NHS expands offer of help to people with diabetes during coronavirus outbreak #covid19rftlks

NHS England | May 2020 | NHS expands offer of help to people with diabetes during coronavirus outbreak

Video consultations and online appointments, as well as routine discussions with GPs, are among a range of measures that the NHS has adopted so that diabetes care can continue throughout the pandemic.

A dedicated helpline has also been introduced, together with Diabetes UK, Novo Nordisk and Insulet, to advise those who need help with insulin.

The new helpline is part of a package of measures already in place for people with diabetes or at risk, including the world-leading Diabetes Prevention Programme, which has already successfully helped almost 90,000 people who were at risk of type 2, to lose a combined weight of more than 407, 967 pounds.

Patients will also receive additional support from online education services for type 1 and type 2 diabetes to help them to manage their condition better (Source: NHS England).

Read the full news release from NHS England

See also: NHS study: “demonstrates that all types of diabetes are independently associated with a significant increased risk of in-hospital death with COVID-19”

NHS study: “demonstrates that all types of diabetes are independently associated with a significant increased risk of in-hospital death with COVID-19” #covid19rftlks

NHS England | May 2020 | NHS expands offer of help to people with diabetes during coronavirus outbreak

NHS England have published the findings of new NHS research which looked at data from 263,830 patients registered with a a General Practice in England on February 19th 2020 with a recorded diagnosis of Type 1, and 2,864,670 patients with a diagnosis of Type 2 diabetes.

The population cohort study assessing risks of in-hospital death using Multivariate logistic regression to examine diabetes status, by type, and associations with in-hospital death, adjusting for demographic factors and comorbidities.

The world-leading studies reveal that people living with type 1 diabetes are at three and a half times the risk, and people living with type 2 are at double the risk of dying in hospital with the virus, compared to people without diabetes.

The strongest risk factor for dying with the virus is age, and people with type 1 diabetes are on average younger than people with type 2 diabetes.

Overall, 7,466 of those who died in hospitals in England had type 2 and 365 who died had type 1 diabetes, and the research suggests that the threat for those under 40 with type 1 or type 2 diabetes is very low, with no recorded deaths in those under 20.

It is thought that the risk to people with diabetes and the virus is in line with the extra risk seen in other infectious conditions such as pneumonia.

The study also shows that in people with both type 1 and type 2 diabetes, even when all other known factors are taken into account, higher blood glucose levels and obesity are linked to higher risk (Source: NHS England).

Abstract
Background
Although diabetes has been associated with COVID-19 mortality, the absolute and relative risks for Type 1 and Type 2 diabetes are unknown.
Methods
A population cohort study assessing risks of in-hospital death with COVID-19 between 1stMarch and 11th May 2020, including individuals registered with a General Practice in England and alive on February 19th 2020.
Multivariate logistic regression examined diabetes status, by type, and associations with in-hospital death, adjusting for demographic factors and comorbidities.
Findings
Of the 61,414,470 individuals registered, 263,830 (0∙4%) had a recorded diagnosis of Type 1 and 2,864,670 (4∙7%) of Type 2 diabetes. There were 23,804 COVID-19 related deaths. One third occurred in people with diabetes: 7,466 (31∙4%) with Type 2 and 365 (1∙5%) with Type 1 diabetes. Crude mortality rates per 100,000 persons over the 72 days for the overall population and for those with Type 1 and Type 2 diabetes were 38∙8
, 138∙3, and 260∙6 respectively. Adjusted for age, sex, deprivation, ethnicity and geographical region, people with Type 1 and Type 2 diabetes had 3∙50 and 2∙03 times the odds respectively of dying in hospital with COVID-19 compared to those without diabetes, attenuated to 2∙86 and 1∙81 respectively when also adjusted for previous hospital admissions with coronary heart disease, cerebrovascular disease or heart failure.
Interpretation
This nationwide analysis in England demonstrates that all types of diabetes are independently associated with a significant increased risk of in-hospital death with COVID-19.
Funding
NHS England & Improvement and Public Health England.


