CCD Rounds: Sharing knowledge and scaling up action to bend the curve on diabetes- latest one 18 June

Cities Changing Diabetes | June 2021 | Sharing knowledge and scaling up action to bend the curve on diabetes

Cities Changing Diabetes is a partnership created to address the social and cultural factors that increase type 2 diabetes vulnerability in urban environments. The partnership is pleased to bring CCD Rounds: a new webinar series for global sharing of best practice and hands-on insight to bend the curve on diabetes. CCD Rounds webinars are an opportunity to learn about diabetes and obesity prevention through real-world examples of health promotion, activities around childhood obesity and best practice policy initiatives.

Tackling the causes of type 2 diabetes & overcoming health inequities with Healthy Goals

Tune in tomorrow (Friday 18 June) from 15:00 –16:00 pm and discover how a sport-and-lifestyle education programme sparked a healthy living movement in a vulnerable community in Leicester, UK. Leicester is home to one of the largest populations of people with diabetes in the country, with around 9 per cent of residents diagnosed with the condition – well above the national average.

Join us to engage with Dr Sophie O’Connell, from the Centre for BME Health, together with Alisson Tripney, from Leicester City in the Community, and learn how Healthy Goals is helping people sustainably improve their wellbeing. The programme has built enthusiastic support among the city’s South Asian society and has leveraged the city’s pride in its home football team to reach an underserved group with practical, fun and educational sessions over a twelve-week programme (Source: Cities Changing Diabetes)

You can read more about the case from Cities Changing Diabetes

Free two day course Understanding Type 1 Diabetes- be quick starts this week 17 & 18 June

NHS | nd | My Type 1 Diabetes

This online course has been designed for people living with type 1 diabetes, but it is also useful for friends, family members, carers or healthcare professionals to learn more about type 1 diabetes.

The welcome pages of this course are available to complete just now and Day 1 content will be released on Thursday the 17th of June and Day 2 content will follow on Friday the 18th of June 2021.

The course aims:

  • To improve your knowledge of what type 1 diabetes is, why controlling it is important and how it can be managed
  • To improve your confidence in managing diabetes
  • To help you make informed choices which will lead to better overall health and wellbeing
  • To share experiences with other people through patient stories and social learning

The outline for day 1

 We will explain what type 1 diabetes is, how it’s diagnosed and treated. We will also discuss blood glucose monitoring and give you everything you need to know about insulin.

Day 2 will focus on the complications of diabetes and how it can impact the rest of the body. Lastly, we’ll discuss what it’s like living with type 1 diabetes covering topics like travelling, driving, and how your lifestyle impacts your diabetes management.

Understanding Type 1 Diabetes MOOC

The effects of a leaflet-based intervention, ‘Hypos can strike twice’, on recurrent hypoglycaemic attendances by ambulance services

Botan, V. et al | 2021| The effects of a leaflet-based intervention, ‘Hypos can strike twice’, on recurrent hypoglycaemic attendances by ambulance services: A non-randomised stepped wedge study | Diabetic Medicine | https://doi.org/10.1111/dme.14612

The study supports the use of information booklets by ambulance clinicians to prevent future attendances and reduce health costs for recurrent hypoglycaemic events.

Abstract
Aims

We aimed to investigate the effect of an intervention in which ambulance personnel provided advice supported by a booklet—‘Hypos can strike twice’—issued following a hypoglycaemic event to prevent future ambulance attendances.

Methods

We used a non-randomised stepped wedge-controlled design. The intervention was introduced at different times (steps) in different areas (clusters) of operation within East Midlands Ambulance Service NHS Trust (EMAS). During the first step (T0), no clusters were exposed to the intervention, and during the last step (T3), all clusters were exposed. Data were analysed using a general linear mixed model (GLMM) and an interrupted-time series analysis (ITSA).

Results

The study included 4825 patients (mean age 65.42 years, SD 19.42; 2,166 females) experiencing hypoglycaemic events attended by EMAS. GLMM indicated a reduction in the number of unsuccessful attendances (i.e., attendance followed by a repeat attendance) in the final step of the intervention when compared to the first (odds ratio OR: 0.50, 95 per cent CI: 0.33–0.76, p   equal to   0.001). ITSA indicated a significant decrease in repeat ambulance attendances for hypoglycaemia—relative to the pre-intervention trend (p equal to 0.008). Furthermore, the hypoglycaemia care bundle was delivered in 66% of attendances during the intervention period, demonstrating a significant level of practice change (p less than 0.001).

Conclusion

The ‘Hypos can strike twice’ intervention had a positive effect on reducing numbers of repeat attendances for hypoglycaemia and in achieving the care bundle. The study supports the use of information booklets by ambulance clinicians to prevent future attendances for recurrent hypoglycaemic events.

