Manchester research: Activity trackers can be useful tools in managing diabetes

University of Manchester|  October  2019 | Activity trackers can be useful tools in managing diabetes

Experts at The University of Manchester have conducted the largest review so far of the effect of movement-monitoring devices, accelerometers and pedometers, on the activity of individuals with diabetes and cardiovascular disease.

The review included data from 36 studies, with more than 5000 participants, researchers investigated the short-term effects of using wearable step-counting devices on the physical activity in adults with cardiometabolic conditions, such as type 2 diabetes, and cardiovascular disease (CVD). They found the devices were associated with small-to-medium improvements in physical activity.

Results from previous studies have shown that the use of pedometers helps patients

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with chronic conditions to increase their physical activity levels. However, the authors of this paper note that a major limitation from previous studies is that interventions involving step-counting devices vary a lot, so it is unclear which interventions are most effective.

Dr Alex Hodkinson, one of the researchers who carried out the study, said; “This study differs to earlier ones because it has looked at which types of interventions using the two most common monitoring devices (accelerometers and pedometers) are most effective in improving physical activity among people with diabetes and cardiometabolic conditions.” (Source: University of Manchester).

Activity trackers can be useful tools in managing diabetes [press release]

The article is available from JAMA Network Open 

 

 

NHS to provide life changing glucose monitors for Type 1 diabetes patients

NHS England | November 2018 | NHS to provide life changing glucose monitors for Type 1 diabetes patients

Simon Stevens Chief Executive of NHS England  has announced that thousands of people with diabetes will be able to access Freestyle Libre; a wearable sensor that means those with the condition no longer need to rely on inconvenient and sometimes painful finger prick blood tests, as the device works by relaying glucose levels to a smart phone or e-reader.  This announcement marks an end to the current variation  some people in different parts of the country were experiencing. 

 

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The pioneering technology should ultimately help people with Type 1 diabetes achieve better health outcomes and benefits for patients include:

  • Easily noticing when sugar levels are starting to rise or drop, so action can be taken earlier
  • Giving patients more confidence in managing their own condition
  • Not having to do as many finger-prick checks (Source: NHS England)

Read the full announcement from NHS England

In the media:

BBC News Diabetes glucose monitors ‘available to thousands more’

 

Text messages improve diabetes self-management and blood sugar control

NIHR | September 2018 | Text messages improve diabetes self-management and blood sugar control

A study from New Zealand underlines how a text message service was well-received by patients with diabetes, the participants who received the text message achieved a small reduction in blood sugar levels. 

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The trial randomized 366 patients with  with poorly controlled type 1 or type 2 diabetes (HbA1c 65mmol/mol or more) to receive either text messages in addition to usual care or usual care alone. The texts were individually tailored to motivate participants to engage in behaviours relating to diabetes management.

What are the implications?

Text message support appears to be a safe, well received, and modestly effective adjunct to standard care for patients with poorly controlled diabetes. However, the HbA1c 4.2mmol/mol difference between the groups was small and did not reach the pre-set 5.5mmol/mol clinically meaningful difference by the researchers. Nevertheless, any improvement is likely to help reduce the risk of complications.

There is increasing interest and investment in UK programmes applying mobile technology to the prevention and management of diabetes and other chronic diseases.

Uncertainties remain around the long-term benefits of such interventions, their cost-effectiveness, their use in overcoming health care inequalities, and the optimal content and frequency of their messages.

For further information see the NIHR Signal

Published Abstract

Objective: To determine the effectiveness of a theoretically based and individually tailored, text message based, diabetes self management support intervention (SMS4BG) in adults with poorly controlled diabetes.

Design: Nine month, two arm, parallel randomised controlled trial. SETTING: Primary and secondary healthcare services in New Zealand.

Participants: 366 participants aged 16 years and over with poorly controlled type 1 or type 2 diabetes randomised between June 2015 and November 2016 (n=183 intervention, n=183 control).

Interventions: The intervention group received a tailored package of text messages for up to nine months in addition to usual care. Text messages provided information, support, motivation, and reminders related to diabetes self management and lifestyle behaviours. The control group received usual care. Messages were delivered by a specifically designed automated content management system.

