The new and emerging field of epigenetics is providing us with new insights into why some people are more at risk of diabetes than others. Until recently it was thought that inheritance and genetics were fairly straightforward factors in diabetes risk.

It turns out that this is too simplistic an idea. Our genes it seems can be influenced to turn on or off in utero, ie as a developing baby in the mothers womb. Some pioneering work on babies born to mothers during the Dutch famine post world war two has shown us that these small for dates babies have an increased tendency to diabetes and high blood pressure later in their lives.

This is the field of epigenetics which supports previous observations that mothers who gain a lot of weight during pregnancy produce offspring with a higher risk of childhood obesity. This represents an interesting point of discussion if a patient asks us as doctors about the cause of their diabetes, their weight problems or their tendency to high blood pressure. These are the very factors of the metabolic syndrome and they seem also to relate to social history as well as simply to current dietary factors.

Finally, and particularly as a mark of respect, to all those groups of people known as indigenous or aboriginal who have such an enormous prevalence of diabetes in their communities, it is worthwhile reflecting on the causes of their metabolic disorders.

Whether they be the Pima Indians from Arizona, Pacific Islanders or the Australian Aborigines the cause of the problem in their eyes can be traced back to their ancestors, to social disharmony, to poverty and to trans-generational trauma caused by enforced lifestyle adaptations. Maybe in part this thought is absolutely correct.