Research in context
Evidence before this study

From March 2020, we performed weekly searches of PubMed and MedRxiv using the terms COVID-19, SARSCoV-2, coronavirus,SARS virus and diabetes. Studies from China, Italy, the USA and the UK have suggested that people with diabetes have higher risks of more severe outcomes with COVID-19, including death. One population-based UK study reported a higher risk of COVID-19 related death in those with diabetes after
adjustment for demographic factors and other comorbidities. However, none of these studies have assessed differences in risk by type of diabetes.
Added value of this study
This is the largest COVID-19 related study, covering almost the entire population of England, and is the first study to investigate the relative and absolute risks of death in hospital with COVID-19 by type of diabetes, adjusting for key confounders. It demonstrates that one third of all deaths in-hospital with COVID-19 occur in people with diabetes. Adjusted for age, sex, deprivation, ethnicity and geographical region, people with Type 1
and Type 2 diabetes had 3.50 and 2.03 times the odds respectively of dying in hospital with COVID-19 compared to those without diabetes. These relative odds were attenuated to 2.86 and 1.81 respectively when also adjusted for previous hospital admissions with cardiovascular comorbidities.
Implications of all the available evidence
People with diabetes are at higher risk of COVID-19 related death, and those with Type 1 diabetes are at higher risk than those with Type2 diabetes. These insights are important in both understanding the pathophysiological mechanisms underlying the determinants of more severe outcomes with COVID-19, and in informing potential clinical and public health responses to the pandemic.

Read the full paper

In the news:

The Guardian Covid-19: people with type 1 diabetes more likely to die than those with type 2 – study

Metro Why are people with diabetes at higher risk of dying from coronavirus?

Should a chronic condition, such as type 1 diabetes, prevent regular exercise?

NICE |nd| Should a chronic condition, such as type 1 diabetes, prevent regular exercise?

In the latest episode of NICE’S podcast NICE Talks, the topic is whether a long term chronic condition such as type 1 diabetes should prevent regular exercise.

The hosts of the podcast speak with Chris Bright, a Welsh International Futsal player, who has lived with type 1 diabetes for 20 years; Professor Partha Kar a Consultant Endocrinologist at Portsmouth Hospitals NHS Trust and aNational Specialty Advisor, Diabetes, for NHS England; and chiropractor Peter Dixon, President of the Royal College of Chiropractors and NICE Fellow. They discuss the NICE recommendations on physical activity for those with type 1 diabetes, available from NICE.

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Listen via Soundcloud

Type 2 Diabetes Peer Mentor Programme

This report outlines the findings from an interim evaluation of a peer mentoring service for people with type 2 diabetes | Bristol Community Health

bristol
Image source: https://www.brigstowe.org/

Brigstowe’s Type 2 Peer Support Project was set up in partnership with Bristol Community Health in October 2018 to investigate the potential benefits of 1-2-1 peer mentoring for people newly diagnosed with type 2 diabetes in Bristol.

The programme is based on Brigstowe’s model of peer mentoring for people diagnosed with HIV and aimed to see if similar wellbeing and health outcomes could be achieved when transferring the model to other long-term health conditions.

 

 

Diabetes UK strategy 2020-2025

Diabetes UK has launched a new strategy called ‘A generation to end the harm: Diabetes UK Strategy 2020-2025’ coinciding with World Diabetes Day 2019 

diabstrat
Image source: https://www.diabetes.org.uk/

There are an estimated 2.85 million people diagnosed with type 2 diabetes in England, and more than 850,000 living with the condition who do not know they have it because they have not yet been diagnosed − bringing the total up to 3.7 million.

