The pandemic is negatively impacting young people with diabetes

Diabetes UK | April  2021 | The pandemic is negatively impacting young people with diabetes

Researchers from King’s College London studying the impact of lockdown and the coronavirus pandemic on young people with diabetes, have presented the findings of their study at this year’s virtual Diabetes UK Professional Conference (DUKPC) this week.

As part of this they have undertaken qualitative research to survey 74 young people with the condition, to better understand their diabetes management as well as their emotional wellbeing. While a little over half (55 per cent) of the participants felt they were well-supported by diabetes team, more than one in five (22 per cent) experienced feelings of ‘demotivation’ which ascribed to being less physically active, disrupted diabetes routines and a lack of support. Equally, Almost two-thirds of people said the pandemic had had a negative impact on their mental wellbeing, and 31 per cent of respondents felt more negatively about their diabetes and future health.

Overall two-thirds of those young people surveyed were looking forward to returning to face-to-face care

Further details available from Diabetes UK

Associations between body-mass index and COVID-19 severity in 6·9 million people in England: a prospective, community-based, cohort study

Gao, M. et al | 2021| Associations between body-mass index and COVID-19 severity in 6·9 million people in England: a prospective, community-based, cohort study | The Lancet Diabetes & Endocrinology | DOI: https://doi.org/10.1016/S2213-8587(21)00089-9

The authors of this paper, report the results of a large, representative community-based cohort study of 6·9 million people in England, UK, to thoroughly characterise the association between BMI and severe COVID-19 outcomes and to explore interactions with demographic characteristics and other known risk factors.

Their findings suggest that the hazard ratio of severe outcomes from COVID-19 (i.e. admission to hospital, admission to ICU, or death) increase progressively above a BMI of 23 kg/m2, which is not attributable to excess risks of related diseases such as type 2 diabetes. We found that BMI is a greater risk factor for younger people (aged 20 to 39 years) than for older people (more than or equal to 80 years), and for Black people than for White people.

Summary

Background

Obesity is a major risk factor for adverse outcomes after infection with SARS-CoV-2. We aimed to examine this association, including interactions with demographic and behavioural characteristics, type 2 diabetes, and other health conditions.

Methods

In this prospective, community-based, cohort study, we used de-identified patient-level data from the QResearch database of general practices in England, UK. We extracted data for patients aged 20 years and older who were registered at a practice eligible for inclusion in the QResearch database between Jan 24, 2020 (date of the first recorded infection in the UK) and April 30, 2020, and with available data on BMI. Data extracted included demographic, clinical, clinical values linked with Public Health England’s database of positive SARS-CoV-2 test results, and death certificates from the Office of National Statistics. Outcomes, as a proxy measure of severe COVID-19, were admission to hospital, admission to an intensive care unit (ICU), and death due to COVID-19. We used Cox proportional hazard models to estimate the risk of severe COVID-19, sequentially adjusting for demographic characteristics, behavioural factors, and comorbidities.

Findings

Among 6 910 695 eligible individuals (mean BMI 26·78 kg/m2 [SD 5·59]), 13 503 (0·20%) were admitted to hospital, 1601 (0·02 per cent ) to an ICU, and 5479 (0·08 per cent) died after a positive test for SARS-CoV-2. We found J-shaped associations between BMI and admission to hospital due to COVID-19 (adjusted hazard ratio [HR] per kg/m2 from the nadir at BMI of 23 kg/m2 of 1·05 [95 per cent CI 1·05–1·05]) and death (1·04 [1·04–1·05]), and a linear association across the whole BMI range with ICU admission (1·10 [1·09–1·10]). We found a significant interaction between BMI and age and ethnicity, with higher HR per kg/m2 above BMI 23 kg/m2 for younger people (adjusted HR per kg/m2 above BMI 23 kg/m2 for hospital admission 1·09 [95% CI 1·08–1·10] in 20–39 years age group vs 80–100 years group 1·01 [1·00–1·02]) and Black people than White people (1·07 [1·06–1·08] vs 1·04 [1·04–1·05]). The risk of admission to hospital and ICU due to COVID-19 associated with unit increase in BMI was slightly lower in people with type 2 diabetes, hypertension, and cardiovascular disease than in those without these morbidities.

Interpretation

At a BMI of more than 23 kg/m2, we found a linear increase in risk of severe COVID-19 leading to admission to hospital and death, and a linear increase in admission to an ICU across the whole BMI range, which is not attributable to excess risks of related diseases. The relative risk due to increasing BMI is particularly notable people younger than 40 years and of Black ethnicity.

Paper available from The Lancet Diabetes & Endocrinology

NHS Facebook campaign helps 40-plus men prevent Type 2 diabetes

NHS England | 19 April  2021 | NHS Facebook campaign helps 40-plus men prevent Type 2 diabetes

A new social media campaign devised by the NHS is targeting males over 40 at risk of developing type 2, in a bid to encourage them to change their lifestyle to avoid developing the condition.

