NICE Medtech innovation briefing [MIB227 t:slim X2 insulin pump for managing blood glucose levels in type 1 diabetes

NICE | 22 September 2020 | Medtech innovation briefing [MIB227 t:slim X2 insulin pump for managing blood glucose levels in type 1 diabetes

NICE has developed a medtech innovation briefing (MIB) on t:slim X2 insulin pump for managing blood glucose levels in type 1 diabetes.

Full details from NICE

Regular use of proton pump inhibitors and risk of type 2 diabetes: results from three prospective cohort studies

Yuan, J. et al. (2020). Regular use of proton pump inhibitors and risk of type 2 diabetes: results from three prospective cohort studies | BMJ Gut| https://gut.bmj.com/content/early/2020/08/29/gutjnl-2020-322557

New evidence indicates that taking acid reflux drugs on a regular basis may increase an individual’s risk of developing type 2 diabetes. BMJ Gut has published research that analysed data from over 200 000 participants who did not have diabetes at the study’s outset, researchers observed the risk of developing diabetes following regular ingestion of proton pump inhibitors (PPSIs) rose by a quarter, an even more marked risk was noted in individuals who used the reflux drugs over longer periods of time.

Significance of this study
What is already known about this subject?
  • Despite the irreplaceable role of proton pump inhibitors (PPIs) in clinical practice, long-term use of PPIs has been linked to a series of health problems such as bone fracture and enteric infections.
  • PPIs have a major impact on gut microbiome which, in turn, may increase the risk of type 2 diabetes, but epidemiological evidence remains unclear.
What are the new findings?
  • In this prospective analysis of 204 689 participants free of diabetes from three ongoing US cohorts, regular use of PPIs was associated with a 24% increased risk of diabetes even after adjusting for putative risk factors and indications for use, with a higher risk observed in individuals with a longer duration of PPI use.
How might it impact on clinical practice in the foreseeable future?
  • Physicians should be aware of the potential risk of type 2 diabetes when prescribing PPIs, particularly for long-term treatment.
  • Screening for abnormal blood glucose and type 2 diabetes may be required for regular PPI users, particularly for high-risk populations.

Abstract

Objective The association between the regular use of proton pump inhibitors (PPIs) and the risk of type 2 diabetes remains unclear, although a recent randomised controlled trial showed a trend towards increased risk. This study was undertaken to evaluate the regular use of PPIs and risk of type 2 diabetes.

Method This is a prospective analysis of 204 689 participants free of diabetes in the Nurses’ Health Study (NHS), NHS II and Health Professionals Follow-up Study (HPFS). Type 2 diabetes was confirmed using American Diabetes Association (ADA) diagnostic criteria. We evaluated hazard ratios (HRs) adjusting for demographic factors, lifestyle habits, the presence of comorbidities, use of other medications and clinical indications.

Results We documented 10 105 incident cases of diabetes over 2 127 471 person-years of follow-up. Regular PPI users had a 24% higher risk of diabetes than non-users. The risk of diabetes increased with duration of PPI use. Fully adjusted HRs were 1.05 for participants who used PPIs for >0–2 years and 1.26 for participants who used PPIs for >2 years compared with non-users.

Conclusions Regular use of PPIs was associated with a higher risk of type 2 diabetes and the risk increased with longer duration of use. Physicians should therefore exercise caution when prescribing PPIs, particularly for long-term use.

Regular use of proton pump inhibitors and risk of type 2 diabetes: results from three prospective cohort studies

Depression in Youth-Onset Type 2 Diabetes

Gulley, L.D. & Shomaker, L. B. (2020) |Depression in Youth-Onset Type 2 Diabetes | Current Diabetes Reports | 20| 51 

This study highlights the paucity of literature around youth onset type 2 diabetes (T2D), and synthesizes what is known about the prevalence of depression in this particular patient group.

Abstract

Purpose of Review

The current review summarizes extant knowledge regarding the prevalence of depression in youth-onset type 2 diabetes (T2D) and how depression might impact glycemic control through stress-related behavioral and physiological mechanisms. The current review also discusses depression intervention studies in adult-onset T2D, as there are no such studies in youth-onset T2D, and provides recommendations for clinical research.

Recent Findings

The prevalence of elevated depression symptoms in youth-onset T2D is approximately 20%. Some studies suggest depression may negatively impact glycemic control through inadequate medication adherence and disordered eating, but there is a dearth of studies investigating associations with depression and physical activity/sedentary time, sleep, and stress-related physiological mechanisms. In adult-onset T2D, evidence-based behavioral interventions tailored to address diabetes-related issues have shown positive effects for depression and glycemic control.

Summary

Future research is needed to characterize the epidemiology of depression in youth-onset T2D and test interventions to improve depression, glycemic control, and health outcomes in this specific pediatric population.

The full article can be requested by Rotherham NHS staff here 

Thousands to benefit from soups and shakes diet on the NHS

Thousands of people will be able to access NHS soup and shake weight-loss plans to tackle type 2 diabetes | via NHS England

The diet and lifestyle plans have been shown to put Type 2 diabetes into remission for people recently diagnosed with the condition, and will now be provided to 5,000 more patients in 10 areas as the first stage in an NHS drive to increase access to the life-changing programme.

Diabetes is estimated to cost the NHS £10 billion a year, while almost one in 20 prescriptions written by GPs is for diabetes treatment.

The year-long plans will see those who could benefit provided with ‘total diet replacement products’, such as shakes and soups, for three months, alongside support to increase their exercise levels.

To help people maintain a healthy lifestyle and avoid complications linked to obesity patients will also be offered managed plans for reintroducing ordinary, nutritious food, with ongoing support from clinicians and coaches after that.

Full detail: Thousands to benefit from soups and shakes diet on the NHS

The impact of accessibility and service quality on the frequency of patient visits to the primary diabetes care provider

Konerding U, Bowen T, Elkhuizen SG, et al. | The impact of accessibility and service quality on the frequency of patient visits to the primary diabetes care provider: results from a cross-sectional survey performed in six European countries | BMC Health Services Research | 2020; 20 (1):800.

Visits to the primary diabetes care provider play a central role in diabetes care. Therefore, patients should attend their primary diabetes care providers whenever a visit is necessary. Parameters that might affect whether this condition is fulfilled include accessibility (in terms of travel distance and travel time to the practice), as well as aspects of service quality (for example in-practice waiting time and quality of the provider’s communication with the patient). The relationships of these variables with the frequency of visits to the primary diabetes care provider are investigated in this study.

The study found the impact of quality of communication on visit frequency is the largest and is stable across all study regions. Hence, increasing quality of communication seems to be the best approach for increasing visit frequency.

Full paper: The impact of accessibility and service quality on the frequency of patient visits to the primary diabetes care provider: results from a cross-sectional survey performed in six European countries