Digital glucose monitors ‘reduce disease burden’ for diabetes patients

Nursing Times | December 2019 | Digital glucose monitors ‘reduce disease burden’ for diabetes patients

A study from the Netherlands aimed to evaluate the benefits of the device in comparison with self-monitoring of blood glucose, it followed more than 1,300 people with type 1 or type 2 diabetes who were using Freestyle Libre  (FSL-FGM )wearable glucose monitors for one year.

A feature in the Nursing Times outlines the positive findings, the data suggest that use of FSL-FGM results in improved well-being and decreased disease burden, as well as improvement of glycemic control. This finding appears to support the ongoing roll out of the devices for type 1 patients in England, which was announced earlier this year (Source: Nursing Times). 

Fokkert Mvan Dijk PEdens M, et al | 2019| Improved well-being and decreased disease burden after 1-year use of flash glucose monitoring (FLARE-NL4) |

 

Abstract

Introduction The FreeStyle Libre is a flash glucose monitoring (FSL-FGM) system. Compared with finger-prick based self-monitoring of blood glucose, FSL-FGM may provide benefits in terms of improved glycemic control and decreased disease burden.

Methods Prospective nationwide registry. Participants with diabetes mellitus (DM) used the FSL-FGM system for a period of 12 months. End points included changes in HbA1c, hypoglycemia, health-related quality of life (12-Item Short Form Health Surveyv2 (SF-12v2) and 3-level version of EuroQol 5D (EQ-5D-3L)), a specifically developed patient-reported outcome measures (PROMs) questionnaire, diabetes-related hospital admission rate and work absenteeism. Measurements were performed at baseline, and after 6 months and 12 months.

Results 1365 persons (55% male) were included. Mean age was 46 (16) years, 77% of participants had type 1 DM, 16% type 2 DM and 7% other forms. HbA1c decreased from 64 mmol/mol to 60  mmol/mol with a difference of −4 mmol/mol. Persons with a baseline HbA1c >70 mmol/mol had the most profound HbA1c decrease: −9 mmol/mol. EQ-5D tariff, EQ-VAS and SF-12v2 mental component score improved. For most, PROMs improved. Work absenteeism rate (/6 months) and diabetes-related hospital admission rate (/year) decreased significantly, from 18.5% to 7.7% and 13.7% to 2.3%, respectively.

Conclusions Real world data demonstrate that use of FSL-FGM results in improved well-being and decreased disease burden, as well as improvement of glycemic control.

The study is available from BMJ Open Diabetes Research & Care 

 

Diabetes Prevention Programme 2018-19, Short Report

The NHS Diabetes Prevention Programme (NHS DPP) is a joint commitment from NHS England, Public Health England and Diabetes UK to deliver, at scale, evidence based behavioural interventions that can prevent or delay the onset of Type 2 diabetes in adults who have been identified as having non-diabetic hyperglycaemia.

This short report uses data collected from GP practices alongside the National Diabetes Audit (NDA) for the period January 2018 to March 2019 inclusive. This report is for England only.

Key facts

  • Non-diabetic hyperglycaemia refers to blood glucose levels that are above normal but not in the diabetic range (HbA1c 42-47 mmol/mol (6.0-6.4%) or fasting plasma glucose 5.5-6.9 mmol/l).
  • People with non-diabetic hyperglycaemia are at increased risk of developing Type 2 diabetes. They are also at increased risk of other cardiovascular conditions.
  • 1.8 million people in England were recorded as having non-diabetic hyperglycaemia for the period January 2018 to March 2019. This is an increase from 1.3 million in 2017-18. The difference is almost certainly due to an increase in the recording of the diagnosis during 2018-19, and not an additional 0.5 million people becoming non-diabetic hyperglycaemic.

Full detail at NHS Digital

National Diabetes Audit Report 1: Care Processes and Treatment Targets

The National Diabetes Audit (NDA) measures the effectiveness of diabetes healthcare against NICE Clinical Guidelines and NICE Quality Standards, in England and Wales. This short report details the top-level findings for the 2018-19 audit.

Key facts

• GP practice participation in England and Wales stands at 98.0 per cent for 2018-19.

• Diabetes specialist service participation increased from 101 in 2017-18 to 112 in 2018-19.

• In England, the percentage of people who had all eight care process checks during 2018-19 stands at 40.8 per cent for people with Type 1 diabetes (42.9 per cent in 2017-18) and 54.3 per cent for people with Type 2 and other diabetes (58.8 per cent in 2017-18).

• In Wales, the percentage of people who had all eight care process checks during 2018-19 stands at 23.3 per cent for people with Type 1 diabetes (24.7 per cent in 2017-18) and 44.7 per cent for people with Type 2 and other diabetes (45.9 per cent in 2017-18).

• In England, the percentage of people who met the new all three treatment targets during 2018-19 stands at 19.6 per cent for people with Type 1 diabetes (18.9 per cent in 2017-18) and 40.5 per cent for people with Type 2 and other diabetes (40.2 per cent in 2017-18).

