Certain social factors are key challenges for people with type 1 diabetes

Diabetes UK

Research we funded has highlighted the importance of people with type 1 diabetes having access to quality education and services, and good housing. These social factors are pivotal building blocks for good health and diabetes outcomes, and can help more people live well and longer. 

Further information – Certain social factors are key challenges for people with type 1 diabetes

Background Research – Exploring blood glucose control in type 1 diabetes

Children with type 1 diabetes do as well at school, research shows

Diabetes UK – 2023-01-25

Research from Cardiff University reveals that although children with type 1 diabetes miss more school days, the condition alone doesn’t have a negative impact on their exam results or chances of going to university.

Type 1 diabetes can affect every aspect of a child’s life, and researchers at Cardiff University have now uncovered more about the impact of living with the condition on educational outcomes.

There are more than 28,000 children with type 1 diabetes living in the UK. Every child deserves the same education, experiences and opportunities as their peers. But families may be concerned that more time off school due to medical appointments, or high and low blood sugar levels, could affect their child’s education.

To find out more, researchers led by Dr Rob French tracked school attendance, GCSE results and university entry rates of more than 1,200 children with type 1 diabetes in Wales since 2006. They compared these to around 263,000 children in the same classes who do not have diabetes.

Further information – Children with type 1 diabetes do as well at school, research shows

Background Research – Robert French, Dylan Kneale, Justin T. Warner, Holly Robinson, James Rafferty, Adrian Sayers, Peter Taylor, John W. Gregory, Colin M. Dayan; Educational Attainment and Childhood-Onset Type 1 DiabetesDiabetes Care 1 December 2022; 45 (12): 2852–2861. https://doi.org/10.2337/dc21-0693

Autoantibody testing can help to diagnose diabetes type correctly

Diabetes Research UK – 26th January 2023

New diabetes type research funded by us has highlighted that not everyone with diabetes is diagnosed with the right type straight away. But the results show that a simple blood test could help to avoid this, by giving doctors extra information about the type of diabetes to help ensure everyone can start the right treatment as soon as possible.

When people are diagnosed with diabetes as adults it can be difficult to tell which type they have, as many symptoms of type 1 diabetes and type 2 diabetes can overlap. And new diabetes type research shows that up to one in three adults are wrongly diagnosed with type 2 when they really have type 1, while one in six diagnosed with type 1 have another type altogether.

Being wrongly diagnosed with type 1 can mean someone starting insulin treatment when they don’t need it, leading to real difficulties managing blood sugar levels. And if someone with type 1 is incorrectly diagnosed and not given insulin, there can be serious consequences. This means that it’s really important to get the diabetes diagnosis right as soon as possible, so people can get the correct support and treatment.

A number of blood tests have been suggested to help doctors diagnose the type of diabetes. One of these looks for molecules in the blood, called autoantibodies. Autoantibodies are made by the immune system when it wrongly targets and destroys insulin-making cells in type 1 diabetes. Other types of diabetes aren’t caused by an immune attack, so testing for these autoantibodies soon after diagnosis could help pick out type 1 from other types of diabetes.

Further information – Autoantibody testing can help to diagnose diabetes type correctly

Background Research – Russell J. Eason, Nicholas J. Thomas, Anita V. Hill, Bridget A. Knight, Alice Carr, Andrew T. Hattersley, Timothy J. McDonald, Beverley M. Shields, Angus G. Jones, for the StartRight Study Group; Routine Islet Autoantibody Testing in Clinically Diagnosed Adult-Onset Type 1 Diabetes Can Help Identify Misclassification and the Possibility of Successful Insulin CessationDiabetes Care 1 December 2022; 45 (12): 2844–2851.

NHS in England will have one strategy for all major conditions, including cancer

BMJ – 25th January 2023

The NHS in England is set to have a major conditions strategy to help determine policy for the care of increasing
numbers of people in England with complex and often multiple long term conditions.
Conditions covered by the strategy will include cardiovascular disease, chronic respiratory disease, dementia,
mental health conditions, and musculoskeletal disorders. Cancer will also be included and will no longer
have its own dedicated 10 year strategy

Further information – NHS in England will have one strategy for all major conditions, including cancer

Government Action on Major Conditions and Diseases – Statement made on 24 January 2023 – UK Parliament

Diabetes (type 1 and type 2) in children and young people: diagnosis and management – medicines for type 2 diabetes (DRAFT update of NG18)

National Institute for Health and Care Excellence – In development [GID-NG10286]Expected publication date: 26 April 2023

This DRAFT update covers new advice on pharmacological agents for improving glycaemic control in children and young people with type 2 diabetes. Liraglutide or dulaglutide (off-label) are detailed as alternatives to insulin where metformin is insufficient under set criteria.

Further details – Diabetes (type 1 and type 2) in children and young people: diagnosis and management – medicines for type 2 diabetes

Diabetes artificial pancreas tech recommended for thousands on NHS

BBC – 10th January 2023

More than 100,000 people in England and Wales with type 1 diabetes could soon be offered new technology to manage their condition on the NHS.

The system uses a glucose sensor under the skin to automatically calculate how much insulin is delivered via a pump.

Health assessors said it was the best way of controlling diabetes, barring a cure.

A charity said it would transform lives and was the “closest thing to a working pancreas”.

