Participants in the Diabetes Prevention Programme loose the equivalent weight of 43 ambulances

NHS England | January 2020 | NHS support sees people lose the weight of 43 ambulances

A recent news release from people completing the world leading NHS Diabetes Prevention Programme have lost the equivalent weight of 43 ambulances.

Currently,  around 4 million people in the UK live with type 2 diabetes, with diabetes and its complications costing the NHS more than £10 billion to treat every year. Almost 90 000 people have now finished the programme, losing a combined weight of 185, 051kg.  The world first service is the first of its kind to have achieved a full national roll-out.

With expert advice on dieting, exercise and healthy lifestyle, the programme will double in size to treat around 200,000 people every year as part of the NHS Long Term Plan.

Complications from the disease can include blindness and foot amputations.

Around 90 per cent of people with diabetes have type 2 and there were over a million obesity diagnoses in hospital patients last year.

Projections show that the growing number of people with diabetes could result in nearly 39,000 people living with diabetes suffering a heart attack in 2035 and over 50,000 people suffering a stroke and one in six hospital beds are occupied with someone with diabetes.

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The 9-12 month programme is designed to stop or delay the onset of the illness through a range of personalised lifestyle interventions, including:

  • Education on lifestyle choices
  • Advice on how to reduce weight through healthier eating
  • Bespoke physical activity programmes

Projections show that the growing number of people with diabetes could result in nearly 39,000 people living with diabetes suffering a heart attack in 2035 and over 50,000 people suffering a stroke and one in six hospital beds are occupied with someone with diabete (Source: NHS England).

Further details are available from NHS England

The Top 5 diabetes long term highlights from the NHS Long-Term Plan

NHS England | January 2019 | The Top 5 diabetes long term highlights

The Deputy Director of NHS England provides an overview of the five takeaways from the NHS Long-Term Plan, they are:

  1. Type 2 diabetes prevention continues to be a priority
  2. Access to diabetes professionals is crucial for optimum treatment and care:
  3. Self-management has a key role in ‘upstream prevention’
  4. Low calorie diets may be a potential treatment option for Type 2 diabetes
  5. Diabetes prevention, treatment and care is going digital

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Read the full blog post at NHS England

Diet and exercise can reduce the risk of developing diabetes during pregnancy

NIHR Signal | January 2019 | Diet and exercise can reduce the risk of developing diabetes during pregnancy

A recent NIHR Signal underlines a systematic review which found that any form of lifestyle intervention reduced the risk of gestational diabetes by 23%, with similar effects for diet, exercise or both. Interventions were most successful when targeted at high-risk populations, though body mass index alone was not associated with an effect.

Diet and exercise are effective ways of preventing the development of diabetes during pregnancy, known as gestational diabetes.

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Gestational diabetes is becoming more common and is associated with poorer outcomes for mother and baby. Diet, physical activity and weight are modifiable risk factors, but trials published to date have shown inconsistent results.

As the authors suggest, comprehensive risk assessments that consider body mass index alongside other risk factors may help to identify women who could benefit most from structured lifestyle interventions during pregnancy

NIHR Signal Diet and exercise can reduce the risk of developing diabetes during pregnancy

ABSTRACT

BACKGROUND: Diet and exercise during pregnancy have been used to prevent gestational diabetes mellitus (GDM) with some success.

OBJECTIVES: To examine the effectiveness of lifestyle intervention on GDM prevention and to identify key effectiveness moderators to improve prevention strategy.

SEARCH STRATEGY: Pubmed, Scopus, Cochrane and cross-references were searched.

SELECTION CRITERIA:
Randomized controlled trials (RCTs) evaluating lifestyle interventions during pregnancy for GDM prevention.

DATA COLLECTION AND ANALYSIS: Two independent reviewers extracted data. Random-effects model was used to analyze the relative risk and 95% confidence interval (RR and 95% CI). Meta-regressions and subgroup analyses were used to investigate important moderators of effectiveness.

MAIN RESULTS: 47 RCTs involving 15745 participants showed that diet and exercise during pregnancy were preventive of GDM (RR 0.77, 95% CI [0.69; 0.87]). Four key aspects were identified to improve the preventive effect: targeting on the high-risk population, early initiation of intervention, proper intensity and frequency of exercise, and gestational weight gain management. Although 24 RCTs targeted on overweight or obese women, BMI failed to predict the effectiveness of an intervention. Instead, interventions are most effective in high-incidence population rather than simply overweight or obese women. Furthermore, exercise of moderate intensity for 50-60 minutes twice a week could lead to about 24% reduction in GDM.

CONCLUSIONS:
The best strategy to prevent GDM is to target on high-risk population predicted by risk evaluation models and to control their gestational weight gain through intensified diet and exercise modifications early in their pregnancy. This article is protected by copyright. All rights reserved.

