Language matters. Addressing the use of language in the care of people with diabetes

Cooper, A., et al. |2018| Language matters. Addressing the use of language in the care of people with diabetes: position statement of the English Advisory Group. Diabetic Medicine| 35|12|P. 1630-1634

 

A new position paper, led by the NHS Diabetes Programme and NHS England, looks at the importance of use and choice of language in the care of people with diabetes. 

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Abstract

The language used by healthcare professionals can have a profound impact on how people living with diabetes, and those who care for them, experience their condition and feel about living with it day‐to‐day. At its best, good use of language, both verbal and written, can lower anxiety, build confidence, educate and help to improve self‐care. Conversely, poor communication can be stigmatizing, hurtful and undermining of self‐care and can have a detrimental effect on clinical outcomes. The language used in the care of those with diabetes has the power to reinforce negative stereotypes, but it also has the power to promote positive ones. The use of language is controversial and has many perspectives. The development of this position statement aimed to take account of these as well as the current evidence base. A working group, representing people with diabetes and key organizations with an interest in the care of people with diabetes, was established to review the use of language. The work of this group has culminated in this position statement for England. It follows the contribution of Australia and the USA to this important international debate. The group has set out practical examples of language that will encourage positive interactions with those living with diabetes and subsequently promote positive outcomes. These examples are based on a review of the evidence and are supported by a simple set of principles.

 

This article has been published in this month’s edition of Diabetic Medicine

Rotherham NHS Staff can request a copy of this article here

Family support among older persons in diabetes mellitus self-management

Results of new study highlight the importance of family support in diabetes mellitus self-management in older persons | BMC Geriatrics

Background
The aging process has functional consequences for older persons, such as degenerative processes of the pancreas resulting in diabetes mellitus. The increasing age of the population will eventually lead to increasing health problems of older persons, including diabetes mellitus. Diabetes mellitus is a chronic disease that requires long-term care through self-management. Diabetes self-management in older persons is influenced by family support as the main support system. This study aimed to explore perceived family support by older persons in diabetes mellitus self-management.

Methods
This study applied descriptive phenomenology method. The data were collected through in-depth interviews. There were nine older persons with diabetes mellitus as participants. Data consisted of in-depth interview recordings and field notes. Data were transcribed and analyzed using Colaizzi’s method.

Results
The results identified that family support as perceived by older persons included daily activity assistance, assistance with obtaining health services, food preparation, financial support, attention, guidance, and problem solving. The response to family support was pleasure as expressed by the older persons.

Conclusions
Physical and economic limitations were a significant hindrance to self-management of diabetes mellitus in older persons; therefore, they require family support to optimize their independence. The results of this study highlight the importance of family support in diabetes mellitus self-management in older persons.

Full reference: Niko Dima Kristianingrum et al. | Perceived family support among older persons in diabetes mellitus self-management BMC Geriatrics | 2018, 18 (Suppl 1) :304 | published 19 December 2018

Perioperative diabetes

Highs and lows: a review of the quality of care provided to patients over the age of 16 who had diabetes and underwent a surgical procedure

perioperative
Image source: http://www.hqip.org.uk

The aim of this study was to highlight where care could be improved in patients with diabetes undergoing surgery.  The overarching theme of the findings was that there was a lack of clinical continuity of diabetes management across the different specialties in the perioperative pathway.

The areas for improvements in care raised by this report, and the recommendations made, have the potential to impact a large portion of surgical patients, providing quality improvement goals for hospitals to measure their practice against.

26,378 diabetes-related lower limb amputations in the last three years

Diabetes UK | December 2018 | 26,378 diabetes-related lower limb amputations in the last three years

New analysis from Diabetes UK  shows there were 26,378 lower limb amputations related to diabetes in England from 2014 to 2017, an increase of almost one- fifth  (19.4%) from 2010-2013.

The analysis reveals that here has been a significant rise in minor lower limb amputations (26.5%), defined as below the ankle, and a more gradual increase in the number of major lower limb amputations (4.1%), defined as below the knee.

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Head of Care at Diabetes UK, Dan Howarth said:

“The shocking number of lower limb amputations related to diabetes grows year on year. An amputation, regardless of whether it’s defined as minor or major, is devastating and life-changing. A minor amputation can still involve losing a whole foot.

“To reduce the number of amputations related to diabetes, we are calling on NHS England to maintain the Diabetes Transformation Fund beyond 2019. Many diabetes amputations are avoidable, but the quality of footcare for people living with diabetes varies significantly across England. Transformation funding since 2017 is working and will help to reduce these variations, but much work still needs to be done.” (Source: Diabetes UK)

Read the full release from Diabetes UK

In the news:

Guardian Record 169 UK patients a week get diabetes-related amputations

New research into pancreatic cancer will study diabetes patients

University of Liverpool | 2018 | £2.17m boost for pancreatic cancer research

New research in progress at the University of Liverpool, has been awarded over £2 million by Cancer Research UK, to identify differences in blood samples from people with newly diagnosed diabetes, to people who will develop pancreatic cancer and those who will not. Approximately 50 per cent of all people with pancreatic cancer will develop diabetes prior to a cancer diagnosis. Currently researchers lack a reliable way to distinguish pancreatic cancer-linked diabetes from normal type-2 diabetes, also known as diabetes mellitus.

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Now scientists at Liverpool will look for biomarkers (molecules in the blood samples) that could help them to identify people with a diabetes diagnosis who could benefit from further tests. The samples from participants will be stored in a biobank so they can be used in future studies to further research in this area (Source: University of Liverpool).