• In Wales, the percentage of people who met the new all three treatment targets during 2018-19 stands at 15.1 per cent for people with Type 1 diabetes (15.2 per cent in 2017-18) and 33.6 per cent for people with Type 2 and other diabetes (35.0 per cent in 2017-18).

Full detail at NHS Digital

 

National Diabetes Audit – Report 2: Complications and Mortality

This report from the National Audit of Diabetes covers complications arising from diabetes. Most cardiovascular and diabetes specific complications are covered.

Part a is divided into three main sections: cardiovascular complications, diabetes specific complications and mortality. Each section aims to address overall rates, time trends, geographical variation and hospital utilisation.

Part b investigates associations between patient characteristics and adverse outcomes. The impact of changes to lifestyle and treatment have been estimated for both the person with diabetes and diabetes services for the first time.

The reports can be downloaded here:

BMJ: Maternal diabetes during pregnancy and early onset of cardiovascular disease in offspring: population based cohort study with 40 years of follow-up

BMJ | November 2019 | Maternal diabetes during pregnancy and early onset of cardiovascular disease in offspring: population based cohort study with 40 years of follow-up| 67| l6398

A study that looked at the associations between maternal diabetes (diagnosed prior to or during pregnancy) and early onset cardiovascular disease (CVD) in offspring during their first four decades of life adds to the evidence around non-genetic intergenerational connections between maternal illness and risk factors for CVD among offspring. The experts who authored the study looked at data from more than 2 million births in Denmark between 1977 and 2016. 

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The findings from this population based study indicate that the children of mothers with diabetes, especially mothers with CVD history or diabetic complications, had increased rates of early-onset CVD throughout the early decades of life. If the associations are causal, then preventing and treating diabetes in women of childbearing age could have a significant impact on the reduction of CVD incidence in the next generation.

The authors argue that their findings highlight the importance of effective strategies for screening and preventing diabetes in women of childbearing age (Source: BMJ).

 

 

Read the full Opinion from BMJ

Yongfu, Y. et al | 2019|  Maternal diabetes during pregnancy and early onset of cardiovascular disease in offspring: population based cohort study with 40 years of follow-up|

Abstract

Objective To evaluate the associations between maternal diabetes diagnosed before or during pregnancy and early onset cardiovascular disease (CVD) in offspring during their first four decades of life.

Design Population based cohort study.

Setting Danish national health registries.

Participants All 2 432 000 liveborn children without congenital heart disease in Denmark during 1977-2016. Follow-up began at birth and continued until first time diagnosis of CVD, death, emigration, or 31 December 2016, whichever came first.

Exposures for observational studies Pregestational diabetes, including type 1 diabetes (n=22 055) and type 2 diabetes (n=6537), and gestational diabetes (n=26 272).

Main outcome measures The primary outcome was early onset CVD (excluding congenital heart diseases) defined by hospital diagnosis. Associations between maternal diabetes and risks of early onset CVD in offspring were studied. Cox regression was used to assess whether a maternal history of CVD or maternal diabetic complications affected these associations. Adjustments were made for calendar year, sex, singleton status, maternal factors (parity, age, smoking, education, cohabitation, residence at childbirth, history of CVD before childbirth), and paternal history of CVD before childbirth. The cumulative incidence was averaged across all individuals, and factors were adjusted while treating deaths from causes other than CVD as competing events.

 

Results During up to 40 years of follow-up, 1153 offspring of mothers with diabetes and 91 311 offspring of mothers who did not have diabetes were diagnosed with CVD. Offspring of mothers with diabetes had a 29% increased overall rate of early onset CVD ; cumulative incidence among offspring unexposed to maternal diabetes at 40 years of age 13.07%, difference in cumulative incidence between exposed and unexposed offspring 4.72% . The sibship design yielded results similar to those of the unpaired design based on the whole cohort. Both pregestational diabetes and gestational diabetes were associated with increased rates of CVD in offspring. We also observed varied increased rates of specific early onset CVDs, particularly heart failure, hypertensive disease, deep vein thrombosis, and pulmonary embolism. Increased rates of CVD were seen in different age groups from childhood to early adulthood until age 40 years. The increased rates were more pronounced among offspring of mothers with diabetic complications. A higher incidence of early onset CVD in offspring of mothers with diabetes and comorbid CVD was associated with the added influence of comorbid CVD but not due to the interaction between diabetes and CVD on the multiplicative scale.

 

Conclusions Children of mothers with diabetes, especially those mothers with a history of CVD or diabetic complications, have increased rates of early onset CVD from childhood to early adulthood. If maternal diabetes does have a causal association with increased CVD rate in offspring, the prevention, screening, and treatment of diabetes in women of childbearing age could help to reduce the risk of CVD in the next generation.

Offspring of mothers with diabetes, especially those mothers with a history of CVD or diabetic complications, have increased rates of early onset CVD from childhood to early adulthood

The article is available in full from The BMJ

See also: Link between diabetes in mothers and heart disease in children