The National Institute of Health and Care Excellence (NICE), the health body recommending the technology, said a more cost-effective price still had to be agreed with manufacturers.

In trials, it improved quality of life and reduced the risk of long-term health complications.

Approximately 400,000 people are currently living with type 1 diabetes in the UK, including around 29,000 children.

Their pancreas produces no, or very little, insulin – an important hormone which helps turn food into energy.

Full article – Diabetes artificial pancreas tech recommended for thousands on NHS

Let people with diabetes choose their own medication, researchers say

Diabetes UK – 7th Dec 22

A largescale new study offers a new approach to treating type 2 diabetes by putting people living with the condition in charge of their own medication.

The TriMaster study is the first to allow people with type 2 diabetes to choose their own medication, after trying three different drugs in succession. It concluded the approach could be a new way of finding the best treatment.

Researchers at the University of Exeter led the Medical Research Council-funded study, which gave people with type 2 diabetes three commonly prescribed drugs, each for a 16-week period in turn.

During the study, researchers monitored the effect of each drug on the 448 peoples’ glucose levels, weight and recorded the side effects.

At the end of the study, now published in Nature Medicine, they got to choose the drug that worked best for them.

Their chosen drug not only lowered glucose most effectively, but also resulted in fewer side effects.

Further information – Let people with diabetes choose their own medication, researchers say

Shields, B.M., Angwin, C.D., Shepherd, M.H. et al. Patient preference for second- and third-line therapies in type 2 diabetes: a prespecified secondary endpoint of the TriMaster studyNat Med (2022)

Long-term Effect of Lifestyle Interventions on the Cardiovascular and All-Cause Mortality of Subjects With Prediabetes and Type 2 Diabetes: A Systematic Review and Meta-analysis.

Diabetes Care – Nov 2022

Background: Lifestyle interventions improve the metabolic control of individuals with hyperglycemia.

Purpose: We aimed to determine the effect of lifestyle interventions on cardiovascular and all-cause mortality in this population.

Data sources: Searches were made through MEDLINE, Cochrane CENTRAL, Embase, and Web of Science (no date/language restriction, until 15 May 2022).

Study selection: We included randomized clinical trials (RCTs) of subjects with prediabetes and type 2 diabetes, comparing intensive lifestyle interventions with usual care, with a minimum of 2 years of active intervention.

Data extraction: Data from the 11 RCTs selected were extracted in duplicate. A frequentist and arm-based meta-analysis was performed with random-effects models to estimate relative risk (RR) for mortality, and heterogeneity was assessed through I2 metrics. A generalized linear mixed model (GLMM) was used to confirm the findings.

Data synthesis: Lifestyle interventions were not superior to usual care in reducing cardiovascular (RR 0.99; 95% CI 0.79-1.23) or all-cause (RR 0.93; 95% CI 0.85-1.03) mortality. Subgroup, sensitivity, and meta-regression analyses showed no influence of type of intervention, mean follow-up, age, glycemic status, geographical location, risk of bias, or weight change. All of these results were confirmed with the GLMM. Most studies had a low risk of bias according to the RoB 2.0 tool and the certainty of evidence was moderate for both outcomes.

Limitations: Most studies had a low risk of bias according to the RoB 2.0 tool, and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach resulted in moderate certainty of evidence for both outcomes. Differences in lifestyle programs and in usual care between the studies should be considered in the interpretation of our results.

Conclusions: Intensive lifestyle interventions implemented so far did not show superiority to usual care in reducing cardiovascular or all-cause mortality for subjects with prediabetes and type 2 diabetes.

Zucatti KP, Teixeira PP, Wayerbacher LF, et al. Long-term Effect of Lifestyle Interventions on the Cardiovascular and All-Cause Mortality of Subjects With Prediabetes and Type 2 Diabetes: A Systematic Review and Meta-analysis. Diabetes Care. 2022 Nov 1;45(11):2787-2795.

Glucagon, from past to present: a century of intensive research and controversies

The Lancet Diabetes & Endocrinology / 22nd December 2022

Summary

2022 corresponds to the 100th anniversary of the discovery of glucagon. This TimeCapsule aims to recall the main steps leading to the discovery, characterisation, and clinical importance of the so-called second pancreatic hormone. We describe the early historical findings in basic research (ie, discovery, purification, structure, α-cell origin, radioimmunoassay, glucagon gene [GCG], and glucagon receptor [GLR]), in which three future Nobel Prize laureates were actively involved. Considered as an anti-insulin hormone, glucagon was rapidly used to treat insulin-induced hypoglycaemic coma episodes in people with type 1 diabetes. A key step in the story of glucagon was the discovery of its role and the role of α cells in the physiology and pathophysiology (ie, paracrinopathy) of type 2 diabetes. This concept led to the design of different strategies targeting glucagon, among which GLP-1 receptor (GLP1R) agonists were a major breakthrough, and combination of inhibition of glucagon secretion with stimulation of insulin secretion (both in a glucose-dependent manner). Taking advantage of the glucagon-induced increase in energy metabolism, biased coagonists were developed. Besides the GLP-1 receptor, these coagonists also target the glucagon receptor to further promote weight loss. Thus, the 100-year story of glucagon has most probably not come to an end…

Full text: Glucagon, from past to present: a century of intensive research and controversies