Habit and diabetes self-management in adolescents with type 1 diabetes

Cummings, C. et al | 2021| Habit and diabetes self-management in adolescents with type 1 diabetes| Health Psychology | .https://doi.org/10.1037/hea0001097

Objective The development of habit (i.e., behavioral automaticity, the extent to which a behavior is performed with decreased thresholds for time, attention [effort], conscious awareness, and goal dependence), for goal-directed health behaviors facilitates health behavior engagement in daily life. However, there is a paucity of research examining automaticity for Type 1 diabetes self-management in adolescence. This study examined if greater perceived automaticity for diabetes self-management was associated with increased daily self-management, decreased daily self-regulation failures in glucose checking, and more optimal daily glycemic levels in adolescents with Type 1 diabetes.

Method: Adolescents aged 13–17 and diagnosed with Type 1 diabetes (n equal to 79) completed the Self-Report Behavioral Automaticity Index, a measure of automaticity of diabetes self-management (i.e., automaticity of glucose checking, carbohydrate counting, and insulin dosing), and a measure of perceived self-management at baseline. One to 3 months later, a subsample of teens (n equal to 42) also completed a daily diary for a 7-day period including perceptions of daily self-management, daily self-regulation failures in glucose checking, and daily glucose levels.

Results: Greater overall automaticity of diabetes self-management was associated with greater baseline and daily self-management, fewer daily self-regulation failures in glucose checking, and lower average daily mean blood glucose levels but not more optimal daily variations in blood glucose levels.

Conclusions: Greater automaticity for diabetes self-management may support more optimal daily diabetes self-management in adolescence. Further research is needed to clarify the benefits and mechanisms of automaticity and explore possible interventions. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

Rotherham NHS staff can request a copy of this article from their Library

Metformin for pregnancy and beyond: the pros and cons

Newman, C. & Dunne, F. P. | 2021| Metformin for pregnancy and beyond: the pros and cons | Diabetic Medicine | https://doi.org/10.1111/dme.14700

The authors of this review set out to review the benefits and potential pitfalls of metformin use in pregnancy. To this end they conducted a literature search of web-based databases (including PubMed, CENTRAL via the Cochrane Library and EMBASE) using identified search terms. They read the full texts of any relevant texts published in English and searched clinicaltrials.gov for relevant unpublished trials. The team included randomised controlled trials (RCTs), cluster RCTs, pilot and feasibility studies in our review. They excluded conference abstracts, case reports and case series. Observational data which were deemed to be of high quality were also considered. Additionally, the researchers searched bibliographies for all relevant publications to identify other studies.

In this paper they report their findings that metformin has many maternal advantages when taken during and after pregnancy, including reduced maternal GWG, PTD and insulin requirements, a reduction in operative delivery and possible reduction in hypertensive disorders and future type 2 diabetes. Some benefits are even greater for women with a BMI more than or equal to 30 kg/m2 (Source: Newman & Dunne, 2021).

Abstract

Context and Aim

Metformin has been used in pregnancy since the 1970s. It is cheap, widely available and is acceptable to women. Despite its increasing use, controversy remains surrounding its benefits and risks. Metformin effectively reduces hyperglycaemia for the mother during pregnancy and it reduces rates of macrosomia and neonatal hypoglycaemia. However, concern exists surrounding an increase in the rate of SGA births and obesity in childhood. We aim to review the evidence and expert opinion behind metformin in pregnancy through to the post-partum period.

Methods

We performed a literature review of relevant studies from online databases using a combination of keywords. We also searched the references of retrieved articles for pertinent studies.

Results

There is strong evidence that metformin is safe in early pregnancy with no risk of congenital malformations. If used throughout pregnancy, it is likely to lead to reduced maternal weight gain and reduced insulin dose in women with type 2 diabetes. In infants, metformin reduces hypoglycaemia and macrosomia but may increase the rate of infants born SGA. There is some evidence of an increased risk of obesity and altered fat distribution in offspring. Metformin appears well tolerated in pregnancy and is more acceptable to women than insulin therapy.

Conclusion

Due to increasing rates of maternal obesity, GDM and type 2 diabetes, metformin use in pregnancy is increasing. Overall, it appears safe and effective but further research is needed to examine mechanisms linking metformin to obesity reported during childhood in some follow-up studies.

