Mohin’s and Jasmine’s Journeys

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Mohin, 56, and Jasminder, 53, are married and live in Lincolnshire, England.
Mohin is a taxi driver and Jasminder works in a department store.
They have two daughters in their 20s.
As of 2023, people living in Lincolnshire have worse average weekly earnings compared to the England average.3
Increased cost of living and poor diet contribute to lower-than-average life expectancy in the region.4
Mohin works long hours and late nights.
Jasminder often works weekends and does all the housework too.
They’re both overweight, but struggle to find time for healthy cooking and exercise.
Britain has one of the highest obesity rates in Europe. Two in three adults are overweight or obese and the NHS spends £6bn a year treating obesity-related ill-health. That is forecast to rise to £10bn a year by 2050.5
In England, women from Asian groups report the very lowest rates of physical activity of any group, with socio-economic and structural inequalities being among the drivers.6
When they can, Mohin and Jasminder gather and enjoy food with extended family and friends. Restricting what they eat at these shared meals would feel antisocial.
Their busy work schedules mean they often rely on snacking and convenience food.
A third of the UK’s food and soft drink advertising spend goes towards confectionery, snacks, desserts and soft drinks — compared to just 1% for fruit and vegetables.7
Higher taxes on sugary drinks have helped reduce free sugar intake in adults by 20%.8
Jasminder makes healthier packed lunches when she can, but Mohin complains they’re like “rabbit food”.
In households where someone has type 2 diabetes, women are more likely than men to prioritise wellbeing and seek to change the family diet.9
Women are more likely than men to perceive themselves in need of weight loss, whereas men may be motivated to lose weight if they understand it as a health issue verified by a health professional.10
When Jasminder begins to feel tired, thirsty and in need of the toilet more often, she goes to her GP. At first he dismisses the symptoms as a normal part of ageing.
1.2 million people in the UK could be living with type 2 diabetes without knowing it. And an estimated 6.4 million are at more risk of developing it based on their blood sugar levels.11
Diagnoses among over-40s have increased 25% in the last six years. For under-40s, it’s 39%.12
When Jasminder returns a few months later to insist on a test, it shows she does have diabetes.
In some cases, women — especially women of colour — will have to make more visits to the doctor to be taken seriously.13
Meanwhile, after months of encouragement from his wife, Mohin has also agreed to see a doctor. He’s been experiencing blurred vision — and shrugging it off as “tired eyes”.
But he’s misdiagnosed with prediabetes rather than diabetes after his tests appeared to indicate lower blood-sugar levels than expected for someone suspected to have diabetes.
It’s well documented that men are more likely than women to avoid medical appointments and NHS health check-ups. Fear of stigma and embarrassment, wanting to appear strong, and poor health literacy are among the barriers cited.14
A genetic variant almost exclusive to people with south Asian heritage can affect the accuracy of the HbA1c test crucial for type 2 diagnosis.15
Opportunities to refer both Mohin and Jasminder to services to help with nutrition advice and exercise options are missed.
People from black and south Asian communities are more likely to develop type 2 diabetes, but are less likely to be able to access the care, treatments and guidance they need.16
Within 18 months, nerve damage in Mohin’s legs have led to both numbness and pain. A foot injury went unnoticed and led to infection, so now he can’t drive.
The cost of treating complications is far lower when people are diagnosed early and can manage their condition at home.
Diabetes costs the NHS more than £1.5m an hour.17
Jasminder hasn’t faced any major complications yet, but her body isn’t responding well to her medication, and she still struggles with her weight.
Women with type 2 diabetes are less likely than men to receive all possible care options.18
In addition, Jasminder’s south Asian background means she’s more likely to store visceral fat, which can build up around organs and cause insulin resistance. 19
Her stress levels are rising now too, as she’s having to cover the bills, as well as take time off to take Mohin to medical appointments.
Mohin’s pain, money worries and sense of being a burden badly affect his mood.
Mohin and Jasminder’s daughters worry about their parents’ future, and how they’ll be able to help them financially and practically.
43,000 people in the UK are out of work as a result of diabetes; a 79% increase since 2019.20

Gender inequalities rooted in women’s and men’s health pathways are fuelling the UK’s diabetes crisis.

And we’re seeing only part of the picture. Right now, sex-disaggregated data for the ‘care cascade’ — that is who is getting diagnosed, treated and properly cared for — isn’t available for diabetes at a national level.

With the right insights, we can reveal and remedy gaps along the entire pathway. What could we do differently with a more gender-targeted approach to diabetes? Some existing interventions are already proven to be making an impact.

See what works

References
1 Diabetes UK — Cost of devastating complications, June 2024
2 NHS England — Diabetes Audit 2023-24 (Quarterly Report January 2023 to March 2024)
3 Office for National Statistics — Average weekly earnings in Great Britain, December 2023
4 North Lincolnshire Director of Public Health Annual Report 2023
5 Office for Public Health Improvement & Disparities (OHID)
6 Institute for Government — Tackling obesity: Improving policy making on food and health, April 2023
7 & 8 The Food Foundation — The Broken Plate: The State of the Nation’s Food System
9 Glasgow Caledonian University — Gender and Diet Management in Type 2 Diabetes, 2021
10 National Institute for Health and Care Research— Managing obesity in men
11 Diabetes UK — Hidden prevalence of type 2 diabetes in the UK
12 Diabetes UK — Reverse the Trend: Reducing Type 2 Diabetes in Young People, May 2024
13 How gender bias affects your healthcare — BBC
14 Missing persons? Men’s use of primary care services — Wiley (Peter Baker), 2024
15 Type 2 diabetes: improving awareness of insulin management in the South Asian population — NHS England
16 Tackling Inequalities Commission Report, 2023 — Diabetes UK
17 Cost of diabetes — diabetes.co.uk
18 National Diabetes Audit, 2021-22: care processes and treatment targets — NHS UK
19 Risks of developing type 2 diabetes among south Asian people — Diabetes UK
20 Diabetes UK — Reverse the Trend: Reducing Type 2 Diabetes in Young People, May 2024

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