Research shows that men over 40 are particularly at risk of getting Type 2 diabetes and this risk increases with age.

The Facebook adverts will highlight the increased risk among white men of this age and encourage them to sign up for support from the Healthier You NHS Diabetes Prevention Programme.

The NHS will post a series of sponsored Facebook ads over the next three weeks which will let users click through to a quiz by Diabetes UK.

If their score is moderate or high they can refer themselves to a local service for support remotely or online, without having to go through a healthcare professional.

The NHS has fast-tracked access to the Healthier You programme after research found that people are twice as likely to die from COVID-19 if they have Type 2 diabetes.

The new drive follows a successful national campaign in August last year which targeted Black and South Asian communities who are more at risk of Type 2 diabetes from the age of 25 (Source: NHS England).

Full details are available from NHS England

Diabetes UK: DUKPC research highlights day 2

Diabetes UK | 20 April 2021 | DUKPC research highlights: day 2

Day 2 of this year’s Diabetes UK Professional Conference (DUKPC) saw new research presented that is investigating the role dietary fibre could play in preventing type 2 diabetes. Dr Denise Robertson, from the University of Surrey was discussing her research looking into substituting normal starch with with resistant starch (in foods such as pulses, bananas and can also be added to food), to determine if it can reduce blood sugar levels and help people with type 2 diabetes to manage their condition. The study is still being conducted, the findings will be available from Diabetes UK on completion (Source: Diabetes UK).

Image source: Diabetes UK Visual summary of the lecture

Further details about the project are available from Diabetes UK

See also Dr Robertson’s blog post Will resistant starch change the way we think about carbs?

DiRECT trial: New findings that suggest that losing weight and being in remission from TD can improve heart health

Diabetes UK | April  2021 | DUKPC research highlights: day 2

At this year’s Diabetes UK Professional Conference (DUKPC), Professor Roy Taylor, from the University of Newcastle discussed his latest findings from the DiRECT trial. Funded by Diabetes UK, the DiRECT trial ( Diabetes Remission Clinical Trial) has been led by Professor Taylor and his colleagues for the last decade. At this year’s online conference Prof Taylor shared new findings that indicate weight loss and going into remission could reduce the risk of heart disease.

29 participants with type 2 diabetes from the trial were analysed to explore how losing weight and going into remission affects risk of heart disease. The researcher used a risk calculator, which combines information on a range of different factors linked with heart disease to predict the risk of having a heart attack or stroke. 

Image source: Diabetes UK Description: Visual summary of the latest DiRECT findings

Six months later, all the participants experienced a reduction in weight and had less internal body fat, and this lowered their risk of heart disease. But the reduction in risk was most pronounced for people who had put their type 2 diabetes in remission compared to those who were not in remission. This gives us early evidence that being in remission could help to protect against heart attacks and strokes later in life. The findings also show that weight loss on its own can benefit health, even if you don’t go into remission.  

This research is really encouraging and builds a picture of how remission can offer people with type 2 diabetes a chance of a better quality of life, without the complications of diabetes. But there’s still more we need to find out about how much remission can protect people against diabetes complications. That’s why it’s important to keep on getting regular health checks even when you are in remission to make sure that any new, or existing complications, can be monitored and treated.  (Source: Diabetes UK)

Full details are available from Diabetes UK

See also: Newcastle University Reversing Type 2 Diabetes and ongoing remission

Free 10 week get moving course for people with diabetes

Diabetes UK | 01 April 2021| Sign up to our free ‘get moving’ classes

Starting in May, Diabetes UK ‘sPhysical Activity Coordinators will be running free 10 week courses specifically tailored to support people who are currently doing less than 30 minutes of exercise a week. 

From boxercise to Tai chi to movement to music, each weekly class will focus on a different gentle activity – giving you the chance to try out new ways to get active and find what suits you. Plus, we’ll be holding Q&A sessions at the end of each class, so that you can find out more about managing your condition and get tips and advice from our clinical experts and guest speakers. 

And because you’ll be part of the same group throughout the entire 10 weeks, you’ll also get the chance to meet and chat to other participants who all have the same goal – to move more and live well with diabetes.

The majority of our Get Moving courses will be held online, so you’ll just need to be able to log in via Zoom to take part. As all 10 classes will be held on the same day and time each week, we’ve got a number of courses running at different times throughout the week for you to choose from – including evenings and the weekend. 

Diabetes UK will also be running specific online courses for: 

  • women only
  • South Asian communities with translation
  • those wanting to do chair-based activities only. 

Simply register your interest to find out more about our time slots and availability, and we’ll be in touch with more details as soon as possible. 

Full details from Diabetes UK

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 | https://doi.org/10.12968/bjcn.2021.26.Sup3.S14

Abstract

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 | https://doi.org/10.12968/bjcn.2021.26.4.199

Abstract

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