Episode 15 Inside Out

Hello, I'm Elaine Dunkley and on this week's Inside Out, we ask,

can the NHS survived diabetes?

We investigate the epidemic of Type 2 diabetes and its impact

on patients and NHS financing.

We'll be speaking to a leading scientist who says the most common

form of the disease can be reversed without drugs.

And we'll be asking, could the NHS save millions

by offering more bariatric surgery to Type 2 diabetes patients?

Around 4.5 million people in the UK now have diabetes and that number

is continuing to rise.

Most of them have Type 2, which is usually linked to lifestyle

and is largely preventable yet diabetic care already costs the NHS

?10 billion a year, 10% of its entire budget.

New figures seen by the BBC show those costs are likely to spiral

if obesity continues to rise.

So, can the NHS survived diabetes?

Our health correspondent, Dominic Hughes, reports.

Today, I d like to invite you to a shoe-shop with a difference.

So, what we ve got here are 140 shoes and they represent the 140

amputations that take place in England every week,

due to diabetes.

Cor.

Quite shocking.

We set up this shoe shop, to show just how serious

Type 2 diabetes can be.

It s really sad.

Has that shocked you?

Yeah.

Most diabetics have Type 2.

Where you come from and your family history can increase your risk.

But doctors say most of it is down to obesity.

Now, new data given exclusively to the BBC by Public Health England

estimates there will be an extra 250,000 people with Type 2 diabetes

by 2035, if we continue to get fatter.

It is not just amputations.

Diabetics are at greater risk of kidney failure,

blindness and even premature death.

The NHS is spending ?10 billion a year on diabetic care.

That is 10% of its entire budget.

As things stand, we are certainly looking at a crisis in diabetes

which threatens to bankrupt the NHS, if we continue with

these current trends.

One of our shoes belongs to Steven Woodman.

We caught up with him as he arrived at the Royal Shrewsbury Hospital for

an appointment with his podiatrist.

Like 90% of diabetics, Steven has the Type 2 version,

which is linked to lifestyle and, so, largely preventable.

But diagnosed as a young man, he ignored his GP s advice.

I was in denial.

I never took it that seriously, so I carried on eating,

going to the pub, doing things people of my age did.

Of course now, I know different.

Like many diabetics, Steven developed an ulcer

on his toe.

Look away now if you are squeamish.

The ulcer would not heal and, in the end, he had

to have his toe amputated.

He has lost two more since then.

My surgeon did say to me, when he was taking my third toe off,

"It's only a matter of time before you lose that one.

"It's inevitable that will go the same way."

Patients with Type 2 diabetes are not just losing their toes.

Some have had to have a foot amputated or even a lower leg.

It is life changing and very expensive.

It is approximately ?20,000 for first six months,

following amputation.

There is the limb fitting.

Even a basic prosthesis costs thousands of pounds.

All of those aspects mean it is a very expensive

process for the state.

Nick Hex is the health economist who worked out the current

cost of diabetes care - that ?10 billion figure.

Most of that is spent on complications.

Foot ulcers and amputations cost nearly ?1 billion a year.

Kidney failure is not far behind.

Then, there is sight loss and nerve damage.

But the biggest cost of all is for heart attacks and strokes.

With both obesity and Type 2 diabetes affecting more and more

of us, costs for diabetic care are expected to increase

to ?17 billion by 2035.

There is a fixed amount of money for the NHS,

so clearly, if one disease area, like diabetes, is taking up more

considerable amount of that cost, then there is less money to spend

on cancer, so it is really important that policy makers think

about the ways costs can be mitigated over next few years,

because there will not be enough to go round.

Just taking all measures.

Back at the Royal Shrewsbury Hospital, Steven is

getting his feet measured.

Losing three toes means he has to have specially-made shoes.

They do not come cheap.

Just out of interest, how much do they cost?

?400-?500.

Wow, really?

We are facing a diabetic epidemic and need to find ways of preventing

those patients from reaching surgeons, because the cost to the

patient and the NHS is skyrocketing.

A new problem is expected to put even more financial

pressure on the NHS.

16-year-old Aisha is one of a small, but growing, number of children

with Type 2 diabetes.

I developed T2D by having a sweet tooth mostly.

I used to try out every new sweet in the store.

I used to drink quite a lot of sugary drinks.

When I was taken to the hospital, it hit me then, because I started

crying and it was shock.

