New diabetes strategy for Leeds

Leeds Clinical Commissioning Group| April 2019| New diabetes strategy for Leeds
Leeds Clinical Commissioning Group (CCG) have released their first diabetes strategy for Leeds.  The summary of the strategy outlines:

  • Outcomes
  • How the CCG will measure impact
  • Year 1 priorities
  • Priorities in future years
  • Key principles

strategy-791200_640.jpg

Summary of the strategy is available from Leeds CCG

The full strategy will be available in May

Further details from Leeds Clinical Commissioning Group

Hyperbaric oxygen therapy for diabetic lower limb ulceration (diabetic foot ulcer) (all ages)

NHS England | April 2019 | Hyperbaric oxygen therapy for diabetic lower limb ulceration (diabetic foot ulcer) (all ages)

NHS England will not routinely commission hyperbaric oxygen therapy for diabetic lower limb ulceration in accordance with the criteria outlined in this document.

In creating this policy NHS England has reviewed this clinical condition and the options for its treatment. It has considered the place of this treatment in current clinical practice, whether scientific research has shown the treatment to be of benefit to patients, (including how any benefit is balanced against possible risks) and whether its use represents the best use of NHS resources.

Full details from NHS England

One-year Follow-up of a Randomized Controlled Trial Piloting a Mindfulness-based Group Intervention for Adolescent Insulin Resistance

Shomaker, L. B. et al. |2019| One-year Follow-up of a Randomized Controlled Trial Piloting a Mindfulness-based Group Intervention for Adolescent Insulin Resistance|Frontiers in Psychology|10| 1040| doi: 10.3389/fpsyg.2019.01040

A follow up to an RCT pilot that looked at the impact of a mindfulness-based intervention (MBI) on adolescent girls with overweight/ obesity at risk of developing type 2 diabetes;  finds that brief MBI may reduce insulin- resistance in this population (at-risk adolescents). 

relax-1276639_640.jpg

Introduction: To explore if a brief mindfulness-based intervention (MBI) leads to sustained, improved clinical outcomes in adolescents at-risk for type 2 diabetes (T2D).

Methods: Participants were 12-17y girls with overweight/obesity, elevated depression symptoms, and T2D family history participating in a randomized, controlled pilot trial of a six-session MBI versus cognitive-behavioral therapy (CBT) group. At baseline and one-year, mindfulness, depression, insulin resistance (IR), and body composition were assessed with validated instruments.

Results: One-year retention was 71% (n=12) in MBI; 81% (n=13) in CBT. At one-year, depression decreased (Cohen’s d=.68) and IR decreased (d=.73) in adolescents randomized to MBI compared to those in CBT. There were no significant between-condition differences in mindfulness, adiposity, or BMI.

Discussion: One-year outcomes from this randomized, controlled pilot trial suggest that brief MBI may reduce depression and IR in at-risk adolescents. Replication and exploration of mechanisms within the context of a larger clinical trial are necessary.

This article can be requested by Rotherham NHS staff from the Library

NICE consultation on four NICE guidelines on the theme of diabetes

NICE | April 2019 | Type 1 diabetes in adults: diagnosis and management

The clinical guideline for Type 1 diabetes in adults: diagnosis and management (NG17) has been checked by NICE for the need for update.  

This 2019 surveillance review has considered four NICE guidelines on the theme of diabetes and all four guidelines will be having a separate stakeholder consultation:

The closing date for all consultations is  8 May 2019

Full details are available from NICE 

Up to a third of people with type 2 diabetes not taking prescriptions properly

University of Leicester | April 2019 | Up to a third of people with type 2 diabetes not taking prescriptions properly

A new study from researchers at the University of Leicester used a special screening approach to analyse urine samples from 228 patients with diabetes taken at their annual diabetes review. The urine samples were screened for 60 different medicines used to treat type 2 diabetes, heart conditions and high blood pressure (hypertension). The experts found that more than a quarter (28.1 per cent) (n=64); had taken none or not all of their prescribed medication. 

medications-257336_640.jpg

Their findings suggest that nearly a third of people with type 2 diabetes may be putting their health at risk because they are not taking their medications correctly.

Dr Prashanth Patel, a consultant and co-director of NCAT at Leicester’s Hospitals, and study co-author, said: “These findings had a knock-on effect, as those who had not been taking their prescription drugs regularly had significantly higher blood sugar levels compared with those who had been.

“We also found they were more prone to higher levels of microalbumin, a marker that the kidneys may not be healthy, as well as higher blood pressure and more fat levels in the blood, otherwise known as the lipid profile.”

Failing to take prescription drugs properly is called non-adherence. This is problematic because, if not managed correctly, type 2 diabetes can lead to further health complaints, such as kidney disease, limb amputation and cardiovascular problems (Source: University of Leicester).

