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

 

500 people with diabetes die prematurely every week

Diabetes UK | November 2018 | 500 people with diabetes die prematurely every week

Recent analysis by Diabetes UK of the most recent NHS National Diabetes Audit report on complications and mortality, shows that 500 people living with the condition die every week. Their statistics show that males and females over 35 and under 64 living with Type 1 diabetes are 3 to 4 times more likely to die prematurely than those without the condition. Men and women in the same age range with Type 2 diabetes are up to two times more likely to die prematurely (. The charity underlines that devastating complications of diabetes, like amputations, sight loss, kidney disease, stroke and heart disease, are preventable if people are supported to manage their diabetes effectively (Source: Diabetes UK).

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Diabetes UK is calling on NHS England to continue its concerted action to improve the quality of local diabetes services beyond 2019, to curb the growing numbers of people dying prematurely because of diabetes.

Read the full story at Diabetes UK

Plant-based or vegan diet linked to better diabetes control and wellbeing

New research shows that plant-based diets were associated with improvement in several areas for adults with type 2 diabetes including emotional well-being, physical well-being, depression, quality of life and general health | BMJ Open Diabetes Research & Care | via OnMedica

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Research published in BMJ Open Diabetes Research & Care analysed 11 trials of diet interventions, including a total of 433 adults with type 2 diabetes, that had clearly defined health outcomes and were peer-reviewed. The findings revealed that plant-based diets were associated with significant improvement in emotional well-being, physical well-being, depression, quality of life, general health, HbA1c levels, weight, total cholesterol and low-density lipoprotein cholesterol in adults with type 2 diabetes compared with several diabetic associations’ official guidelines and other comparator diets.

Whilst the review authors noted the  limitations of the study, they concluded that plant-based diets can significantly improve psychological health, quality of life, HbA1c levels and weight and therefore the management of diabetes.

Full reference: Toumpanakis A, et al. |  Effectiveness of plant-based diets in promoting well-being in the management of type 2 diabetes: a systematic review | BMJ Open Diabetes Research & Care | published online 30 October 2018

See also:

Diabetes: a ‘ticking time bomb’ for the NHS

Lack of specialist support and rising numbers of people living with the condition will create huge complications, say experts | via The Guardian

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The combination of an increase of people with type 2 diabetes over the past 20 years, cuts to NHS spending on continuing professional development and insufficient specialist support and expertise for people with type 1 diabetes will result in “huge complications” over the next two decades, according to experts at a Guardian round table event . Clinicians, academics, policy advisers and people with personal experience of diabetes discussed how to improve care in the UK. All the panellists acknowledged the need to do better in terms of care for people with diabetes.

Full story at The Guardian

 

AI app for gestational diabetes adopted by NHS

The NHS has adopted a software system to help manage gestational diabetes. The system from Sensyne Health comprises a smartphone application which connects to a wireless blood glucose monitor. 

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Glucose measurements, free-text commentary and requests for a call-back are transmitted directly to a dashboard for the multi-disciplinary team at the hospital in charge. The care team can also communicate directly with the patient via the system. The app has now completed a two-year clinical evaluation and is available for implementation across the NHS.

Full detail at Med Tech Innovation

Exclusive: Role of diabetes nurse ‘evolving’ to plug mental health gap

Nursing Times | October 2018 | Exclusive: Role of diabetes nurse ‘evolving’ to plug mental health gap

The latest article in the Nursing Times explains how diabetes nurses are supporting patients with diabetes with their mental health, who are unable to access treatment elsewhere. The article cites Diabetes UK data which found 3 in 5 patients with the condition experience mental health or emotional problems, including depression, anxiety and needle phobia. 
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Lesley Mills, consultant nurse in diabetes at Warrington and Halton Hospitals NHS Foundation Trust, explains how the role is “evolving” to encompass patients to address gaps for these patients. As such diabetes specialist nurses were extending their remit to support patients with diabetes.

“There are not enough psychologists, psychiatrists, counsellors and all these people do need that help so it’s evolved to often the work of the nurse specialist to do at least some of that work,” Ms Mills told Nursing Times.

“There are things like NICE guidance that say they should have access to those people but if those people don’t exist or the waiting list is six months before they can be seen then we have got to do something,” she said. (Source: Nursing Times)

The full, unedited news piece is available from the Nursing Times 

 

Related article: Nursing Times Diabetics more likely to die from suicide, accidents and alcohol [Please request from the Library 

Making hospitals safe for people with diabetes

Diabetes UK | October 2018 | Making hospitals safe for people with diabetes

The report from Diabetes UK has been created by an alliance of groups and individuals striving to improve hospital care for people with diabetes. Thorough engagement with diabetes inpatient teams, ward staff, people with diabetes and hospital management means we now understand the depth of the challenges facing the NHS in improving diabetes inpatient care. For their report, Diabetes UK visited hospitals across the country to find out what works.

Making hospitals safe Diabetes UK

Image source: Diabetes.org.uk

The report outlines six points that the UK needs to make hospitals safer for people with diabetes.

  • multidisciplinary diabetes inpatient teams in all hospitals
  • strong clinical leadership from diabetes inpatient teams
  • knowledgeable healthcare professionals who understand diabetes
  • better support in hospitals for people to take ownership of their diabetes
  • better access to systems and technology
  • more support to help hospitals learn from mistakes.

The report outlines these points in more detail and highlights what needs to be in place in all acute hospitals across England to make sure every stay for someone with diabetes is safe.

The report’s recommendations are based on models from across the UK which have been shown to improve patient care (Source: Diabetes UK).

Losing weight soon after a diabetes Type 2 diagnosis could prevent long-term damage, says new research

College of Medicine and Integrated Health| October 2018 | Losing weight soon after a diabetes Type 2 diagnosis could prevent long-term damage, says new research

University of Newcastle researchers discovered that losing weight soon after a diabetes Type 2 diagnosis could prevent long-term damage. The research was presented at the European Association for the Study of Diabetes  conference recently held in Berlin. 

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The scientists reported that following a a strict diet sooner could prevent further damage to the pancreas; researchers found that those who ate more healthily 2.7 years after diagnosis were more likely to go into remission than those who didn’t begin eating a reduced calorie intake for at least 3.8 years (Source: College of Medicine and Integrated Health).

Read the full news item at the College of Medicine and Integrated Health 

Consultation on the new NHS Diabetes Prevention Programme framework

NHS England has published summaries of results from a consultation on the development of the NHS Diabetes Prevention Programme framework. The consultation covered the potential to use remote and digital technologies in the new service specification to enable the programme to offer greater uptake and access for service users.