The state of diabetes treatment coverage in 55 low-income and middle-income countries

Flood, D. et al | 2021| The state of diabetes treatment coverage in 55 low-income and middle-income countries: a cross-sectional study of nationally representative, individual-level data in 680 102 adults | The Lancet Healthy Longevity |

This cross-sectional cohort study is the largest assessment of comprehensive diabetes treatment using individual-level data from nationally representative samples of adults across low-income and middle-income countries (LMICs) of diverse income groups and geographical regions. 

Key points:

  1. Less than one in ten people with diabetes in LMICs receive comprehensive diabetes treatment as recommended by WHO; scaling up the capacity of health systems to deliver treatment not only to lower glucose but also to address cardiovascular disease risk factors, such as hypertension and high cholesterol, are urgent global diabetes priorities.
  2. The authors make cross-country estimates of diabetes treatment that could be used by health systems in LMICs to benchmark current and future performance
  3. They report individual characteristics such as young age and lower body-mass index that are associated with low coverage of diabetes treatment; these individual-level findings can be used by health systems to direct care to underserved groups.

The authors findings suggest that improving access to comprehensive treatment not only to lower glucose but also to address cardiovascular disease risk factors such as hypertension and elevated cholesterol are global diabetes priorities.

Paper available in full from The Lancet Healthy Longevity

Insulin Safety Week

Insulin Safety Week 2021 | nd | Insulin Safety Week

Insulin Safety Week is designed to raise awareness of insulin safety among healthcare professionals. It is taking place this week -17 May to 23 May 2021-

Diabetes Specialist Nurse Forum UK has produced a poster to support healthcare professionals to be insulin safe, they will be sharing top tips throughout the week on their Twitter account @DSNforumUK

You can also follow the #thinkinsulin on Twitter

Impact of Type 1 Diabetes in the Developing Brain in Children: A Longitudinal Study

Published in the latest edition of Diabetes Care is a longitudinal study which followed children with type 1 and a control gropu with no diabetes for up to 12 years.


 To assess whether previously observed brain and cognitive differences between children with type 1 diabetes and control subjects without diabetes persist, worsen, or improve as children grow into puberty and whether differences are associated with hyperglycemia.

Research design and methods

One hundred forty-four children with type 1 diabetes and 72 age-matched control subjects without diabetes (mean ± SD age at baseline 7.0 ± 1.7 years, 46% female) had unsedated MRI and cognitive testing up to four times over 6.4 ± 0.4 (range 5.3–7.8) years; HbA1c and continuous glucose monitoring were done quarterly. FreeSurfer-derived brain volumes and cognitive metrics assessed longitudinally were compared between groups using mixed-effects models at 6, 8, 10, and 12 years. Correlations with glycemia were performed.


Total brain, gray, and white matter volumes and full-scale and verbal intelligence quotients (IQs) were lower in the diabetes group at 6, 8, 10, and 12 years, with estimated group differences in full-scale IQ of −4.15, −3.81, −3.46, and −3.11, respectively (P  less than 0.05), and total brain volume differences of −15,410, −21,159, −25,548, and −28,577 mm3 at 6, 8, 10, and 12 years, respectively (P  less than 0.05). Differences at baseline persisted or increased over time, and brain volumes and cognitive scores negatively correlated with a life-long HbA1c index and higher sensor glucose in diabetes.


 Detectable changes in brain volumes and cognitive scores persist over time in children with early-onset type 1 diabetes followed longitudinally; these differences are associated with metrics of hyperglycemia. Whether these changes can be reversed with scrupulous diabetes control requires further study. These longitudinal data support the hypothesis that the brain is a target of diabetes complications in young childre

Immunotherapies can slow the development of type 1 diabetes, and one day could make up part of a cure for the condition

@DiabetesUK | 28 April 2021 | Immunotherapies can slow the development of type 1 diabetes, and one day could make up part of a cure for the condition

The latest research to be presented at DUKPC21 suggests that immunotherapies- treatments that retrain the immune system so that the pancreas is not attacked- can be used to slow type 1 diabetes ( T1D )by up to three years. In this trial, led by Professor Kevan Herold, Yale School of Medicine, those participants receiving the treatment (Teplizumab, an immunotherapy drug), on average developed type 1 diabetes five years after initial diagnosis. In those receiving the placebo 78 per cent developed T1D in the two years following their diagnosis.