University of Leicester [press release]  Up to a third of people with type 2 diabetes not taking prescriptions properly

The study has been published in Diabetes Care 

Full reference: Patel, P., Gupta, P., Burns, A., Mohamed, A. A., Cole, R., Lane, D., … & Khunti, K. (2019). Biochemical Urine Testing of Adherence to Cardiovascular Medications Reveals High Rates of Nonadherence in People Attending Their Annual Review for Type 2 Diabetes. Diabetes care.

Abstract

OBJECTIVE Liquid chromatography—tandem mass spectrometry (LC-MS/MS) is a new method to objectively and robustly detect nonadherence. We applied this technique to study nonadherence to cardiovascular medications in people with type 2 diabetes (T2DM).

RESEARCH DESIGN AND METHODS Routine urine samples, received at the time of the annual diabetes review from 228 people with T2DM in primary care, were assessed for adherence by LC-MS/MS.

RESULTS A total of 28.1% patients (N = 64) were nonadherent to antidiabetic, antihypertensive, and/or lipid-lowering medications. Nonadherence to statins was the highest at 23.7%, and nonadherence to oral hypoglycemic agents was 9.3%. HbA1c, albumin-to-creatinine ratio, and lipid profiles were significantly higher in the patients who were nonadherent compared with those who were adherent to treatment.

CONCLUSIONS This unique study shows that routine urine samples can be used for adherence testing screening by LC-MS/MS and has demonstrated high nonadherence rates especially to statins in people with T2DM. Future intervention studies using LC-MS/MS as a diagnostic/therapeutic tool may help to improve clinical outcomes.

Rotherham NHS staff can request this article here 

 

Maternal gestational diabetes linked to diabetes in children

OnMedica | April 2019 | Maternal gestational diabetes linked to diabetes in children

Children whose mothers had gestatational diabetes during their pregancy are more likely to develop diabetes, finds new research.  The study published in the Canadian Medical Association Journal (CMAJ) analysed data  from 73,180 mothers and the researchers compared data on single births from mothers with gestational diabetes to births from mothers without gestational diabetes. They found an association between gestational diabetes mellitus and incidence of childhood- and youth-onset diabetes in offspring with the incidence of  pediatric diabetes was higher in offspring born to mothers with gestational diabetes mellitus than in mothers without gestational diabetes mellitus. 

autumn-1850044_640 (1)

A child or teen whose mother had gestational diabetes was therefore nearly twice as likely to develop diabetes before the age of 22 years than a child or teen whose mother did not experience gestational diabetes.

An association between gestational diabetes and diabetes in children was found from birth to age 22 years, from birth to 12 years, and from 12 to 22 years (Source: OnMedica)

OnMedica Maternal gestational diabetes linked to diabetes in children

The article is available to read in full from CMAJ 

Full referene:

Blotsky, A.L.,  Rahme, E., Dahhou, M., Nakhla, M., Dasgupta, K. | 2019| Gestational diabetes associated with incident diabetes in childhood and youth: a retrospective cohort study

Abstract

BACKGROUND: Indicators of childhood- and youth-onset diabetes may be useful for early detection of diabetes; there is a known association between composite exposure of parental type 2 diabetes and gestational diabetes mellitus with childhood- and youth-onset diabetes. We examined associations between gestational diabetes mellitus and incidence of childhood- and youth-onset diabetes in offspring.

METHODS: Using public health insurance administrative databases from Quebec, Canada, we randomly selected singleton live births with maternal gestational diabetes mellitus (1990–2007) and matched them 1:1 with singleton live births without gestational diabetes mellitus. Follow-up was to Mar. 31, 2012. We examined associations of diabetes in offspring with maternal gestational diabetes mellitus through unadjusted and adjusted Cox proportional hazards models. In secondary analyses, we separately considered age groups ranging from birth to age 12 years, and age 12 to 22 years.

RESULTS: Incidence of pediatric diabetes (per 10 000 person-years) was higher in offspring born to mothers with gestational diabetes mellitus than in mothers without gestational diabetes mellitus. In an adjusted Cox proportional hazards model, maternal gestational diabetes mellitus was associated with development of pediatric diabetes overall, during childhood, and in youth.

INTERPRETATION: Gestational diabetes mellitus is associated with incident diabetes in offspring during childhood and adolescence. Future studies are needed to examine longer-term outcomes in patients with pediatric diabetes with a maternal history of gestational diabetes mellitus, to ascertain how they compare with other patients with childhood- or youth-onset diabetes, in terms of disease severity and outcomes.

More than 90% of childhood- and youth-onset diabetes in Canada is type 1 diabetes.

