Sixty five people a day in the UK are dying early from complications arising from diabetes, which is the “fastest-growing epidemic of our time”, according to a charity.
The number of adults with diabetes in the UK has risen by more than 1.5 million in the past decade to more than 4.5 million, including an estimated 1 million who have type 2 diabetes but do not know it.
Diabetes UK analysis of official figures found that 20 people a day underwent diabetes-related amputations, and about 80% of these procedures were preventable.
It also said 203 people a day suffered heart failure, 78 suffered strokes and 39 needed dialysis or kidney transplants, and that people with diabetes were more likely to develop these problems.
To mark World Diabetes Day, the charity is seeking to raise awareness of the life-threatening complications of the condition.
“It is the fastest-growing epidemic of our time,” said Chris Askew, the chief executive of Diabetes UK. “The more you know about diabetes, the better. Cutting your risk of developing devastating complications is crucial.”
He said that as a result of research into specialist eye tests, diabetes was no longer the leading cause of blindness in the working age population, an example of how complications could be avoided when diabetes is managed properly.
Research has found only a small minority of people with diabetes are taking courses designed to help patients manage the symptoms, and others are missing out on health checks.
Diabetes is caused by too much glucose in the blood, or the inability to process glucose. About 10% of people with the condition have type 1 diabetes, meaning their bodies cannot produce insulin, the hormone that breaks down glucose. Type 1 diabetes is treated by daily insulin doses and usually affects children or young adults.
Between 85% and 90% of people with diabetes have the type 2 strand, meaning they do not produce enough insulin or the insulin they produce doesn’t work properly. The condition can be managed by following a healthy diet and increasing physical activity.
The decade-long increase in the number of adults with diabetes in the UK is largely due to an increase in type 2 diabetes. People are more likely to get type 2 if they are overweight, and it usually occurs in later life.
The number of cases is predicted to continue to rise dramatically in the next five years, and Askew said governments and health bodies had a responsibility to take action.
“Significant investment in diabetes care and prevention by UK and national governments and the NHS begins to recognise the scale of the challenge,” he said. “This needs to be sustained to provide enough effective care for everyone living with diabetes and tackling the rapid rise of type 2.”
Diabetes UK has a specialist helpline that can be contacted on 0345 123 2399 or helpline@diabetes.org.uk.
Increased numbers of women suffered from a serious complication of IVF last year, according to official figures that raise concerns about the use of powerful fertility drugs.
In 2015, 60 women were admitted to hospital with severe ovarian hyperstimulation syndrome (OHSS), a 40% increase on the previous year. The condition, which is triggered when the ovaries swell up and leak fluid, is potentially life-threatening. Symptoms include abdominal swelling and pain, nausea, dehydration and blood clots in the legs.
Leading fertility doctors warned that the trend could be driven by doctors giving women stronger drugs to harvest more of their eggs, with a view to boosting the chances of a successful pregnancy.
Professor Geeta Nargund, a senior consultant at St George’s Hospital in London and medical director of Create Fertility, said: “OHSS is a preventable condition. The number should never go up, it should always go down in modern fertility practice.”
In the past decade the numbers of OHSS cases have been steadily falling as clinics have shifted towards milder treatments, but the latest figures suggest a reversal of this trend.
Nick Macklon, professor of obstetrics and gynaecology at the University of Southampton, believes the increase could be linked to recent improvements in embryo and egg freezing technology.
In theory, the ability to freeze eggs and delay transferring embryos until the ovaries have settled down should help avoid serious cases of OHSS, which can be worsened by pregnancy. However, it also provides a greater incentive for clinicians to obtain as many eggs as possible to maximise a couple’s chances of success, he said.
“This escape route may have encouraged clinicians to return to harder stimulation regimens,” said Macklon, adding that recent Human Fertilisation and Embryology Authority (HFEA) figures showing higher pregnancy rates when around 15 eggs are obtained may also have played a role.
During IVF, a woman is typically given injections of drugs designed to stimulate the ovaries into releasing eggs, which are then harvested, fertilised and either transferred back to the patient or frozen for future use. Some women are more sensitive to the drugs, however, and their ovaries are sent into overdrive, causing them to enlarge and release chemicals into the bloodstream.
Fluid from the blood vessels leaks into the abdomen, and in severe cases, into the space around the heart and lungs. Mild OHSS is common, affecting about one in three women, but the condition can result in serious health problems and -extremely rarely – women have died.
Blood tests are now used by clinics to predict who is at risk of OHSS, based on their natural levels of a hormone called AMH. “We might reasonably expect that the trend in incidence should therefore be down rather than up, so I think there is likely to be a real cause rather than statistical artefact behind the rise,” said Macklon. “The overall numbers remain very low compared with the past, but I think there is a message in these data to remain vigilant about preventing OHSS by avoiding high dose stimulation where possible.”
According to HFEA data, in 2014, 42 cases of severe OHSS were recorded, compared to 46 the previous year, but last year the figure rose to 60 cases.
The regulator classifies severe OHSS as a grade B adverse incident, one level below the most serious category, which includes the death of a patient or an embryo being transferred to the wrong woman.