Image description visual summary of research Source: Diabetes UK

Two year diagnosis delay for patients with type 2

28 April 2021 via Nursing Times

Analysis of data from the UK Biobank- a database containing half a million people’s health and genetic information- shows that patients waited on average more than 2 years for their type 2 diabetes to be diagnosed. Those most likely to experience a delay in diagnosis were female, patients having a lower body mass index and lower blood sugar levels were all factors likely to be implicated in delay.

They found that 1 per cent of the cohort (2 022)  had a reported HbA1c of 48mmol/mol or over – the threshold, when combined with additional measures, at which type 2 diabetes is diagnosed.

The researchers from the University of Exeter observed that common symptoms – such as going to the toilet a lot, extreme thirst, feeling more tired than usual and losing weight without trying – often came on slowly and could be easy to miss. They also discovered that almost one in four people (23 per cent) had still not received a diagnosis after five years of having elevated blood glucose levels.

In addition, they found that having a lower HbA1c within the type 2 diabetes range, and/or lower BMI, was associated with a delayed diagnosis.

The researchers suggested that this was because these people may be less likely to experience symptoms or may be less likely to be given a test to confirm type 2 diabetes.

They noted that the findings highlighted the importance of attending annual health checks for those aged 40 years and above, to ensure any elevated blood glucose levels were detected early on.

They added that the findings emphasised the need for increased awareness among clinicians of the importance of type 2 diabetes checks in women and those with lower body weight.

Full story from Nursing Times

‘Teaching: individual’ to improve adherence in hypertension and type 2 diabetes

Innes Para, D. , Romero Guevara, S.L, & Roja, L.Z | 2021| British Journal of Community Nursing |

This single-blind, randomised clinical trial with a two-arm, parallel-group design recruited patients with type 2 diabetes to evaluate the efficacy of a nursing intervention involving individual teaching compared with usual care to improve adherence with therapeutic regimens in people with hypertension and/or type-2 diabetes mellitus (T2DM).

At the outset of the study, he participants’ variables were within normal parameters, the results proved that the individual teaching nursing intervention improved adherence to treatment and yielded a significant reduction in systolic blood pressure (SBP) in 24 hours, with both ambulatory blood pressure monitoring and automated office blood pressure at the 6-month follow-up; however, the reduction was not significant at 12 months, nor was it significant for HbA1c levels at any of the follow-up times

Key points
  • Educational interventions that use strategies with a multifaceted approach have turned out to be more effective to improve adherence to treatment
  • Interventions led by nurses and in collaboration with other members of the health team have shown to improve adherence to treatment
  • The nursing-led multifaceted individual teaching intervention has been effective in improving adherence to the therapeutic regimen and in the short term reducing SBP in people with hypertension and T2DM
  • This intervention did not achieve significant changes in HbA1c levels, more studies are needed that include uncontrolled patients, with HbA1c values above the control range

Full paper available from the British Journal of Community Nursing

WHO: Global Diabetes Compact

The WHO Global Diabetes Compact: a new initiative to support people living with diabetes | The Lancet Diabetes & Endocrinology |

100 years ago insulin was discovered—today, it is inaccessible for millions.

WHO is launching the Global Diabetes Compact today (April 14, 20210. Bringing together partners, the Compact seeks to increase access to treatment and improve outcomes for both type 1 and type 2 diabetes, ensuring everyone can access comprehensive, affordable, and quality care in primary health settings. The Compact will also support the prevention of type 2 diabetes associated with obesity, unhealthy diet, and physical inactivity. In doing so, we want to reduce premature mortality and complications from both type 1 and type 2 diabetes, and slow the rapidly-growing incidence of type 2 diabetes.