Aisha now has to rely on medicine to control her condition.

But she has managed to lose a stone in weight and those fizzy drinks

are a thing of the past.

It's been really hard at times, but you can only have health once

and you can't buy your health.

You have to keep changing your diet plan, to keep fit and healthy.

New research shows the number of children like Aisha with Type 2

diabetes has nearly doubled in the last ten years.

And they are likely to develop complications much earlier.

People who are getting T2D when they're 15 or 16 are likely

to have significant problems maybe at the age of 35, 36,

and that's really much younger than you d expect.

These are things like renal failure and heart attacks and strokes

and it is going to have a huge impact for them.

Ultimately, tackling the rise in Type 2 diabetes will depend

on reducing our waistlines.

I believe we're facing a crisis and we really need concerted action

right across society, for us to fund more research,

provide best possible care and, crucially, prevent so many cases

of Type 2 in future.

Steven's diabetes has stabilised, but it is too late to save his job.

The toe amputations have left him unsteady on his feet and he has been

told by his employer that he is no longer fit for work.

Given everything you have been through, Steve,

what would your advice be to people being diagnosed now with T2D?

For God's sake, take it seriously.

Don't make the mistake I did.

It's the biggest regret I've ever made in my entire life.

It's a dreadful nasty disease.

It takes no prisoners.

It's a terrible thing.

It's widely believed if you have the most

commonest form of diabetes, Type 2, you will have it for life.

But a leading scientist from Newcastle is challenging

that orthodox view.

He says the disease can be reversed without drugs.

So, could his radical approach be the answer to the

diabetes time bomb?

Chris Jackson reports from the North East.

He thinks his diabetes could kill him.

How do you feel at the minute?

I haven't really got any energy.

I mean, I easily get out of breath.

What are you actually worried about with this?

I'm concerned about having a stroke, having a heart attack,

kidney failure, and different types of things that can happen.

It's frightening when you think about it.

But, a few miles away, a world-renowned professor believes

he's found a solution that could help Ed and many like him.

Type 2 diabetes is reversible for most people, certainly

in the first ten years.

Roy Taylor's claim has stunned the medical world.

Are we potentially on the cusp of a revolution here?

I believe we are.

If he's right, Professor Taylor will help hundreds of thousands

of diabetes patients free themselves of the condition

and save the NHS billions of pounds.

And it's all a question of what you eat.

Or, rather, what you don't.

Professor Taylor's team at Newcastle University asked

volunteers with Type 2 diabetes to go on a very low-calorie diet,

designed to melt away fat from key parts of the body.

Our hypothesis was that Type 2 diabetes was typified by too

much fat in the liver.

And if we got rid of that, things might return to normal.

We look at this organ, that's the liver.

The level of fat is, in fact, 36%, which is extremely high.

But after eight weeks of this diet, just look at this, 2% liver fat.

It has gone black.

We're down here.

So that's a dramatic change.

An amazing difference.

This is the same person but you might say reborn.

Fat levels also fell in the pancreas, the organ that

controls blood sugar levels.

The most exciting thing is the function.

Type 2 diabetes, after one week, a bit of a response.

Four weeks, eight weeks, it had gone back to normal.

The function's been restored, and that is a magic thing.

With insulin production back to normal, the patient's Type 2

diabetes went into remission.

How excited are you about this?

Extremely excited because this is sorting out a condition that's

caused puzzlement for a long time.

Now Professor Taylor is undertaking a much bigger study backed

by a research grant of more than ?2 million, with volunteers

from the North East.

The large study will actually find out how many people are likely to be

able to follow this diet in routine general practice, and will diabetes

stay away for the two-year follow-up period of the study?

So how has diabetes actually changed your life?

What do you have to do now?

That's basically all the medication I've got to take, you know?

But Ed's not waiting around for the results.

He's been fighting his Type 2 for years.

Now, in line with Professor Taylor's model, he's decided to restrict

himself to 800 calories a day for eight weeks.

What can't you touch in this now?

Well, that's one.

Oh, right, the spreads.

Some cheesy bits in there.

Yes, if it's processed meats, I don't think you're supposed

to have them as well.

This is going to be difficult, isn't it?

Because the rest of the family and going to have to keep

on eating normally.

So what's to stop you coming in here and having a raid?

Nothing, really.

The temptation's aways there.

800 calories, that's not a lot, is it?