The effects of a leaflet-based intervention, ‘Hypos can strike twice’, on recurrent hypoglycaemic attendances by ambulance services: A non-randomised stepped wedge study

Diabetes Healthcare Hub

This week (14- 18 June 2021) is Diabetes Week, to mark this publisher Elsevier has created the Diabetes Healthcare Hub to help healthcare professionals navigate diabetes. Here you will find the latest evidence-based clinical resources and information about prevention and treatment options available to patients.

The Hub has three focus areas: for type 1, type 2 and gestational diabetes. These areas contain clinical overviews, patient education, journal articles and more to support patient care.

The Diabetes Hub is available from Elsevier, the majority of the content is free

Balancing diabetes and pregnancy: the keys are shared decision-making and technology

Cochrane | 11 June 2021 | Balancing diabetes and pregnancy: the keys are shared decision-making and technology

This blog provides a patient-perspective Emma Doble, who lives with Type 1 Diabetes and gave birth for the first time in 2020, reflects on her pregnancy journey. She highlights the importance of technology and shared decision-making, and calls for better postnatal care for women with diabetes. 

The blog is available from Cochrane

National Paediatric Diabetes Audit (NPDA) annual reports

Royal College of Paediatrics & Child Health & Health Quality Improvement Programme | June 2021 | National Paediatric Diabetes Audit (NPDA) annual reports

This annual, national report annual, national reports, Care processes and outcomes highlight the main findings on the quality of care for children and young people with diabetes mellitus in England and Wales.

Image source: rcpch.ac.uk

The 2019-20 report- the most current, published June 2021- covers the health checks (care processes) and outcomes for children and young people with diabetes who have attended PDUs (paediatric diabetes units) from 1 April 2019 to 31 March 2020.

The report aims to address a series of questions relating to paediatric diabetes care, which include:

  • What proportion of children and young people with diabetes are reported to be receiving key age-specific processes of diabetes care, as recommended by NICE?
  • How many achieve outcomes within specified treatment targets?
  • Are children and young people with diabetes demonstrating evidence of small vessel (microvascular) disease and/or abnormal risk factors associated with large vessel (macrovascular) disease prior to transition into adult services?

Key messages in the report
  • Paediatric diabetes teams have demonstrated laudable commitment to data driven quality improvement by succeeding in submitting their 2019-20 datasets during the first wave of the COVID-19 pandemic, despite severe disruption to services. 
  • National median HbA1c remained constant at 61.5 mmol/mol between 2018-19 and 2019-20.    
  • Considerable variation in HbA1c target outcomes amongst children and young people with Type 1 diabetes persists between PDUs even after case-mix adjustment. 
  • The completion rates of all recommended health checks for Type 1 diabetes increased between 2018-19 and 2019-20, except for eye screening.
  • The proportion of children and young people with Type 1 diabetes who were assessed as requiring additional psychological or CAMHS support outside of MDT clinics increased from 39.1 per cent in 2018-19 to 43.9 per cent in 2019-20.
  • One fifth (19.4 per cent) of children and young people with Type 1 diabetes were using a real-time continuous glucose monitor (rtCGM). Children using this technology were found to be more likely to be achieving lower HbA1c targets, 
  • Increased use of rtCGM was associated with living in less deprived areas and White ethnicity, with those in the most deprived areas and Black children and young people least likely to be using this technology. 
  • Those living in more deprived areas were found to have a higher risk of retinopathy, albuminuria, needing additional psychological support, and higher HbA1c levels.

See RCPCH for the full suite of resources related to this year’s (and previous year’s) audits

NEJM: Trends in Diabetes Treatment and Control in U.S. Adults, 1999–2018

Fang, M., Wang, D.,  Coresh, J., & Selvin, E. |2021 | Trends in Diabetes Treatment and Control in U.S. Adults, 1999–2018 | NEJM | https://www.nejm.org/doi/full/10.1056/NEJMsa2032271?query=TOC

Background

Documenting current trends in diabetes treatment and risk-factor control may inform public health policy and planning.

Methods

We conducted a cross-sectional analysis of data from adults with diabetes in the United States participating in the National Health and Nutrition Examination Survey (NHANES) to assess national trends in diabetes treatment and risk-factor control from 1999 through 2018.