Professor Adam Balen, chairman of the British Fertility Society and a spokesman for the Royal College of Obstetricians and Gynaecologists, said: “OHSS is a potentially serious complication of fertility treatment, particularly IVF. Most women will recover with pain relief; however, for severe cases, women may need to be admitted to hospital and given treatment to reduce their risk of developing blood clots, which is a serious complication of the condition.”
HFEA figures show a steady upward trend in the number of IVF cycles carried out annually, rising from 68,000 in 2014 to around 72,000 in 2015 (roughly a 6% increase), which might explain part of the increase in adverse incidents last year.
“I said ‘call my mum,’ and then ‘no, call an ambulance.’”
Lee Cowden, who suffered a heart attack as a result of OHSS. Photograph: Sophia Evans for the Observer
A decade ago, Lee Cowden, a primary school teacher from Surrey, was newly married and lying in bed with her husband, Iain, after a weekend away in Norfolk. “I remember sitting up in bed gasping and saying to my husband ‘I can’t breathe.’” she said. “We hadn’t been married that long and I said ‘call my mum,’ and then ‘no, call an ambulance.’”
Lee later discovered she had suffered a heart attack as a result of OHSS.
At 25 she had decided to start trying for a baby, because her diagnosis of polycystic ovary syndrome meant she would need fertility treatment. She had been prescribed stimulation drugs to induce ovulation, but when it hadn’t worked the clinic had doubled the dose.
The first sign that she was suffering OHSS was abdominal pains, but the clinic told her this was probably due to a benign ovarian cyst. In fact, her ovaries had become severely over-stimulated and this eventually led to a blood clot forming that travelled to her heart.
“I felt a stabbing pain between my shoulder blades, which I knew was a sign of a heart attack, but I thought: don’t be ridiculous, you’re 25,” she recalls.
Since then, she said, she has met many others who have suffered from milder forms of OHSS. “So many women … think overstimulation is part and parcel of treatment,” she said. “It’s not acceptable.”
Lee, now 37, made a good recovery – although she will take daily heart medication for the rest of her life – and went on to have IVF treatment using milder drugs. She conceived her daughter, Molly, who is now nearly ten. Two years later, she conceived naturally, and her second daughter, Ruby, is eight.
The study did not look at no matter whether IVF treatment method was to blame for the higher threat of issues. Photograph: Picture Broker/Rex Functions
Young children born after IVF therapy have a greater threat of complications ranging from preterm birth to neonatal death, in accordance to a key review into the health of newborns.
Medical professionals identified that single IVF babies were practically twice as very likely to be born early, to be stillborn, or to die within the initial 28 days of delivery compared with those conceived naturally.
But the study, primarily based on more than 300,000 births in South Australia in between 1986 and 1992, did not search at whether or not IVF treatment method was to blame, and leaves open the possibility that the IVF infants fared worse for other causes, such as wellness troubles, or older age, that brought on couples to be infertile in the first spot.
“There is in all probability a contribution from both the therapy and patient elements,” mentioned Michael Davies, who led the study at the University of Adelaide. “We have really unfriendly perform practices that indicate households defer kid-bearing right up until women are relatively outdated, and that is tragic.”
The age of the health care information, with the most recent currently being from 2002, signifies they offer an overview of newborn little one health that is a lot more than a decade previous, during which time IVF technological innovation and clinical procedures have sophisticated.
“We want to include much more information to see if the enhancements in embryology and clinical treatment more than the past five to 10 years have flowed via to improve these perinatal outcomes. That is very plausible, but we do not know,” Davies stated.
The researchers found that preterm birth charges rose from four.7% in naturally conceived infants to eight% in these born to couples who had IVF. Neonatal deaths rose from .three% in naturally conceived infants to .five% in IVF children.
The findings construct on previous perform that has found equivalent charges of birth difficulties in IVF babies. A survey of health-related testimonials published in 2004 found that IVF babies had around twice the chance of death shortly ahead of or soon after birth, and a similarly elevated risk of reduced birthweight and preterm birth.
“What is difficult to tease out is how considerably is due to the treatment itself and how much is due to underlying infertility which the Artwork [assisted reproductive technology] is overcoming,” explained Dagan Wells at the Institute of Reproductive Sciences at Oxford University.
Creating in the journal, Plos One, the researchers claim that freezing embryos ahead of thawing and implanting them – an increasingly frequent procedure – can overcome the risk of preterm birth following ICSI or Intra-Cytoplasmic Sperm Injection, in which sperm are injected right into eggs. Freezing may assist because the embryos are implanted after the woman’s hormones have settled down soon after therapy to make more eggs.
The most striking discovering, which wants confirmation, was of a group of girls who were diagnosed as infertile but had infants following continuing to attempt naturally. Infants born to these girls appeared to fare much worse than others, with average birthweights that were 250g lighter than other folks conceived naturally. The chance of these babies getting stillborn was virtually 7 occasions higher.
The result in of the difficulty is unclear and demands confirmation, but if real may be down to the parents’ health or lifestyles. But Davies suspects that the females are acquiring other therapy that is to blame. “We know this group of women have a tendency to use a drug referred to as clomiphene citrate for infertility. It is a extremely frequent, very low cost drug, but its adverse consequences have not been terribly effectively studied. We are now really keen to investigate this,” he said.