The normal calorie intake, I think, for a man is around 2,500.

Where do you fit in on that?

Me?

Yeah.

I would possibly say into the 3,500 type of thing, you know?

We're all rooting for you.

Great.

It starts now.

It does.

Ed's undertaking this radical diet with the backing of his GP.

Have you actually noticed an increase in Type 2 diabetes?

I've been here a long time.

When I first came, we had about 40 patients who were diabetic.

Now we've got nearly 300.

I mean, it's a huge increase.

Mike's surgery has so many diabetes patients, it has a nurse

devoted to their care.

Today, she's giving Ed his annual review.

Do you want to step on the scales for me?

126.

Which is 1,912.

We need to do a waist measurement.

I'll put those there.

144 centimetres, which is 57 inches.

57 inches?

Not quite Marilyn Monroe.

Have you worked out a plan?

With your food?

Yeah, sort of.

Write down the foods that you like.

Make a plan and sit down with the family and it's easier,

I think.

He's one of more than 200,000 people in the North East

and Cumbria with diabetes.

That's more than 7% of the adult population.

And, in little more than a decade, it's expected to rise

to 300,000, more than 9%.

In Cumbria, there's a different approach.

Here, the belief is that, typically, diabetes is a lifelong condition.

So the emphasis is on education to reduce the risks

rather than eradication.

What are the long-term effects for your health?

We've got nerve damage, we've got eyes, trouble

with the kidneys and trouble with the heart.

The course is largely aimed at people with newly

diagnosed Type 2 diabetes.

It provides an opportunity both to understand the basics,

to get to grips with the basics, but also to share stories,

to ask questions in a safe environment.

For people with Type 2 diabetes, the risk is increased.

Here, it's all about behaviour, not just calories.

Back in Newcastle, three weeks have gone by and it's

so far, so good for Ed.

Well, I'm starving.

A chicken stir-fry, so it's all healthy.

Fabulous.

Thank you very much indeed.

What difference has it made so far?

I've lost four inches off my waist.

And my sugar levels have gone right down to normal levels,

which are about six.

Have you spotted a difference in him?

A big difference, yeah.

In what way?

Well, he seems a lot happier since he's been doing it.

Really proud of him, he's done really well.

What's been the most difficult thing?

I think mainly the planning of meals.

Not having the same repetitive stuff every day, you know?

One person who's already achieved success is Alan Donaldson.

We can step outside and walk the hills and get our exercise.

He reversed the threat of diabetes after blood tests three years ago

by dramatically changing his diet.

I found Roy Taylor's work brilliant work and, within ten weeks,

I'd lost a load of weight and my blood sugar was normal.

Ten weeks.

My mind controls what I eat now, not my eyes and my stomach.

The next stage for you, exercise.

Because that is what I do every day now.

I mean, I felt really encouraged by what I've heard from you.

It just gives us the motivation to carry on, you know?

Ted, do you just want to come through?

Yeah.

Eight weeks are up.

Ed is back at the surgery.

Has the diet made a difference?

That is 50 inches.

You were 57 inches, now you're down to 50.

That is seven inches of your waist.

Great.

Which is fantastic.

Yeah.

Shall we do the big one now?

Shall we do the weight?

Yeah.

So we were 126.

And that is 118.

So that, by my reckoning, is 8.6 kilograms lost,

which is 1 stone, 5 lbs.

Brilliant.

I can tell you, I do feel lighter on my feet,

and I feel more alert.

Best of all, Ed's blood sugar levels have fallen dramatically,

close to a point where he can say he is free of the disease.

We are still saying you are diabetic, but it is reversing.

It is reversing.

Like I said before, it is working.

Absolutely.

Ed has given himself something to smile about and has now

increased his calorie intake to healthy, normal levels.

But that is the real challenge in the months and years to come,

to stay away from the bad food habits that

contributed to his diabetes.

For the time being, many experts believe it is impossible

to reverse Type Two diabetes.

For them, Professor Taylor's views are medical heresy,

and there is a long way to go before he will convince them otherwise.

I think we are winning the battle.

We expected to be a years before it becomes widely accepted.

We hope it will become part of routine treatment,

but that depends upon the results of the study which is

currently under way.

For patients with Type 2 diabetes, managing their condition

through stringent diets can be incredibly challenging,

so what about more drastic measures?

Well, a top international surgeon has told Inside Out London that far

more people should be offered bariatric weight-loss surgery.