Results

Diabetes control improved from 1999 to the early 2010s among the participants but subsequently stalled and declined. Between the 2007–2010 period and the 2015–2018 period, the percentage of adult NHANES participants with diabetes in whom glycemic control (glycated hemoglobin level, less than 7 per cent) was achieved declined from 57.4 per cent (95 per cent confidence interval [CI], 52.9 to 61.8) to 50.5 per cent (95 per cent CI, 45.8 to 55.3). After major improvements in lipid control (non–high-density lipoprotein cholesterol level, less than 130 mg per deciliter) in the early 2000s, minimal improvement was seen from 2007–2010 (52.3 per cent ; 95 per cent CI, 49.2 to 55.3) to 2015–2018 (55.7 per cent ; 95 per cent CI, 50.8 to 60.5). From 2011–2014 to 2015–2018, the percentage of participants in whom blood-pressure control (less than140/90 mm Hg) was achieved decreased from 74.2 per cent (95 per cent CI, 70.7 to 77.4) to 70.4 per cent (95 per cent CI, 66.7 to 73.8). The percentage of participants in whom all three targets were simultaneously achieved plateaued after 2010 and was 22.2 per cent (95 per cent CI, 17.9 to 27.3) in 2015–2018. The percentages of participants who used any glucose-lowering medication or any blood-pressure–lowering medication were unchanged after 2010, and the percentage who used statins plateaued after 2014. After 2010, the use of combination therapy declined in participants with uncontrolled blood pressure and plateaued for those with poor glycemic control.

Conclusions

After more than a decade of progress from 1999 to the early 2010s, glycemic and blood-pressure control declined in adult NHANES participants with diabetes, while lipid control leveled off. (Funded by the National Heart, Lung, and Blood Institute.)

Contact the Library for a copy of this article

BMJ: Low and very low carbohydrate diets for diabetes remission

Goldenberg, J. Z. & Johnston, B. C. | 2021 |  Low and very low carbohydrate diets for diabetes remission| BMJ | 373 | n262| doi:10.1136/bmj.n262

The latest in the series of Fast Facts synthesises evidence around patients who follow a low and very low carbohydrate diet for remission of diabetes. The paper published in The BMJ shows that dietary interventions that restrict carbohydrate intake for the management of diabetes are of particular interest to researchers, healthcare providers, and patients. Based on evidence of moderate to low certainty from 23 randomized trials (n equal to 1 357), evidence synthesis suggests that patients who adhere to low or very low carbohydrate diets for six months might achieve diabetes remission without adverse consequences. But the definition of low and very low carbohydrate diets, the long term health effects of carbohydrate restricted diets, and the working definitions of diabetes remission are debated, requiring further investigation, particularly for longer term health outcomes based on evidence from randomized trials.

Paper available from The BMJ

Do adolescent sedentary behavior levels predict type 2 diabetes risk in adulthood?

Scandiffio, J. A., & Janssen, I. et al | 2021| Do adolescent sedentary behavior levels predict type 2 diabetes risk in adulthood? | BMC Public Health | 21| 969 

This longitudinal study builds on the work of a previous study which looked at sedentary behaviour in adolescence to determine whether this predicts type 2 diabetes. The purpose of this study was to determine whether different levels of both screen-based and non-screen based sedentary behaviours during adolescence are associated with the risk of developing type 2 diabetes in adulthood. They studied these associations using data from the 970 British Cohort Study with assessments of sedentary behaviour at age 16 and a subsequent 30-year follow-up for incident cases of type 2 diabetes.

The research team observed that 16-year-olds who watched TV and videos for more than 4 h/day had a twofold increased risk for developing type 2 diabetes over the next three decades

Time spent using a computer, doing homework, and reading at age 16 were not associated with type 2 diabetes risk.

Abstract
Background

The objective was to determine whether time spent in different types of sedentary behavior during adolescence are associated with the risk of developing type 2 diabetes in adulthood.

Methods

Participants were 3 942 adolescents aged 16 years who were part of the 1970 British Cohort Study. Sedentary behavior was assessed using a questionnaire that asked participants to indicate how much time they spent watching TV and videos, using the computer, reading, and doing homework. Incident cases of type 2 diabetes were determined quadrennially until 46 years of age. The association between adolescent sedentary behaviors and type 2 diabetes was determined using Cox proportional hazards regression that controlled for sex, body mass index, sugary beverage consumption, smoking status, physical activity at baseline, and physical activity in adulthood .

Results

There were 91 incident cases of type 2 diabetes with an incidence rate of 9 cases/10,000 person-years. By comparison to those who watched TV and videos for 2 or less hours/day, type 2 diabetes risk was not different in those who watched for 2.1–4.0 h/day (HR equal to 0.89, 95 per cent CI  equal to  0.54, 1.47) but was increased by 2.06-fold (95 per cent CI  equal to  1.24, 3.43) in those who watched for more than 4 h/day. Time spent using a computer, reading, and doing homework were not significantly associated with type 2 diabetes.

Conclusion

Spending more than 4 h/day watching television and videos at age 16 was associated with an increased risk of type 2 diabetes. Conversely, using a computer and non-screen based sedentary behaviors were not associated with type 2 diabetes risk.

Primary paper Do adolescent sedentary behavior levels predict type 2 diabetes risk in adulthood?