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

[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

Fish oil pills ‘no benefit’ for type 2 diabetes

Brown, T., Brainard, J., Song, F., Wang, X., Abdelhamid, A. & Hooper, L. | 2019| Omega-3, omega-6, and total dietary polyunsaturated fat for prevention and treatment of type 2 diabetes mellitus: systematic review and meta-analysis of randomised controlled trials | BMJ|  366 | l4697|  doi: https://doi.org/10.1136/bmj.l4697 :

Research that investigated whether omega-3 and other fatty acids were beneficial to people with type 2 diabetes has found that increasing long chain omega-3 intake had little or no effect on diagnosis or glucose metabolism; the study’s authors also report that there may be  negative outcomes at high dose. 

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Abstract

Objective To assess effects of increasing omega-3, omega-6, and total polyunsaturated fatty acids (PUFA) on diabetes diagnosis and glucose metabolism.

Design Systematic review and meta-analyses.

Data sources Medline, Embase, Cochrane CENTRAL, WHO International Clinical Trials Registry Platform, Clinicaltrials.gov, and trials in relevant systematic reviews.

Eligibility criteria Randomised controlled trials of at least 24 weeks’ duration assessing effects of increasing α-linolenic acid, long chain omega-3, omega-6, or total PUFA, which collected data on diabetes diagnoses, fasting glucose or insulin, glycated haemoglobin (HbA1c), and/or homoeostatic model assessment for insulin resistance (HOMA-IR).

Data synthesis Statistical analysis included random effects meta-analyses using relative risk and mean difference, and sensitivity analyses. Funnel plots were examined and subgrouping assessed effects of intervention type, replacement, baseline risk of diabetes and use of antidiabetes drugs, trial duration, and dose. Risk of bias was assessed with the Cochrane tool and quality of evidence with GRADE.

Results 83 randomised controlled trials (mainly assessing effects of supplementary long chain omega-3) were included; 10 were at low summary risk of bias. Long chain omega-3 had little or no effect on likelihood of diagnosis of diabetes or measures of glucose metabolism. A suggestion of negative outcomes was observed when dose of supplemental long chain omega-3 was above 4.4 g/d. Effects of α-linolenic acid, omega-6, and total PUFA on diagnosis of diabetes were unclear (as the evidence was of very low quality), but little or no effect on measures of glucose metabolism was seen, except that increasing α-linolenic acid may increase fasting insulin (by about 7%). No evidence was found that the omega-3/omega-6 ratio is important for diabetes or glucose metabolism.

Conclusions This is the most extensive systematic review of trials to date to assess effects of polyunsaturated fats on newly diagnosed diabetes and glucose metabolism, including previously unpublished data following contact with authors. Evidence suggests that increasing omega-3, omega-6, or total PUFA has little or no effect on prevention and treatment of type 2 diabetes mellitus.

Systematic review registration PROSPERO CRD42017064110.

 

The full article is available from the  BMJ

In the news:

BBC News Fish oil pills ‘no benefit’ for type 2 diabetes

Digital diabetes prevention rolled out as part of NHS Long Term Plan

NHS England | August 2019| Digital diabetes prevention rolled out as part of NHS Long Term Plan

Pilot schemes, offering convenient, 24/7 access to online advice significantly boosted the numbers taking up the flagship Diabetes Prevention Programme (DPP). More than two-thirds of people (68%) referred to the digital schemes participated compared with face-to-face support. 

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Those at risk of developing Type 2 but who cannot make face-to-face support sessions will be the first to benefit from the expansion which starts this month.

They will receive:

  • Wearable tech that monitors levels of exercise;
    • Apps which allow users to access health coaches and educational content
  • Online peer support groups;
    • The ability to set and monitor goals electronically

Dr Jennifer Smith Diabetes Programme Director Public Health England, said: “The success of the pilot’s early findings shows we are breaking new ground to help those most at risk of type 2 diabetes to literally take their health into their own hands at their own time and pace. Many of us use on-the-go digital technology every day and this is a fabulous next step in diabetes prevention.” (Source: NHS England)

Full details are available from NHS England

In the news:

Diabetes.co.uk  NHS England to offer wearable tech to help people reduce type 2 diabetes risk

The Guardian Thousands at risk of type 2 diabetes to be offered wearable tech