He claims it's the closest thing we have to a cure and the most

cost-effective way for the NHS to treat type two diabetics.

We sent along Dr Ranj Singh to find out more.

David Benge weighs 21 and a half stone and has Type 2 diabetes.

I was diagnosed about seven years ago.

Since then, my diabetes has deteriorated.

His blood sugar levels are no longer being controlled.

It affects my extremities, so my fingers and my toes

particularly at night time.

I do have difficulty getting to sleep, because my toes

are fizzing and vibrating.

It's painful.

David used to be more positive than he has been of late.

I think, with the health issues and the weight gain,

it drags you down and makes you feel less positive about yourself and how

other people might perceive you.

But all this is about to change.

It's the start of a new life.

It's like being reborn.

Today, here at Kings College Hospital, David

is undergoing surgery, with the aim of putting his

diabetes into remission.

I've just had a discussion with the professor, who has actually

informed me that I come off my medication directly

after the operation, because it should be

in remission straight away.

Professor Francesco Rubino is carrying out the operation.

He has been researching the effects of bariatric surgery on Type 2

diabetes for 15 years.

This is the most effective intervention that we have today.

The operation, a gastric bypass, was originally used

to treat stomach ulcers.

Then, it became an obesity treatment.

Now, it is proving a lifesaving operation for Type 2 diabetes.

The operation is all done by keyhole surgery, which is safer and less

invasive for the patient.

Bariatric operations for diabetes are among the safest form

of surgical operations we have today.

During the operation, the stomach is permanently divided,

using stitches, to create a new small stomach pouch.

The small bowel is then measured, divided and brought up

to permanently join the pouch.

The redundant stomach and small bowel are reattached further down.

The stomach is now divided in two portions.

The food will not be able to go anymore in this part

of the stomach and this part is now completely bypassed.

The operation puts diabetes into remission by altering

the hormones in the gut which, in turn, influences

insulin production.

The stomach and the intestine are an important organ for

the regulation of sugar metabolism.

So, altering the anatomy of those resets the metabolism of glucose

and sugar and this is why we see such dramatic

improvement of diabetes.

At the moment, around 90% of people who have this procedure will get

better control of their condition.

Even more importantly, up to 60% will see a remission

in their diabetes.

It is ?6,000 per operation, but that is a small cost,

compared to a lifetime of treatment and related illness.

Yet, despite this success, only 1% of eligible people are offered it.

I think many GPs don't know this surgery is an excellent

option to treat diabetes.

I don't think this is yet perceived as a life-saving

operation, as it is.

Current recommendations state only Type 2 diabetes patients with a BMI

of above 30 are suitable for this operation.

However, not all patients with this disease are overweight.

Barbara was initially refused surgery because

she was not fat enough.

I suffer from a very rare, non-obese metabolic disease, called

familial partial lipodystrophy.

What that means is I have an inability to store fat,

so it goes into the liver, pancreas and muscles which are not

capable of storing fat and causes complete disfunction in them.

Her condition caused her to develop Type 2 diabetes.

Over 100 units of insulin a day made no change to the condition.

I was getting worse.

Barbara paid for a private consultation with Professor Rubino.

She decided a gastric bypass was her only option.

Eventually, the NHS agreed to fund it.

Barbara is now one month after surgery and I think

she is doing extraordinarily well.

Most importantly, she has come off the insulin three or four days

after the operation and, ever since, she has maintained

improved blood sugar levels.

Professor Rubino is now calling for guidelines to change.

He says BMI should not be the only consideration.

Now we know surgery can also be a diabetes treatment and so,

I think, there is a need for NICE to update the diabetes guidelines.

We put Professor Rubino s concerns to the Director of Policy for NICE,

Professor Mark Baker.

NHS England told us that, "Bariatric surgery should only be

considered for severe obesity, where other approaches have

not been successful."

It may seem like a revolutionary treatment, but not

everyone is suitable.

However, David is one of the lucky ones.

It's now two weeks since the procedure.

My sugar levels have come down, naturally, so it's been superb.

Are you glad you had the operation?

Absolutely.

It's just got better and better.

Dr Ranj Singh with that story.

Well, that's it from Inside Out for this week.

Join the teams across England on Monday evening, 7:30pm, BBC One,

for more stories from your area.

Goodbye.

And if you've been affected by the issues raised in this