 

Full reference:  Guo, X. et al | 2018|  Improving the effectiveness of lifestyle interventions for gestational diabetes prevention: a meta-analysis and meta-regression| Bjog |doi.org/10.1111/1471-0528.15467

CCG Diabetes Assessment 2017/18

NHS England | January 2019 | CCG Diabetes Assessment 2017/18

This document contains the independent panel commentary, methodology of the ratings for 2017/18 and the CCG individual assessment ratings for 2017/18.

The measures are drawn from the 2016/17 and 2017/18 National Diabetes Audits which include data from 95 and 98 per cent of GP practices respectively. This means all areas have robust measurements of their diabetes performance.

The data show that overall the proportion of people reaching treatment targets is stable but there is much underlying variation. The panel has continued to use the same measurements and targets for HbA1c, blood pressure and cholesterol to ensure consistency between years.

The panel has chosen to use the benchmarks from 2016/17 as this better illustrates year-on-year progression in improvement. The improvements this year mean that there are therefore more areas with the higher ratings than if 2017/18 benchmarks had been used. The regional distribution has evolved over the last year so that there are no CCGs rated as inadequate in London now, while there is a concentration in the North (Source: NHS England).

CCG Diabetes Assessment 2017/18

Assessing and managing the acute complications of diabetes mellitus

Palk, L.E. |2018| Assessing and managing the acute complications of diabetes mellitus. |Nursing Standard| doi: 10.7748/ns.2018.e11250

Nurses commonly encounter patients with type 1 or type 2 diabetes mellitus in their practice. Management of these conditions requires an in-depth knowledge of blood glucose monitoring. It is essential that nurses are aware of normal blood glucose levels, so that they can respond to complications caused by elevated and reduced blood glucose levels. This article aims to enhance nurses’ knowledge of the acute metabolic complications of diabetes, such as diabetic ketoacidosis and hyperosmolar hyperglycaemic state, to assist in their recognition and management in clinical practice. It discusses the causes, pathophysiology and treatment of these complications, which are regarded as potentially life-threatening medical emergencies (Source: Nursing Standard).

Rotherham NHS staff may request the article from the Library 

£1000: The cost of delivering a type 2 diabetes remission programme in the NHS

University of Glasgow | December 2018 | £1000: The cost of delivering a type 2 diabetes remission programme in the NHS

A new study that involved researchers from the universities of Glasgow and Newcastle suggests rolling out a Type 2 diabetes remission programme in the NHS could cost around £1,067 per participant in its first year – or, factoring in the likelihood of success, £2,564 for each case of remission. Researchers say findings ‘make the case for shifting resources to offer remission’ in the future.

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Calculating the cost of the the 12-month programme, accounting for savings for reduced drug and medical needs, was £1,067. The researchers compared the treatment costs of the two groups in DiRECT: those on the weight loss programme (the intervention group), and those receiving current standard NHS care (the control group).

Mike Lean, Professor of Human Nutrition at the University of Glasgow and consultant physician at Glasgow Royal Infirmary, said: “The cost of a year’s programme to achieve remission of Type 2 diabetes is less than the annual cost of continuing to treat this progressive and often debilitating condition – particularly at its later stages. It is becoming hard to see why, ethically, people with Type 2 diabetes should not be offered the chance, and supported, to achieve remission if they can. This is no quick fix, but instead a promising medical treatment with potentially huge benefits.”

DiRECT is testing a low-calorie weight management programme in over 300 people across Glasgow and Tyneside. The programme, which involves an 800 calorie liquid diet and structured, long-term support from a healthcare professional to reintroduce healthy food and maintain the weight loss, is aiming to establish if the approach could put people with Type 2 diabetes into remission and keep them there in the longer term.

The programme is delivered within NHS primary care, it is relatively inexpensive compared to serious and expensive complications of Type 2 diabetes

A new study suggests rolling out a Type 2 diabetes remission programme in the NHS could cost around £1,067 per participant in its first year – or, factoring in the likelihood of success, £2,564 for each case of remission. Researchers say findings ‘make the case for shifting resources to offer remission’ in the future (Source: University of Glasgow).

Read more about the research in this press release University of Glasgow 

The article is available to read from the Lancet Diabetes & Endocrinology

Reversing my type 2 diabetes

NHS Business Services Authority |January 2019| Reversing my type 2 diabetes

As part of NHSBSA’s health and fitness month, Diversity and Inclusion Manager at NHSBSA Rachel Brown, writes about the importance of having a supportive work environment which encourages colleagues to improve their health and the steps she has taken to reverse a type 2 diabetes diagnosis.

