesity and diabetes, and his efforts to design interventions to address these global health challenges.
“There is an urgency to address the issues of obesity and diabetes, particularly here in Malaysia, where our prevalence has reached alarming levels that are severely impacting the nation’s overall health and healthcare infrastructure,” says Professor Adeeba.
Professor Wareham opened his address by reflecting on the monumental discovery of insulin by Banting and Best, which occurred a century ago and revolutionised the treatment of Type 1 diabetes. “This landmark discovery has enabled the measurement of insulin and facilitated the distinction between Type 1 and Type 2,” Professor Wareham says.
“As we continue to explore the focal points of diabetes, we need to also comprehend the associated complications that come with it – the grim reality is that diabetes greatly escalates the risk of heart disease, end-stage renal disease, lower extremity amputation, and even blindness. While there is considerable progress made in the screening and managing of diabetes-related complications, these challenges still impose a substantial burden on society,” he adds.
Professor Wareham highlighted the concerning connection between the rising rates of obesity and the growing occurrence of diabetes worldwide. “80 per cent of individuals with diabetes live in lower-middle-income countries, where healthcare resources are often limited. This thus poses a significant challenge to healthcare systems in these regions,” he states.
“Diabetes is not solely a medical predicament but is also a societal quandary with far-reaching economic ramifications, thereby needing dire attention of policymakers,” Professor Wareham argued. He explored the factors contributing to the differing risks of diabetes among various populations and individuals, keenly acknowledging the interplay between genetic and environmental elements.
In his discourse, Professor Wareham highlighted the importance of accurately characterising obesity by delving into the intricate relationship between insulin resistance genes and fat distribution in the body. “Contrary to the conventional assumption that central fat is the primary issue in Type 2 diabetes, individuals harbouring specific insulin resistance genes actually tend to possess lower fat mass in their legs. This unique genetic predisposition leads to the spillover of fat into central areas of the body, significantly heightening the risk of diabetes,” he explains.
Moreover, he emphasised the pivotal role of genetics in obesity, illuminating how an individual’s genetic predisposition can provide a more empathetic perspective. He shared an enlightening case study of a patient who grappled with a genetic condition that presented formidable challenges despite her ardent efforts to maintain an active and healthy lifestyle. This profound insight into genetic factors empowers individuals to comprehend that they are not entirely responsible for their predicaments.
“I must admit I do have reservations on labelling conditions like diabetes and obesity as mere ‘lifestyle diseases’. I would propose the term ‘behaviours’ instead that best encapsulates the multifaceted nature of these health issues. Lifestyle choices are not exclusively individual but are more profoundly influenced by external factors, encompassing the environment, genetic predispositions, and socioeconomic conditions,” he expressed.
Professor Wareham’s current collaboration with Monash University on developing a Malaysian version of Intake24, an online self-completed computerised food diary and dietary recall system, underscores his dedication to global health and international collaboration. This initiative embodies his commitment to bridging international boundaries and fostering cooperation in addressing the pressing global health challenges related to nutrition and dietary habits.
In his presentation, Professor Wareham masterfully unveiled the intricacies of obesity and diabetes, underscoring the compelling need for a multifaceted approach. He eloquently emphasised the significance of considering both individual and societal elements in addressing these health challenges.
In conclusion:
- Type 2 diabetes is a clinical manifestation of an underlying pathophysiological problem.
- Type 2 diabetes is a public health manifestation of an underlying societal problem.
- Rich countries are struggling with the economic costs of treating diabetes to prevent complications.
- Rich countries can afford a combined approach to prevention that includes “clinical” high-risk approaches and societal-level interventions.
- LMICs with poorly developed healthcare systems have to prioritise care for those with diabetes now and whole societal prevention approaches.
