Evidence-based nutrition guidelines for the prevention and management of diabetes

Diabetes UK |  March 2018  | Evidence-based nutrition guidelines for the prevention and management of diabetes

Diabetes UK has produced nutrition guidelines relevant to people at risk of developing Type 2 diabetes and people with Type 1 and Type 2 diabetes. Special considerations have also been discussed for Gestational diabetes and Cystic Fibrosis- Related diabetes. The guidelines build upon those published by Diabetes UK in 2011, but a number of sections have been added to reflect changes in practice, clinical guidelines and policy priorities. Such as prevention of Type 2 diabetes and a section relevant to dietary sugars.

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Image source: diabetes-resources-production

Children are not included in the scope of these guidelines. The International Society of Paediatric and Adolescent Diabetes (ISPAD) clinical practice guidelines have been adopted by Diabetes UK.

The guidelines recommend:

  • An individualised approach to diet taking into consideration the person’s personal and cultural preferences
  • People eat more of certain foods such as vegetables, fruits, wholegrains, fish, nuts and pulses
  • People eat less red and processed meat, refined carbohydrates and sugar sweetened beverages.

They can be downloaded here 

National Diabetes Inpatient Audit 2017

Diabetes UK,  Health Quality Improvement Partnership, Public Health England & NHS Digital  | March 2018  | National Diabetes Inpatient Audit 2017

The National Audit  measures the quality of diabetes care provided to people with diabetes while they are admitted to hospital, by answering the following questions:

  • Did diabetes management minimise the risk of avoidable complications?
  • Did harm result from the inpatient stay?
  • Was patient experience of the inpatient stay favourable?
  • Has the quality of care and patient feedback changed since NaDIA 2010, 2011, 2012, 2013, 2015 and 2016?

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Image source: digital.nhs.uk

Key facts:

  • Bedside data on 16,010 inpatients was submitted, 200 more than NaDIA 2016
  • Around 1 in 6 hospital beds are occupied by a person with diabetes (18 per cent). 1 in 15 of the total population have diabetes (7 per cent)
  • More than a quarter of hospital sites report no dedicated diabetes inpatient specialist nurses (DISNs) (28 per cent)
  • One fifth of hospital sites do not have a multi-disciplinary footcare team (MDFT) (20 per cent), though this proportion has reduced from 42 per cent in 2011
  • Almost one third of inpatients with diabetes have a medication error during their hospital stay (31 per cent)

 

The one page summary can be downloaded here

The full report can be read here at NHS Digital 
Alternatively, the report is also available as a PowerPoint presentation, it can be accessed here

 

Couch potato habits are more harmful if family members have type 2 diabetes

University of Liverpool  | March 2018  |  Sedentary lifestyles ‘more harmful’ if type 2 diabetes in the family

A new study emphasises how beneficial physical exercise can be for those with a familial history of Type 2 diabetes. Although earlier research has suggested that physical inactivity can have harmful effects on the body, this research advances previous  findings, by suggesting these effects could be even greater if there is a family history of Type 2 diabetes.

Researcher Dr Kelly Bowden Davies, from Liverpool University’s Institute of Ageing and Chronic Disease, conducted the study with a team of researchers, said: “The results of our study highlight the critical importance of avoiding low levels of physical activity and sedentary behaviour, for example too much sitting, television viewing, computer gaming and so on. We know the benefits of exercise, the challenge now is to encourage people to simply move more and sit less.”

The research which was funded by Diabetes UK,  looked at 45 individuals with an average age of 36, who were physically active,  that is they all walked at least 10,000 steps a day.  A  third of the sample (16) had a close relative with a diagnosis of Type 2 diabetes.  Initially, the participants reduced their physical activity for two weeks, which included driving, rather than walking, and using lifts or escalators instead of stairs to limit the number of steps to around 1,500 a day.  Participant’s leisure time was spent at home, mainly watching TV or playing computer games.

Following this period of relative inactivity,  the researchers found that all of the sample  had higher levels of fat and their bodies were less able to respond to the hormone, insulin (known as insulin resistance) than at the outset.  Equally, following an additional fortnight’s observation, this time the participant’s resumed their more active lifestyles, they were assessed again and the researchers found the adverse effects were reversed.

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For the research team, this underlines how beneficial physical activity can be, and the important role it plays in reducing the risk of developing Type 2 diabetes.

Dr Elizabeth Robertson, Director of Research at Diabetes UK, said: “This Diabetes UK study sheds light on the potential harmful effects that short-term inactivity could have on our health, especially if we have a close family history of Type 2 diabetes.

“People with Type 2 diabetes in the family are two to six times more likely to develop the condition than those who do not have a family history of the condition. Living an active lifestyle and eating a healthy balanced diet are the key ways to reduce your risk of Type 2 diabetes.”

