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Focus Article - Latest Issue

FOCUS - 21 March 2016


And healthy eating classes in an attempt to stop them getting Type-2 diabetes – says Andrew Gregory in The Mirror. He goes on to say: "Initially, 100,000 people will be placed on a £7million programme aimed at controlling a disease which costs the NHS £10billion a year. Charities say failure to tackle an alarming rise in cases of the illness could leave the NHS bankrupt.

Those accepted on the NHS Diabetes Prevention Programme will be put on tailor-made exercise programmes, helped to lose weight and educated on healthy eating and lifestyle. Entry criteria for the programme are linked to guidelines which define high risk for Type 2 diabetes as being overweight and having high blood sugar levels. The scheme will initially be available across 27 areas of England – covering around half the population – followed by a national roll-out by 2020."

Nick Triggle of the BBC adds: "GPs are being asked to identify the people who would benefit the most from the programme. This will be done through blood-glucose testing and monitoring for signs of pre-diabetes. While Type-1 diabetes cannot be prevented and is not linked to lifestyle, Type-2 often is."

Both journalists quote NHS England chief executive Simon Stevens, who said the scheme would reduce hospital admissions, prevent strokes and the complications of diabetes, such as amputations. "By offering targeted support for at-risk individuals, the NHS is now playing its part in the wider campaign against obesity, which is already costing the country more than we spend on the police and fire service combined," he said.

NT @ the BBC also quotes Diabetes UK chief executive Chris Askew, who said the programme should prove significant for many people at risk of diabetes. "This will provide them with the best possible chance of reducing their risk of developing diabetes and living a long full healthier life," he said.

As I say, the cost of the programme is £7m this year – but bear in mind that this is being set against the £10bn annual spend on diabetes care, and the fact that this is a condition that can cause great misery and loss of 'quality of life' ... not to mention loss of life. It's also a condition that millions of us are sleepwalking into – blissfully unaware of the consequences of the 21st century lifestyle. It'll take more than this initiative to turn the tide – but at least this is a step in the right direction.



With urinary infections (cystitis and the like) is high and could render some antibiotics ineffective as first-line treatments, warns a study published by The BMJ. 

Antimicrobial resistance is an internationally recognised threat to health. Throughout the world, children are frequent consumers of antibiotics - and such routine use has been shown to increase the probability of antibiotic resistance in adults with urinary tract infections. Yet little is known about the prevalence of bacterial resistance in children or the risk factors of importance in this group. 

So a team of UK researchers from University of Bristol and Imperial College London set out to review studies investigating the prevalence of antibiotic resistance in urinary tract infections. They found that, within OECD (Organization for Economic Cooperation and Development) countries, half of all samples were resistant to ampicillin/amoxicillin, a third to co-trimoxazole, and a quarter to trimethoprim. These are antibiotics that are/have commonly been relied on to treat 'water infections.' However, resistance was substantially greater in non-OECD countries.

Lead author Ashley Bryce, of the University of Bristol highlights that “Prevalence of resistance to commonly prescribed antibiotics in primary care in children with urinary tract infections caused by E coli is high, particularly in countries outside the OECD, where one possible explanation is the availability of antibiotics over the counter.”

So things are bad enough here – but outside the OECD they're much worse ... and bear in mind that this resistance may persist for up to six months after treatment.

We quite like the fact that antibiotics are cheap and readily available over the counter in some countries when we go on holiday – it seems a refreshing break from the red tape that we are subjected to here. But there is a downside – antibiotic resistance is a major threat to us and our children and, moreover, there is evidence that the overuse of antibiotics in children may be linked to asthma. All the more reason to give them only where needed.



Is a subject that has been hotly discussed since George Osborne’s ill-fated budget. The ‘BMJ Open’ has something to add to the debate. It tells us that the sugar content in fruit drinks marketed to kids is “unacceptably high” – including natural fruit juices – and smoothies are among the worst offenders.

According to research carried out by the University of Liverpool (etc) almost half the products assessed contained at least a child’s entire daily recommended maximum sugar intake of 19 g or almost five teaspoons. These findings were published ahead of the launch of the UK government’s childhood obesity strategy. Increasing public awareness of the detrimental effect sugar sweetened drinks have on kids’ teeth and waistlines has prompted many parents to opt for seemingly healthier fruit juice and smoothie alternatives … but this is a case of ‘out of the frying pan and into the fire.’

To assess the sugar content of fruit juice drinks, 100% natural juices, and smoothies marketed specifically to children, the researchers measured the quantity of ‘free’ sugars per 100 ml in 203 standard portion sizes (200 ml) of UK branded and supermarket own label products, using the pack labelling information provided. ‘Free’ sugars refer to sugars, such as glucose, fructose, sucrose, and table sugar, which are added by the manufacturer, and naturally occurring sugars in honey, syrups, fruit juices and fruit juice concentrates, but not the naturally occurring sugars found in whole fruits and vegetables, which the body metabolises differently and which act to curb energy intake.

The results highlighted wide variations in the amount of free sugars between different types of drink and within the same type of product. The sugar content ranged from 0-16 g/100 ml, with the average 7 g/100 ml. But sugar content was significantly higher in pure fruit juices and smoothies.

Almost 60% of all the products would get a red traffic light label – a coding system designed by the UK’s Food Standards Agency to help consumers identify high levels of fat, salt, and sugar in processed food and drink – the researchers point out. Some 78 products contained non-calorific sweeteners, such as aspartame … and, although these are claimed to be safe, health experts believe that a reduction in the overall sweetness of products is required for children’s taste buds to become accustomed to less sugar in their diets, say the researchers. To give us an idea of the extent of the problem, even in the ‘fluoride era’, more children in England are being admitted to hospital because of tooth decay than for any other reason. What is more is that, by giving our kids a ‘sweet tooth’, we are fanning the flames of the diabetes epidemic.

Current dietary guidelines recommend that a serving of fruit juice/drink/smoothie should be no more than 150ml, but only six of the products assessed matched this portion size. Furthermore, the labels on all the products contained a reference intake, which is in line with European law. But this figure applies to an average sized adult woman who does an average amount of physical activity, so these are wholly inappropriate for children, the researchers say … and particularly kids who sit indoors watching TV and immersing themselves in computer games rather than playing outside.

Based on their findings, the boffins make several recommendations:

  • Fruit juices/juice drinks/smoothies with a high free sugar content should not count as one of the UK government’s ‘5 a day’ recommendations, as is currently the case
  • Fruit should preferably be eaten whole, not as juice
  • Parents should dilute fruit juice with water or opt for unsweetened juices, and only allow these drinks during meals
  • Portion sizes should be limited to 150 ml/day
  • Manufacturers should stop adding unnecessary amounts of sugars, and therefore calories, to their fruit drink/juice/smoothie products – and if they can’t do this voluntarily, the government should step in with statutory regulations.

What this report and others like it emphasise is that what we docs do to keep people healthy is dwarfed by what everyone can do for themselves and their kids merely by making a few lifestyle changes. Who knows … if everyone paid heed to the experts our workload would shrink dramatically … and maybe we GPs could return to the civilised existence depicted in the old radio series ‘Mrs Dale’s Diary’ whereby Dr Dale always went home for tea rather than grabbing a sandwich on the run as we do now. Perhaps that should inspire a new motto: “Don’t do it for your own good – do it for the good of your beloved GP!”

Dr John Cormack

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