“Why prevention is important for Wales”
Around eight percent of adults in Wales – approximately 200,000 people – are living with type 2 diabetes (15). Type 2 diabetes has serious consequences for individual health and wellbeing. The condition greatly increases the risk of heart attacks and strokes (16), and can also damage small blood vessels, leading to serious complications such as blindness, kidney disease, and nerve damage that may cause pain, numbness, or even limb loss (17).
The burden is not limited to physical health. People with type 2 diabetes are also more likely to experience depression, reduced quality of life, and anxiety due to the ongoing management of the disease and the risk of future complications (18). The financial implications are also considerable, with the direct cost of patient care for 2 diabetes estimated at £500 million per year, accounting for around 10% of the NHS Wales budget (19).
Type 2 diabetes occurs when the body does not produce enough insulin or cannot use it effectively, leading to high blood glucose (sugar) levels (20) - typically assessed using HbA1c (reflecting average blood sugar levels over preceding two-three months) (21,22). In normoglycaemia, insulin works as it should to keep blood sugar within a healthy range (HbA1c <42 mmol/mol) (23). Prediabetes sits in between (HbA1c 42-47 mmol/mol) – where insulin is still made but is less effective, causing blood sugar to rise above normal, though not yet high enough for a diabetes diagnosis (HbA1c >47 mmol/mol) (24).
Prediabetes is an important warning sign for type 2 diabetes but also provides an opportunity for prevention. Research shows that modest lifestyle changes, such as improvements in diet and increases in physical activity, can improve the way in which the body uses insulin, and in turn, regulate blood sugar (25).
To support individuals at this crucial stage, the Welsh Government have funded Public Health Wales to deliver the All-Wales Diabetes Prevention Programme (AWDPP) - a national initiative aimed at reducing the incidence of type 2 diabetes in Wales (7). The AWDPP builds on pilot work undertaken in Afan Valley (5) and North Ceredigion (6), where a brief 30-minute intervention was shown to improve blood sugar levels and reduce progression to type 2 diabetes. Launched in June 2022, individuals across Wales identified as having prediabetes are invited to take part in the programme.