Main outcome measures: Primary outcome measure was change in glycaemic control (HbA1c) from baseline to nine months. Secondary outcomes included change in HbA1c at three and six months, and self efficacy, diabetes self care behaviours, diabetes distress, perceptions and beliefs about diabetes, health related quality of life, perceived support for diabetes management, and intervention engagement and satisfaction at nine months. Regression models adjusted for baseline outcome, health district category, diabetes type, and ethnicity.

Results: The reduction in HbA1c at nine months was significantly greater in the intervention group. Of 21 secondary outcomes, only four showed statistically significant improvements in favour of the intervention group at nine months. Significant improvements were seen for foot care behaviour (adjusted mean difference 0.85, overall diabetes support, health status on the EQ-5D visual analogue scale, and perceptions of illness identity. High levels of satisfaction with SMS4BG were found, with 161 (95%) of 169 participants reporting it to be useful, and 164 (97%) willing to recommend the programme to other people with diabetes.

Conclusion: A tailored, text message based, self management support programme resulted in modest improvements in glycaemic control in adults with poorly controlled diabetes. Although the clinical significance of these results is unclear, the findings support further investigation into the use of SMS4BG and other text message based support for this patient population.

Full reference:

Dobson, R. et al.| 2018| Effectiveness of text message based, diabetes self management support programme (SMS4BG): two arm, parallel randomised controlled trial| BMJ|Vol. 361 | 2018 | doi: 10.3310/signal-000640

Type 2 diabetes mellitus in older people: key principles of modern day management

Strain, W. et al. |Type 2 diabetes mellitus in older people: a brief statement of key principles of modern day management including the assessment of frailty. A national collaborative stakeholder initiative | Diabetic Medicine | Volume35, Issue 7 | July 2018 | p838-845

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Abstract

Rates of population ageing are unprecedented and this, combined with the progressive urbanization of lifestyles, has led to a dramatic shift in the epidemiology of diabetes towards old age, particularly to those aged 60–79 years.

Both ageing and diabetes are recognized as important risk factors for the development of functional decline and disability. In addition, diabetes is associated with a high economic, social and health burden.

Traditional macrovascular and microvascular complications of diabetes appear to account for less than half of the diabetes‐related disability observed in older people. Despite this, older adults are under‐represented in clinical trials.

Guidelines from organizations such as the National Institute for Health and Care Excellence (NICE), the European Association for the Study of Diabetes, and the American Diabetes Association acknowledge the need for individualized care, but the glycaemic targets that are suggested to constitute good control are too tight for frail older individuals.

We present a framework for the assessment of older adults and guidelines for the management of this population according to their frailty status, with the intention of reducing complications and improving quality of life for these people.

Full document available here

 

Tablets to treat manage diabetes are successful in the long-term, finds Exeter study

University of Essex | June 2018 | “Miracle treatment” long-term success for babies with diabetes

A new international cohort study that looked at the use of  sulphonylurea tablets to treat neonatal diabetes has found that this form of treatment is successful over the long-term in managing this type of diabetesThis decade long study involved 81 patients  across 20 countries including Norway, Italy, France and Poland (via University of Essex).

Professor Hattersley said: “Switching from regular insulin injections was life-changing for these people who had been on insulin all their life; many described it as “a miracle treatment”.  Not only does this eradicate the need to inject with insulin several times a day, it also means much better blood sugar control. This is the first study to establish that this treatment is safe and works excellently for at least 10 years and all indications are that it will continue to work for decades more. This is great news for the thousands of patients who have made the switch from insulin.”

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Dr Elizabeth Robertson, Director of Research at Diabetes UK, said: “It’s so important that people living with rare forms of diabetes, like neonatal diabetes, receive the right diagnosis and treatment. That’s why we are delighted to have been able to help fund this vital work, demonstrating for the first time that sulphonylurea tablets are a safe and effective way for some people with neonatal diabetes to manage their condition for the long term. Moving forward, we hope research will uncover ways to prevent the developmental issues people with neonatal diabetes face.

“Nine out of ten people with this condition can switch from insulin therapy when they get the right diagnosis, so we would like all children diagnosed with diabetes under six months to be tested for neonatal diabetes, so the right treatment can help them get the best start in life.”

The full news article is available from the University of Essex 

A journal article based on this research has now been published in The Lancet Diabetes & Endocrinology

The full article “Effectiveness and safety of long-term treatment with sulfonylureas in patients with neonatal diabetes due to KCNJ11 mutations: an international cohort study”  can be read here