The new strategy from Diabetes UK focuses on achieving five key outcomes by 2025:

  • more people with type 1, type 2 and all other forms of diabetes will benefit from new treatments that cure or prevent the condition
  • more people will be in remission from type 2 diabetes
  • more people will get the quality of care they need to manage their diabetes well
  • fewer people will get type 2 and gestational diabetes
  • more people will live better and more confident lives with diabetes, free from discrimination.

The charity said that more than half of all cases of type 2 diabetes could be prevented or delayed, and in turn, the risk of developing the related complications, by tackling overweight and obesity.

Full document: A generation to end the harm: Diabetes UK Strategy 2020-2025

See also: Obesity rate doubles over past 20 years | OnMedica

Flash: My diabetes crystal ball

NHS England | November 2019 | Flash: My diabetes crystal ball

To mark Diabetes Awareness month this month (November) NHS England are publishing a series of blogs from the perspective of patients with diabetes. In the first blog, a patient with type 1 diabetes explains how using flash glucose monitoring has been life-changing in managing her condition.

Flash: My diabetes crystal ball

Taking a Type 1 diabetes honeymoon

Diabetes UK | October 2019 | Taking a Type 1 diabetes honeymoon

People with recently-diagnosed type 1 diabetes mellitus (T1D) may undergo a transient period of glycaemic control with less exogenous insulin. This ‘remission’ is sometimes referred to as the honeymoon phase; with this in mind recent research conducted by experts at University College London wanted to identify why the partial recovery does not happen to everyone as this could inform a better understanding of glycaemic control. 

The team at UCL used data from ADDRESS 2 a collection of information and blood samples from over 5,000 people newly diagnosed with Type 1 diabetes, funded by Diabetes UK – to look at the characteristics of those who did and didn’t experience a honeymoon.
blur-checking-close-up-1001897.jpgThey tracked participants for 12 months after their diagnosis and defined a honeymoon period as a daily insulin dose of 0.4 units per kg of body weight (which is less insulin than most people with Type 1 would typically take), with an HbA1c of less than 53 mmol/mol (7.0%).

They found that the honeymoon was most likely to occur three months after a Type 1 diagnosis, but can begin anywhere up to 12 months after.

Prevalence of remission increased at age 20 years and at 3 months after diagnosis.

In those aged less than 20 years remission was more likely in males with no ketoacidosis and few symptoms (Source: Diabetes UK)

Read Diabetes UK  Taking a Type 1 diabetes honeymoon [press release] 

Full reference:

Humphreys, A. et al | 2019 | Individual and diabetes presentation characteristics associated with partial remission status in children and adults evaluated up to 12 months following diagnosis of type 1 diabetes: An ADDRESS-2 (After Diagnosis Diabetes Research Support System-2) study analysis |Diabetes Research and Clinical Practice | Vol.155| https://doi.org/10.1016/j.diabres.2019.107789

 

Abstract 

Aims

People with recently-diagnosed type 1 diabetes mellitus (T1D) may undergo a transient period of glycaemic control with less exogenous insulin. Identification of predictors of this ‘remission’ could inform a better understanding of glycaemic control.

 

Methods

Participants in the ADDRESS-2 study were included who had 1 or 2 assessments of remission status (coincident insulin dose and HbA1c measurement, with remission defined by ≤0.4 units insulin/kg-body-weight/day with HbA1c < 53 mmol/mol). Demographic and clinical presentation characteristics were compared according to remission status and predictors of remission were explored by logistic regression analysis.

 

Results

1470 first and 469 second assessments of remission status were recorded within 12 months of diagnosis of T1D. Step increases in the probability of remission were identified at age-at-diagnosis 20 years and 3 months after diagnosis (both p under 0.001). Among those aged less than  20 years, remission was associated with male gender (p equal to 0.02), no ketoacidosis (p equal to 0.02) and fewer than 2 symptoms at presentation (p equal to  0.004). None of these characteristics predicted remission in those aged equal to over  20 years. In the subgroup with two assessments, transition to remission was independently associated with first remission assessment in months 1–2 post-diagnosis (p equal to 0.01), with age-at-diagnosis more than or equal to  20 years (p equal to 0.01) and, in those aged less than 20 years, with an early HbA1c of less than 57 mmol/mol. Adiposity, ethnicity, autoantibody status and other autoimmune disease were unrelated to remission.