Read the full blog post at NHSBSA

 

Physical activity reduces mortality in patients with diabetes

New research suggests patients with type 2 diabetes should be prescribed physical activity to control blood sugar and improve heart health | European Association of Preventive Cardiology | via ScienceDaily

Patients with type 2 diabetes should be prescribed physical activity to control blood sugar and improve heart health. That is one of the recommendations in a position paper of the European Association of Preventive Cardiology (EAPC), a branch of the European Society of Cardiology (ESC). The paper is published in the European Journal of Preventive Cardiology, a journal of the ESC.

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One in 11 adults worldwide have diabetes, of which 90% is type 2 diabetes. Nearly all patients with type 2 diabetes develop cardiovascular complications, which are the leading causes of death in this group.

The paper provides practical recommendations for doctors on how to motivate patients to incorporate physical activity into their daily routine, set achievable and measurable goals, and design individualised exercise training programmes to meet those goals.

Full story at ScienceDaily

Journal reference: Kemps, H. et al. | Exercise training for patients with type 2 diabetes and cardiovascular disease: What to pursue and how to do it. A Position Paper of the European Association of Preventive Cardiology (EAPC) |  European Journal of Preventive Cardiology | January 14th 2019

Transforming elective care services diabetes

NHS England | January 2019 | Transforming elective care services diabetes

NHS England have created Transforming elective care services diabetes– a handbook to support the improvement of local health and care systems for diabetes elective care services.

This handbook sets the national context and challenges facing elective care services in England. It considers the national diabetes challenge

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Image source: england.nhs.uk/wp-content

The handbook includes:

  • Opportunities for improvement transforming outpatients
  • Opportunities for improvement shared decision making and self- management support

Transforming elective care services diabetes

Following heart health guidelines may also reduce diabetes risk, finds US research

Science Daily | January 2019 | Following heart health guidelines also reduces diabetes risk

Lifestyle characteristics that are associated with supporting a healthy heart have also been found to reduce the risk of diabetes, in a new US study.  Researchers at Ohio State Wexner Medical Center, assessed diabetes among 7,758 participants in the REasons for Geographic and Racial Differences in Stroke (REGARDS) Study and used the American Heart Association’s Life’s Simple 7 as a guide for measuring heart health among the group.

 

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The Simple 7 health factors and lifestyle behaviours characteristics are:

  • physical activity
  • diet
  • weight
  • cholesterol
  • blood pressure
  • blood glucose
  • tobacco use

Overall, the study participants who were in the recommended, ideal ranges for at least four of the seven health factors had a 70 per cent lower risk of developing diabetes over the next decade.

Lead author of the study Dr. Joshua J. Joseph, an endocrinologist and assistant professor at The Ohio State University Wexner Medical Center, said:

“What’s interesting is when we compared people who had normal blood glucose and those who already had impaired blood glucose; those in normal levels who attained four or more guideline factors had an 80 percent lower risk of developing diabetes. Those who were already diabetic or prediabetic and met four of the factors had no change in lowering their risk for diabetes.”

He added: “Healthy people need to work to stay healthy. Follow the guidelines. Don’t proceed to high blood sugar and then worry about stopping diabetes. By that point, people need high-intensity interventions that focus on physical activity and diet to promote weight loss and, possibly, medications to lower the risk of diabetes.”

Read the full news story from Science Daily

The findings are published in the latest issue of Diabetologia 

Aims/hypothesis

Ideal cardiovascular health (CVH) is associated with lower diabetes risk. However, it is unclear whether this association is similar across glycaemic levels (normal [<5.6 mmol/l] vs impaired fasting glucose [IFG] [5.6–6.9 mmol/l]).

 

Methods

A secondary data analysis was performed in the REasons for Geographic and Racial Differences in Stroke (REGARDS) study. Incident diabetes was assessed among 7758 participants without diabetes at baseline (2003–2007) followed over 9.5 years. Baseline cholesterol, blood pressure, diet, smoking, physical activity and BMI were used to categorise participants based on the number (0–1, 2–3 and more than or equal to 4) of ideal CVH components. Risk ratios (RRs) were calculated using modified Poisson regression, adjusting for cardiovascular risk factors.

Results

Among participants (mean age 63.0 [SD 8.4] years, 56% female, 73% white, 27% African-American), there were 891 incident diabetes cases. Participants with equal to or more than 4 vs 0–1 ideal CVH components with normal fasting glucose (n = 6004) had 80% lower risk, while participants with baseline IFG (n = 1754) had 13% lower risk.  Additionally, the magnitude of the association of ideal CVH components with lower diabetes risk was stronger among white than African-American participants (p for interaction = 0.0338).

 

Conclusions/interpretation

A higher number of ideal CVH components was associated with a dose-dependent lower risk of diabetes for participants with normal fasting glucose but not IFG. Tailored efforts that take into account observed differences by race and glycaemic level are needed for the primordial prevention of diabetes.

 

Science Daily Following heart health guidelines also reduces diabetes risk

This article is available to Rotherham NHS staff  and can be requested here