Preventing Type 2 diabetes

Guidance on how to optimise the NHS Diabetes Prevention Programme in order to identify those at risk of Type 2 diabetes and help lower their risk of developing the disease | Public Health England

NHS DPP
Image source: www.gov.uk

Healthier You: NHS Diabetes Prevention Programme (NHS DPP)

The NHS DPP is a joint commitment from Public Health England, NHS England and Diabetes UK. The Programme, launched in 2015, delivers evidence based behavioural interventions at scale for individuals identified as being at high risk of developing Type 2 diabetes.

The NHS DPP is underpinned by a strong evidence base. PHE has published a systematic review and meta-analysis examining the effectiveness of diabetes prevention programmes.

The goals of the NHS DPP are to:

  • reduce the incidence of Type 2 diabetes
  • reduce the incidence of complications associated with Type 2 diabetes – heart, stroke, kidney, eye and foot problems related to diabetes
  • reduce health inequalities associated with incidence of Type 2 diabetes, over the longer term

In the short-term, the Programme recognises that a stronger focus on identifying people who are at risk of diabetes is likely to increase recorded incidence of diabetes as more undiagnosed cases are uncovered. This is important to recognise as it is possible to live for some time with undiagnosed Type 2 diabetes; in 2015, an estimated 900,000 people had Type 2 diabetes but were undiagnosed.

There is strong international evidence that demonstrates how behavioural interventions, with a focus on supporting people to maintain a healthy weight and be more active, can significantly reduce the risk of developing Type 2 diabetes. The NHS DPP behavioural intervention reflects this evidence, as it is underpinned by 3 core goals:

  • achieving a healthy weight
  • achievement of dietary recommendations
  • achievement of the Chief Medical Officers’ (CMO) physical activity recommendations
Dr Jonathan Valabhji outlines the aims of NHS Diabetes Prevention Programme

Full detail: Health matters: preventing Type 2 Diabetes

Diabetes test strips recalled in new alert

Medicines and Healthcare products Regulatory Agency | May 2018| Diabetes test strips recalled in new alert

People with diabetes are advised to stop using and return specific lots of Accu-Chek Aviva and Accu-Chek Performa test strips following a recent recall by the manufacturer. 

Accu-Chek Inform II test strips have also been recalled but are supplied in the UK by Roche for professional use only.

The test strips may give increased strip error messages prior to dosing with blood and in some cases may give falsely high or low readings which may be hard to detect.

The Medicines and Healthcare products Regulatory Agency (MHRA) are urging users to check the lot numbers of their test strips against the lot numbers listed in the table below. More information can be found in this field safety notice. It is estimated that more than 260,000 packs have been affected.

If anyone finds they have test strips from the affected lots, they are advised to seek alternative testing methods and return affected lots to their pharmacy or shop where they will be offered a replacement.

It is also advised anyone with concerns about their blood glucose readings should discuss this with a healthcare professional.  (Source: Medicines and Healthcare products Regulatory Agency)

The full release and a list of affected products can be read here

Source: Medicines and Healthcare products Regulatory Agency

In the media:

Daily Mail  Diabetes testing kits are urgently recalled amid fears they give false readings and could put lives at risk

Depression in type 1 diabetes and risk of dementia

Study find that for people with Type 1 Diabetes, depression significantly increases dementia risk | Aging & Mental Health

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Objective: Depression afflicts 14% of individuals with type 1 diabetes (T1D). Depression is a robust risk factor for dementia but it is unknown if this holds true for individuals with T1D, who recently started living to an age conferring dementia risk. We examined if depression is a dementia risk factor among elderly individuals with T1D.

Methods: 3,742 individuals with T1D age ≥50 were followed for dementia from 1/1/96-9/30/2015. Depression, dementia, and comorbidities were abstracted from electronic medical records. Cox proportional hazard models estimated the association between depression and dementia adjusting for demographics, glycosylated hemoglobin, severe dysglycemic epidsodes, stroke, heart disease, nephropathy, and end stage renal disease. The cumulative incidence of dementia by depression was estimated conditional on survival dementia-free to age 55.

Results: Five percent (N = 182) were diagnosed with dementia and 20% had baseline depression. Depression was associated with a 72% increase in dementia (fully adjusted HR = 1.72; 95% CI:1.12-2.65). The 25-year cumulative incidence of dementia was more than double for those with versus without depression (27% vs. 12%).

Conclusions: For people with T1D, depression significantly increases dementia risk. Given the pervasiveness of depression in T1D, this has major implications for successful aging in this population recently living to old age.