The full news item is available from University of Liverpool

Sedentary lifestyles ‘more harmful’ if type 2 diabetes in the family

In the media:

The Telegraph Just two weeks of sedentary office working risks diabetes – new report

Patient data saves lives: Diabetes

Better use of data is essential to speed up diagnosis, research new treatments, plan better NHS services and monitor the safety of drugs. However, most patients feel they don’t know how their data are used in the NHS.

Understanding Patient Data have developed a series of animations to address this gap in knowledge.

Watch the video, Patient data saves lives: Diabetes below:

Other titles in this series include:

  • Patient data saves lives: The bigger picture (watch)
  • Patient data saves lives: Cancer (watch)
  • Patient data saves lives: Asthma (watch)
  • Patient data saves lives: Heart attack (watch)
  • Patient data saves lives: Dementia (watch)

For further information about how and why patient data is used, visit the UPD website: www.patientdata.org.uk

National Diabetes Audit 2016-2017 full report – Care Processes and Treatment Targets

Health Quality Improvement Partnership | March 2018 |  National Diabetes Audit, 2016-17 Report 1: Care Processes and Treatment Targets|

The National Diabetes Audit  (NDA) provides a comprehensive view of diabetes care in England and Wales and measures the effectiveness of  diabetes healthcare against NICE Clinical Guidelines and NICE Quality Standards.

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The audit asked five focused questions:

  1. Is everyone with diabetes diagnosed and recorded on a practice diabetes register?
  2.  What percentage of people received the NICE key processes of diabetes care?
  3.  What percentage of people achieved NICE defined treatment targets for glucose
    control, blood pressure and cholesterol?
  4. What percentage of people are offered and attend a structured education course?
  5. For people with registered diabetes what are the rates of acute and long term
    complications (disease outcomes)?

 

Key findings

  • 7375 GP practices provided a full submission to the NDA,  meaning primary care participation was 95.3 per cent which is an increase from 82.4 per cent in 2015- 16. 99 specialist services also participated.
  • There was more than 10 per cent  improvements in HbA1c for Type 1 diabetes and blood pressure for Type 2 diabetes over the 6 years between 2011-12 to 2016-17.
  • Young people are almost half as likely to achieve treatment targets as their older counterparts.

 

Its four key recommendations are:

  1. Develop and implement systems for GP practices that clarify who has attended patient education courses.
  2.  Reduce variation; every service and locality has results that are significantly poorer than their peers.
  3. Seek new approaches to improving management for those overall doing worst – people of working age and younger.
  4. People with diabetes should review these results and consider asking questions locally if their CCG/LHB, GP or specialist service appears to be performing poorly.

(HQIP)

The full report, National Diabetes Audit 2016-2017 full report – Care Processes and Treatment Targets is available from NHS Digital

Related materials :

A shorter version of the report was published in November 2017, it can be accessed here

A one page summary is available from Health Quality Improvement Partnership (HQIP) here 


There are additional materials on severe mental illness (SMI) and Learning Disability with Diabetes available here

National Diabetes Footcare Audit: Third Annual Report 2014-2017
This document presents findings on care structures, patient management and outcomes of care for people with active diabetic foot ulcers.

National Diabetes Inpatient Audit, England and Wales 2017
Measures the quality of care diabetes inpatients received, to support quality improvement

 

Smartphone app usage leads to health improvements for diabetes patients

Imperial College London | Do you want to beat Type 2 diabetes? There’s an app for that! | March 2018

Over 400 patients with Type 2 diabetes in North-West London used apps on smartphones to support them in monitoring and helping to control their condition.  Imperial College London collaborated with North West London Collaboration of Clinical Commissioning Groups (CCG), to enable more than 400 patients from 18 GP practices across North West London to trial the digital apps during four months last year. The three apps used during the trial, Changing Health, OurPath, and Oviva, were described by patients as being easy to use.  Participants also reported positive feelings, such as  increased motivation, as well as being better informed about food; they also enjoyed the tips and advice available. 

iphone-410311_1280Key findings:

  • Patients saw a significant reduction in body mass index (BMI), blood pressure and blood sugar (HbA1c) levels
  • patients lost on average two to three kilograms of weight
  • 118 patients participating provided details of their medication, of those 20 per cent were able to stop taking the diabetes medication metformin during the trial.

Patients who participated in the trial represented a range of ages, ethnicities and social backgrounds, characterised as being ‘hard to reach’ by the researchers.

Dr Tony Willis, the Diabetes Clinical Lead explained “the results have been beyond our expectations”. He elaborated “there was an excellent uptake of patients completing the trial using the apps. This alongside the clinically significant improvements in HbA1c, blood pressure and weight; show just how well people respond when they can receive support at the click of a button.”