Read the full news story from University of Liverpool 

 

 

Fish oil supplements do not reduce cardiovascular deaths in people with diabetes without existing vascular disease

NIHR | December 2018 | Fish oil supplements do not reduce cardiovascular deaths in people with diabetes without existing vascular disease

The ASCEND study, which assesses primary cardiovascular prevention for people with any type of diabetes studied the impact of taking Omega-3 fatty acid supplements. In a NIHR Signal which highlights the research, reports that it found taking these supplements makes no difference to cardiovascular outcomes in people with diabetes but without established cardiovascular disease. Serious vascular events like heart attack, stroke or deaths from these occurred in approximately a tenth of participants irrespective of whether they took daily omega-3 or placebo capsules for seven years.

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The results are consistent with a recent large Cochrane review assessing omega-3 fatty acids in any population. Pooled analysis of around 40 high-quality trials of omega-3 supplements similarly found no effect on cardiovascular events or mortality.

The finding supports NICE recommendations that omega-3 fatty acids should not be offered to people with diabetes for the prevention of cardiovascular disease (Source: NIHR).

Full details of the Signal are at NIHR 

Full reference:

ASCEND Study Collaborative Group| 2018|Effects of n− 3 Fatty Acid Supplements in Diabetes Mellitus| New England Journal of Medicine| 379 |16| P. 1540-1550.

Published abstract

Background
Increased intake of n-3 fatty acids has been associated with a reduced risk of cardiovascular disease in observational studies, but this finding has not been confirmed in randomized trials. It remains unclear whether n-3 (also called omega-3) fatty acid supplementation has cardiovascular benefit in patients with diabetes mellitus.
Methods
We randomly assigned 15,480 patients with diabetes but without evidence of atherosclerotic cardiovascular disease to receive 1-g capsules containing either n-3 fatty acids (fatty acid group) or matching placebo (olive oil) daily. The primary outcome was a first serious vascular event (i.e., nonfatal myocardial infarction or stroke, transient ischemic attack, or vascular death, excluding confirmed intracranial hemorrhage). The secondary outcome was a first serious vascular event or any arterial revascularization.
Results
During a mean follow-up of 7.4 years (adherence rate, 76%), a serious vascular event occurred in 689 patients (8.9%) in the fatty acid group and in 712 (9.2%) in the placebo group. The composite outcome of a serious vascular event or revascularization occurred in 882 patients (11.4%) and 887 patients (11.5%), respectively. Death from any cause occurred in 752 patients (9.7%) in the fatty acid group and in 788 (10.2%) in the placebo group. There were no significant between-group differences in the rates of nonfatal serious adverse events.
Conclusions
Among patients with diabetes without evidence of cardiovascular disease, there was no significant difference in the risk of serious vascular events between those who were assigned to receive n-3 fatty acid supplementation and those who were assigned to receive placebo. (Funded by the British Heart Foundation and others; Current Controlled Trials number, ISRCTN60635500 ; ClinicalTrials.gov number, NCT00135226.)

The full article can be requested by Rotherham NHS staff, simply complete the form here 

 

The benefits and harms of aspirin for people with type 2 diabetes are finely balanced

NIHR | December 2018 |The benefits and harms of aspirin for people with type 2 diabetes are finely balanced

The findings of research that studied over 15000 UK adults with either type of diabetes but with no known cardiovascular disease is highlighted in a new NIHR signal.  

The ASCEND randomised controlled trial gave half of the participants either 100mg of aspirin or a sugar tablet. In addition they were also assigned to daily capsules containing n−3 fatty acids or matching placebo. 

Daily aspirin reduced the risk of serious vascular events among people with diabetes, while increasing the risk of major bleeding to a similar extent. Aspirin prevented one person in every 100 from having a heart attack or stroke over seven years, but an additional person per 100 experienced a major bleed.

The ASCEND study is one of three large placebo-controlled trials investigating the effects of 100mg daily aspirin for primary prevention in people without established cardiovascular disease. However, unlike other trials (in healthy older adults), this study found that aspirin had no effect on cancer risk during the study period.

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The finding supports NICE recommendations that aspirin shouldn’t be prescribed to people with diabetes who do not have existing cardiovascular disease (Source: NIHR).

Read the full Signal from NIHR 

Published abstract also available from NIHR 

12% of men and 9% of women with a very high waist circumference had either diagnosed or undiagnosed diabetes, finds NHS Digital’s analysis of 2017 data

The majority of adults (64%) in England in 2017 were overweight or obese reports the UK  Health Survey for England 2017. It finds that males were more likely to be overweight (but not obese) compared to females, but females were more likely to be obese.

There was an association identified between the weight of the parents and children. Offspring of obese mothers were 28 per cent more likely to be obese, almost a quarter (24 per cent) of children of obese fathers were obese.

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Total diabetes was associated with waist circumference. 12% of men and 9% of women with a very high waist circumference had either diagnosed or undiagnosed diabetes. This compared to 6% of men and 2% of women with high waist circumferences and 4% of men and 1% of women with a desirable waist circumference.

Doctor-diagnosed diabetes increased in the period during 1994 and 2017, with
some year-on-year fluctuation; from 3% to 8% among men, and from 2% to 5% among women.

The report also covers:

  • Fruit and vegetable consumption
  • Smoking
  • Alcohol consumption
  • Risk factors
  • Adult health conditions: Cardiovascular disease, diabetes, high cholesterol, hypertension, chronic pain

Read the full report:  Health Survey for England 2017: Summary of key findings  from NHS Digital 

In the news:

BBC News Most adults living unhealthy lifestyles