The research article is available to read from CMAJ 

Virtual reality system piloted to help spot diabetes-related emergencies

The NHS England diabetes team has partnered with virtual reality medical training company Oxford Medical Simulation to train doctors in a bid to improve care for patients with diabetes | via Med-Tech Innovation

The training will allow doctors to practice in virtual reality medical emergencies. Dr Partha Kar, NHS England clinical director of diabetes said: “Embracing technology is at the heart of the NHS Long Term Plan and training doctors using virtual reality is another example of modernising the NHS to help improve care for patients with diabetes.”

Combining clinical expertise from the NHS, volunteer patient input and world leading virtual reality software, doctors can now put on virtual reality headsets and practice taking care of patients as often as they want, without risking lives.

The system is being piloted through Health Education England in a multicentre trial in the South of England, with development funded by Novo Nordisk. If supported by evidence from the pilot there are plans for further roll-outs nationwide throughout 2019.

Full detail at Med-Tech Innovation

See also:  NHS pilots virtual reality system to help spot diabetes-related emergencies | Diabetes UK

Dietary carbohydrate intake and mortality

Study finds both high and low percentages of carbohydrate diets were associated with increased mortality, with minimal risk observed at 50–55% carbohydrate intake | The Lancet Public Health

bread-587597_1920Background
Low carbohydrate diets, which restrict carbohydrate in favour of increased protein or fat intake, or both, are a popular weight-loss strategy. However, the long-term effect of carbohydrate restriction on mortality is controversial and could depend on whether dietary carbohydrate is replaced by plant-based or animal-based fat and protein. We aimed to investigate the association between carbohydrate intake and mortality.

Methods
We studied 15 428 adults aged 45–64 years, in four US communities, who completed a dietary questionnaire at enrolment in the Atherosclerosis Risk in Communities (ARIC) study (between 1987 and 1989), and who did not report extreme caloric intake. The primary outcome was all-cause mortality. We investigated the association between the percentage of energy from carbohydrate intake and all-cause mortality, accounting for possible non-linear relationships in this cohort. We further examined this association, combining ARIC data with data for carbohydrate intake reported from seven multinational prospective studies in a meta-analysis. Finally, we assessed whether the substitution of animal or plant sources of fat and protein for carbohydrate affected mortality.

Findings
During a median follow-up of 25 years there were 6283 deaths in the ARIC cohort, and there were 40 181 deaths across all cohort studies. In the ARIC cohort, after multivariable adjustment, there was a U-shaped association between the percentage of energy consumed from carbohydrate (mean 48·9%, SD 9·4) and mortality: a percentage of 50–55% energy from carbohydrate was associated with the lowest risk of mortality. In the meta-analysis of all cohorts (432 179 participants), both low carbohydrate consumption (lees than 40%) and high carbohydrate consumption (more than 70%) conferred greater mortality risk than did moderate intake, which was consistent with a U-shaped association (pooled hazard ratio 1·20, 95% CI 1·09–1·32 for low carbohydrate consumption; 1·23, 1·11–1·36 for high carbohydrate consumption). However, results varied by the source of macronutrients: mortality increased when carbohydrates were exchanged for animal-derived fat or protein (1·18, 1·08–1·29) and mortality decreased when the substitutions were plant-based (0·82, 0·78–0·87).

Interpretation
Both high and low percentages of carbohydrate diets were associated with increased mortality, with minimal risk observed at 50–55% carbohydrate intake. Low carbohydrate dietary patterns favouring animal-derived protein and fat sources, from sources such as lamb, beef, pork, and chicken, were associated with higher mortality, whereas those that favoured plant-derived protein and fat intake, from sources such as vegetables, nuts, peanut butter, and whole-grain breads, were associated with lower mortality, suggesting that the source of food notably modifies the association between carbohydrate intake and mortality.

Full reference: Seidelmann, S. B. et al. | Dietary carbohydrate intake and mortality: a prospective cohort study and meta-analysis | The Lancet Public Health | published August 16, 2018

Improving foot care outcomes for people with diabetes in Wessex

NICE | April 2019|Improving foot care outcomes for people with diabetes in Wessex

NICE’s shared learning database has published Improving foot care outcomes for people with diabetes in Wessex

Reducing the number of amputations among people living with diabetes in Wessex has been a key aim of the Wessex Cardiovascular Clinical Network (CVD CN). A structured series of projects have been undertaken since 2015, which has included significant engagement with a wide range of clinicians, operational managers, commissioners and patients.

icon-1717391_640.png

The Wessex Foot Care standards were jointly developed and agreed by local stakeholders including clinicians and commissioners, with the Specialist Clinical Network facilitating the process. They set out the care that people with diabetes should expect based on NICE NG19, 2015 and that commissioners and providers should strive to provide, and were also published in 2015. The implementation of the standards across Wessex aims to reduce variation in care and improve outcomes for people living with diabetes related foot complications. A peer review of all diabetes foot care services across Wessex has recently been undertaken to support regional service improvements and included patient interviews.

Full details from NICE