The apps provide support patients that are unable to or choose not to attend diabetes education classes to help control their diabetes. They are designed to encourage healthy eating and exercise and, educate people on how to manage and control their condition.

To read more about the trial at Imperial College London News

You can read more about NHS England’s digital innovations here

Research aims to improve pregnancy care for women with diabetes

Diabetes UK | 2018 | Research aims to change the lives of pregnant women with diabetes 

Babies whose mothers have Type 1 or Type 2 diabetes can grow too small or too large during pregnancy, and this is thought to be linked to the mother’s blood glucose levels. A large or small baby can lead to complications,  such as premature birth and caesarean section and traumatic childbirth.

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A new research project led by  Dr Jenny Myers uses an innnovative ultrasound technique to measure the impact that a mum’s blood glucose levels have on the growth of their developing baby.  The team’s previous research has shown measuring a baby’s thigh during pregnancy, using a 3D ultrasound, is a reliable method to predict how the baby will grow.

They will measure women’s blood sugar levels, using continuous glucose monitors, at different points during their pregnancy. To help them better understand the link between blood glucose control and the growth of babies in the womb.  The researchers will invite women to help us test new treatments and therapies, designed to support expectant mums to better manage their blood sugar levels at the most critical points during their pregnancy. Dr Myers envisages this will enable more effective care and treatments to mothers when they most need it most.

The research is funded by Diabetes UK

Further details are available from Diabetes UK

Diabetes UK: Volunteer Clinical Champion roles available for healthcare professionals

Could you be a Diabetes UK Clinical Champion? The charity is currently recruiting healthcare professionals from across the diabetes pathway including, consultants, GPs, nurses, dietitians, podiatrists senior pharmacists and psychologists, to apply to become Clinical Champions. Applicants should be experienced in treating the complex needs of people with diabetes, and have the potential to lead real change.

Successful applicants participate in a two-year leadership development programme, where they learn about influencing change, and benefit from peer support and peer learning. Concurrently, they deliver a project to improve or transform local diabetes care that they have identified as a pressing issue in their locale. (Diabetes UK)

There are 65 Clinical Champions across the UK. You can read more about some of the Clinical Champions’ achievements and their work  here.

 

The voluntary role runs for two years Clinical Champions will come into post in June 2018 and will complete the programme in May 2020.

The deadline for application is 28 March 2018. Full details are at Diabetes UK

2008 recession led to increase in obesity, diabetes and mental health issues

The 2008 recession resulted in changes to individuals’ health behaviour, with a significant increase in the likelihood of obesity, diabetes and mental health problems | Social Science & Medicine | Story via ScienceDaily.

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Researchers from City University London and King’s College London looked at data from the Health Survey for England (HSE), a cross-sectional survey taken yearly from a representative sample of about 9,000 English households. They specifically used data on respondents above 16 years of age for the period 2001-2013. In addition to socio-economic characteristics, the HSE includes information on a wide range of health lifestyles and health conditions.

The results of the study suggest that the start of the recession was associated with worse dietary habits and increased BMI and obesity. It was also associated with a shift away from risky behaviours, as a decrease in smoking and alcohol consumption was seen. In addition, there was an increase in the use of medicines and a higher likelihood of suffering diabetes and mental health problems, all of which were generally experienced more acutely by those with less education and by women.

Researchers discovered that the probability of being obese and severely obese increased by 4.1 and 2.4 percentage points respectively. Similarly, the probability of having diabetes was 1.5 percentage points higher after 2008, with the prevalence of mental health problems increasing by 4 percentage points.

Full story at ScienceDaily

Full reference: Mireia Jofre-Bonet, Victoria Serra-Sastre, Sotiris Vandoros |  The impact of the Great Recession on health-related risk factors, behaviour and outcomes in England | Social Science & Medicine, 2018.

Improving Diabetic Foot Care: A Guide for Commissioners

The College of Podiatry in collaboration with Health Education England and Insight Health Economics have produced a toolkit for commissioners in England to enable Diabetic Foot Care services to provided more effectively.

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The College are calling on healthcare commissioners to prioritise diabetic foot care and end avoidable amputations that can have a devastating impact on the lives of patients and their families and cost the NHS millions.

Complications from diabetic foot disease are costing the NHS in England more than a billion pounds a year. Today, and every day, 23 people with diabetes in England will have a toe, foot or leg amputated. A third of these are major amputations, meaning that the patient loses their whole foot above the ankle or even more of their leg. Many of these amputations are preceded by diabetes related foot ulcers, caused by a combination of impaired circulation and nerve damage – common problems experienced by people with diabetes.

Experts believe that by improving the way diabetic foot health is commissioned and delivered, around half of these life-shattering surgeries could be avoided.

Full detail: Improving Diabetic Foot Care: A Guide for Commissioners