Further details are available from The Lancet Diabetes & Endocrinology

The tip of the iceberg: an overview of diabetic foot disease

Wilson, P. & Patton, D. | 2021 | The tip of the iceberg: an overview of diabetic foot disease |


Diabetic foot disease is the leading cause of lower-extremity amputation globally and imposes a significant burden for healthcare services and patients alike. The main pathology is ulceration, due to neuropathy or peripheral arterial disease. The most frequent sign is ulceration on the foot. Ulceration needs to be referred to the multidisciplinary diabetic foot team promptly for a comprehensive management plan to be developed. Delay in referral is associated with poor outcomes. Management of diabetic foot ulceration is multifaceted, including offloading, revascularisation, infection control, debridement, glycaemic control and wound care. Management plans need to be patient focused and developed collaboratively across primary and secondary care settings.

This article is available to Rotherham NHS staff and can be requested from the Library

Diabetes education to provide the necessary self-management skills

Wilson, V. | 2021 | Diabetes education to provide the necessary self-management skills | British Journal of Community Nursing | Vol. 26 | No. 4 |


Diabetes is a chronic health condition requiring patients to provide 95% of their own care. Having control over this condition and the self-care behaviours necessary for good diabetes self-management can be achieved with patient empowerment and effective diabetes education. The patient must perceive that they have this level of control to maintain good diabetes self-management, enabling prevention or delay of diabetic complications. Currently, there are 3.9 million people who have been diagnosed with diabetes in the UK, 90% of whom have Type 2 diabetes. However, there has also been a rise in prevalence of Type 1 diabetes in recent years – caused by autoimmune disease rather than lifestyle factors. The number of individuals now living with diabetes exerts a huge toll on the NHS and community healthcare resources, making it crucial that patients manage their condition as well as possible to reduce the human and healthcare costs of treating diabetes complications.

We can provide a copy of this article to Rotherham NHS staff, just contact the Library for the paper

New study suggests vegan diet could control blood sugar for people with, or at risk of, type 2 diabetes

NIHR | March 2021 | New study suggests vegan diet could control blood sugar for people with, or at risk of, type 2 diabetes

A plant-based lifestyle may help to support control of blood sugar for people with or at risk of type 2 diabetes

Previous research into the causes of type 2 diabetes has found a strong association between a molecule in the blood called TMAO and increased risk of heart disease.  Co- Author of the study Professor Tom Yates said,

“Research has found that TMAO is particularly linked to animal products in the diet such as red meat, eggs and dairy. Due to the increased risk of patients with type 2 diabetes also developing heart disease, research suggests that there is a connection between diet, type 2 diabetes and heart functioning.” 

The Plant Your Health study looked at the impact of a vegn diet in people with or at risk of developing type 2 diabetes. . The researchers looked at whether a molecule which is produced when food, such as that derived from animal products, is digested in the gut. The molecule TMAO (or trimethylamine N-oxide) is a molecule produced when food, particularly from animal sources, is broken down in the gut. Its presence is associated with an increased risk of heart disease, which is often linked to type 2 diabetes.

Over 20 participants with type 2 or at risk of developing it, were recruited, they substituted their regular diet with vegan alternatives and were encouraged to exercise more. At the study’s outset all participants were given a health check, which including TMAO, blood sugar and cholesterol levels

The experts have concluded that a plant-based lifestyle may help control blood glucose levels

NIHR New study suggests vegan diet could control blood sugar for people with, or at risk of, type 2 diabetes

University of Leicester [press release] Vegan diet could control blood sugar for people with type 2 diabetes

[Primary Paper] Evaluation of an 8-Week Vegan Diet on Plasma Trimethylamine-N-Oxide and Postchallenge Glucose in Adults with Dysglycemia or Obesity