 

Conclusions

For those diagnosed before 20 years of age, males, ketoacidosis-free, with fewer symptoms and low early HbA1c were more likely to experience remission, but remission was most likely in anyone aged more than or equal to  20 at diagnosis.

The Library & Knowledge Service can provide access to this article for Rotherham NHS Staff, request a copy here

 

Why do people with diabetes miss appointments?

Eades, C. & Alexander, H.  | 2019| A mixed‐methods exploration of non‐attendance at diabetes appointments using peer researchers | Health Expectations |https://doi.org/10.1111/hex.12959

A team of researchers conducted telephone interviews people with diabetes who had missed appointments 10 people were interviewed, a further 34 people who had missed appointments completed a questionnaire.  The data produced provide insights into their perceptions of their diabetes and diabetes appointments. Key reasons for missing appointments were low perceived value of appointments and the feeling that diabetes had little impact upon their lives’. 

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Abstract

Background

Non‐attendance at diabetes appointments is costly to the health service and linked with poorer patient outcomes.

 

Objective

Peer researchers aimed to conduct interviews and survey people who miss appointments about their beliefs and perceptions regarding their diabetes and diabetes appointments.

 

Design

A mixed‐methods cross‐sectional design with interviews conducted by peer researchers with diabetes and a questionnaire was used.

 

Setting and participants

Peer researchers conducted semi‐structured telephone interviews in one health board in Scotland with ten people who had missed diabetes appointments. A further 34 people who had missed appointments completed a questionnaire. The study was informed by two psychological theories (the Theory of Planned Behaviour and the Self‐Regulation Model), and interviews were analysed using thematic analysis.

 

Results

Interviewees planned to attend appointments but practical barriers, low perceived value of appointments and the feeling that diabetes had little impact upon their lives’ emerged as key reasons for missing appointments. Questionnaire data supported these findings and showed that respondents perceived diabetes to have only mildly serious consequence and cause limited concern and emotional impact. Participants’ understanding of their condition and perceptions of personal control and treatment control were low. Gender, perceived behavioural control and emotional representations were significantly associated with the number of appointments missed in the previous year.

Conclusions

These findings highlight the importance of psychological variables in predicting non‐attendance at diabetes appointments and provide avenues for how non‐attendance might be tackled.

 

The full article is available from Health Expectations 

[NICE update] Type 2 diabetes in adults: management

NICE |  August 2019 | Type 2 diabetes in adults: management

NICE has updated Type 2 diabetes in adults: management, this guideline covers the care and management of type 2 diabetes in adults (aged 18 and over). It focuses on patient education, dietary advice, managing cardiovascular risk, managing blood glucose levels, and identifying and managing long-term complications.

Full details from NICE

NICE: Dapagliflozin with insulin for treating type 1 diabetes

NICE | August 2019| Dapagliflozin with insulin for treating type 1 diabetes

Today (28 August 2019) has published  final guidance on an innovative treatment for type 1 diabetes. Dapagliflozin is the first licenced oral add-on therapy to insulin in type 1 diabetes

Dapagliflozin (brand name Forxiga) with insulin is available on the NHS. It is a possible treatment for type 1 diabetes in adults with a body mass index (BMI) of at least 27 kg/m2, when insulin alone does not control blood sugar levels well enough, if:

  • you are on insulin doses of more than 5 units per kilogram of body weight per day and
  • you have done a structured education programme that includes information about diabetic ketoacidosis, and
  • treatment is started and supervised by a consultant physician specialising in endocrinology and diabetes.

Further details are available from NICE