Full reference: Gilsanz, P. et al. | Depression in type 1 diabetes and risk of dementia | Aging & Mental Health | Published online: 10 Apr 2018 DOI: 10.1080/13607863.2018.1455167

Blood test could allow some people with type 1 diabetes to come off insulin

BBC News | May 2018 | Diabetes blood test ‘could mean end to daily insulin jabs’

Doctors at the Western General in Edinburgh developed a C-peptide blood test last summer, which enables patients with type 1 diabetes to come off insulin. The team have now set up a full screening programme,  following the discovery of a patient with a genetic form of diabetes.  Since then a number of patients have completely come off insulin and some patients have been able to manage their condition through their doctors’ personalising treatments for them. Historically, it has been believed that patients with type 1 do not produce any insulin. 

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Professor Mark Strachan, who is a consultant in diabetes and endocrinology at the Western General Hospital, has now called for every patient to undergo screening – which costs £6 a time. The team say the programme has had “transformational” results which, for some people, could mean the end of daily injections (Source: BBC News).

The full news item is at BBC News

BBC News | Diabetes blood test ‘could mean end to daily insulin jabs’

Negative feelings and diabetes

Science Daily | May 2018 | Brain activity helps explain diabetics’ negative feelings, risk for depression

A US study suggests that negative feelings in people with a diagnosis of diabetes, or prediabetes,  might be due to problems regulating blood sugar levels that influence emotional response in the brain (via Science Daily).
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Researchers  gauged the startle response of participants, to provide a measure of their central nervous system activity, using tiny electrodes placed below their eye. The participants were shown a series of negative, positive and neutral images designed to elicit an emotional response. The electrodes captured the rate of flinch or startle, a contraction we cannot control, associated with each image.

Their findings show that participants with higher levels of insulin resistance were more startled by negative pictures.  They argue the evidence is even more compelling when combined with the results of EEG tests recording activity when the brain is at rest. Study participants with prediabetes and Type 2 diabetes had more activity on the right side of the brain, which is associated with depression and negative emotions.  By extension, if someone is predisposed to focusing on negative things, it may become a barrier for losing weight and reversing health issue

Tovah Wolf, an author of the study said: “For people with blood sugar problems, being more stressed and reactive can cause blood sugar to spike. If people with prediabetes and diabetes are trying to reverse or treat the disease, stressful events may hinder their goals,” Wolf said. “Frequent negative reactions to stressful events can lead to a lower quality of life and create a vicious cycle that makes it difficult to be healthy.

The full news item is available from Science Daily 

This paper has now been published in Psychosomatic Medicine

Abstract

Objective

Pre-diabetes and type 2 diabetes (i.e., hyperglycemia) are characterized by insulin resistance (IR). These problems with energy metabolism may exacerbate emotional reactivity to negatively valenced stimuli and related phenomena like predisposition toward negative affect, as well as cognitive deficits. Higher emotional reactivity is seen with hyperglycemia and IR. Yet, it is largely unknown how metabolic dysfunction correlates with related neural, hormonal, and cognitive outcomes.

Methods

Among 331 adults from the Midlife in the United States (MIDUS), we cross-sectionally examined eye- blink response (EBR) to gauge reactivity to negative, positive, or neutrally-valenced pictures from international affect picture system (IAPS) stimuli proximal to an acoustic startle probe. Increased EBR to negative stimuli was considered an index of stress reactivity. Frontal alpha asymmetry, a biomarker of negative affect predisposition, was determined using resting electroencephalography (EEG).

Methods

Baseline urinary cortisol output was collected. Cognitive performance was gauged using the Brief Test of Adult Cognition by telephone (BTACT). Fasting glucose and insulin characterized hyperglycemia or the homeostatic model assessment of IR (HOMA-IR).

Results

Higher HOMA-IR corresponded to an increased startle response, measured by EBR magnitude, for negative versus positive stimuli [R2=0.218, F(1,457)=5.48, p=.020, euglycemia: Mean±SD=.092±.776, hyperglycemia: Mean±SD=.120±.881]. Participants with hyperglycemia vs. euglycemia showed greater right frontal alpha asymmetry [F(1,307)=6.62, p=.011, euglycemia: Mean±SD=.018±.167, hyperglycemia: Mean±SD=-.029±.160] and worse BTACT arithmetic performance [F(1,284)=4.25, p=.040, euglycemia: Mean±SD=2.390±1.526), hyperglycemia: Mean±SD=1.920±1.462]. Baseline urinary cortisol (log10 μg/12 hr) was also dysregulated in individuals with hyperglycemia [[F(1,324)=5.09, p=.025, euglycemia: Mean±SD=1.052±.332, hyperglycemia: Mean±SD=.961±.362].

Conclusion

These results suggest that dysmetabolism is associated with increased emotional reactivity, predisposition toward negative affect, and specific cognitive deficits.
Wolf, T, Tsenkova, V,  Ryff, C.,  Richard, D. , J. Davidson, Auriel A. Willette. Neural, Hormonal, and Cognitive Correlates of Metabolic Dysfunction and Emotional ReactivityPsychosomatic Medicine, 2018; 1 DOI: 10.1097/PSY.0000000000000582

The full article may be requested by Rotherham NHS staff here