A recent modelling study, published in BMJ Open, suggests that preventing pre-diabetes from progressing to type 2 diabetes through lifestyle changes could reduce the carbon footprint associated with treating the disease's complications by over half. The study also indicates that effective management of established type 2 diabetes could decrease greenhouse gas emissions by 21%.\n\nGlobally, 537 million adults were living with diabetes in 2021, a number projected to reach 783 million by 2045. In 2021, diabetes and its complications were linked to approximately 6.7 million deaths worldwide. In the UK, the NHS incurred £14 billion in diabetes-related costs in 2021-2022. Despite clinical guidance, a significant portion of individuals with type 2 diabetes in England (36%) and Wales (39%) do not meet target glycosylated hemoglobin levels.\n\nWhile the financial and health benefits of diabetes treatment have been studied, the environmental impact, specifically greenhouse gas emissions, has received less attention. The NHS in England's annual carbon footprint was about 25 megatons of CO2 equivalent (CO2e) in 2019, representing approximately 4% of national emissions, with a commitment to net zero by 2040.\n\nResearchers integrated an environmental module into existing diabetes data analytics to estimate the lifetime impact of improved clinical outcomes on greenhouse gas emissions. They assessed two scenarios: (1) preventing pre-diabetes progression in individuals over 40 through diet and exercise, compared to no intervention; and (2) comparing well-controlled diabetes with medicines to poorly controlled disease in individuals aged 54 and older. Emissions calculations factored in ongoing drug treatment, anticipated cardiovascular, renal, and eye complications, and associated procedures, medication, and travel.\n\nThe analysis showed that preventing pre-diabetes progression resulted in an additional 6 years of life and significantly lower lifetime complication rates (244 vs 60,167 events per 100 patients), particularly for renal (73% fewer events) and eye disease (59% fewer events). The total greenhouse gas emissions associated with care for those who remained pre-diabetic were 67% less (19,129 kg CO2 over a lifetime) than for those who progressed naturally. This reduction was mainly due to decreased need for treating complications (cardiovascular 36%, renal 98%, eye disease 73%) and no need for type 2 diabetes drug treatment (88.5% decrease).\n\nFurthermore, well-controlled type 2 diabetes added almost 2 extra years of life and reduced CO2e emissions by 21% (14,545 kg CO2e over 23 years vs 18,516 kg CO2e over 21 years) compared to uncontrolled disease, even with a 2-5 year treatment delay. These savings were also primarily driven by avoiding the treatment of complications.\n\nThe researchers acknowledged limitations, including the lack of standardized methodologies for determining greenhouse gas emissions linked to various therapeutics and complication management, especially for resource-intensive procedures. Data on the reduced carbon footprint from adopting healthier lifestyles by those with pre-diabetes were also unavailable. The study focused on environmental impact rather than healthcare costs as an outcome.\n\nDespite these limitations, the study concludes that effective prevention of type 2 diabetes through diet and exercise in adults with pre-diabetes, and optimal disease management in adults with type 2 diabetes through early implementation of evidence-based recommendations, can improve patient outcomes and reduce the healthcare-related environmental impact. Reductions in the incidence of comorbidities, especially cardiovascular and renal events, are identified as key factors for reducing greenhouse gas emissions.