  • Metformin has been used outside of pregnancy for decades and has multiple benefits in pregnancy including reduced weight gain and a potential decrease in pre-eclampsia (PET).
  • However, some clinicians have concerns regarding its use due to increased rates of small for gestational age (SGA) births and adiposity in infants exposed to metformin.
  • With the rising rates of obesity and gestational diabetes (GDM), cheap, acceptable and effective treatments for hyperglycaemia are needed.
  • This study follows the use of metformin from the pre-conception to the post-partum period and examines the evidence for and against its use.

The primary paper is available from the journal Diabetic Medicine

Glycaemic control during the lockdown for COVID-19 in adults with type 1 diabetes #Covid19RftLks

Garofolo, M. et al | 2021| Glycaemic control during the lockdown for COVID-19 in adults with type 1 diabetes: A meta-analysis of observational studies | Diabetes Research and Clinical Practice | doi: https://doi.org/10.1016/j.diabres.
2021.109066

This review is available online ahead of print. It updates an earlier systematic systematic review and meta-analysis of studies assessing the effects of lockdown during COVID-19 pandemic on glucose metrics in adult subjects
with type 1 diabetes using continuous glucose monitoring (CGM) and flash glucose monitoring (FGM).

The reviewers report that in their meta-analysis of aggregate data shows that well-controlled people with type 1
diabetes on both MDI and CSII with continuous or flash glucose monitoring did not experience a 14 deterioration in glucose control throughout the COVID-19 lockdown, showing a modest, though statistically significant improvement in many glucose control parameters (Garofolo et al, 2021).

Abstract

Aims:

To assess the effects of lockdown due to COVID-19 pandemic on glucose metrics, measured by glucose monitoring systems, in adult individuals with type 1 diabetes.

Methods: We conducted a systematic literature search for English language articles from MEDLINE, Scopus and Web of Science up to February 28, 2021, using “diabetes”, “lockdown”, and “glucose” as key search terms. Time in range (TIR) was the main outcome; other metrics were time above range (TAR), time below range (TBR), mean blood glucose (MBG) and its variability ( per cent CV), estimated HbA1c (eA1c) or glucose management indicator (GMI).

Results: Seventeen studies for a total of 3,441 individuals with type 1 diabetes were included in the analysis. In the lockdown period, TIR 70-180 mg/dl increased by 3.05 per cent declined by 3.39 per cent (-5.14 to -1.63 per cent ) and 1.96 per cent (-2.51 to -1.42 per cent ), respectively (p less than 0.0001 for both). Both TBR less than 70 and less than 54 mg/dL remained unchanged. MBG slightly decreased by 5.40 mg/dL (-7.29 to – 3.51 mg/dL; p less than 0.0001) along with a reduction in per centCV. Pooled eA1c and GMI decreased by 0.18 per cent (-0.24 to -0.11 per cent ; p less than 0.0001) and a similar reduction was observed when GMI alone was considered (0.15 per cent, -0.23 to – 0.07 per cent; p less than 0.0001). Sensor use was only slightly but not significantly reduced during lockdown.

Conclusions: This meta-analysis shows that well-controlled people with type 1 diabetes on both MDI and CSII with continuous or flash glucose monitoring did not experience a deterioration in glucose control throughout the COVID-19 lockdown, showing a modest, though statistically significant improvement in many glucose control parameters.

Glycaemic control during the lockdown for COVID-19 in adults with type 1 diabetes: A meta-analysis of observational studies [paper ahead of print]

Healthcare shift workers with type 2 needed for study

The Shift-Diabetes study | nd | Healthcare shift workers with type 2 needed for study

Researchers at King’s College London are recruiting hospital or residential care-based shift workers(any job role) with diagnosed type 2 diabetes and are interested in helping with their research to understand more about how shift work influences diet and blood sugar levels in people with type 2 diabetes as part of a Diabetes UK funded study.

The study has two parts, a monitoring study and an informal interview, participants can choose to be part of one or both.

Full details from the study’s page The Shift-Diabetes study

Can DNA-based diets improve blood sugar levels in people at high risk of type 2? New study needs participants to find out the answer

Diabetes UK | August 2021 | Can DNA-based diets improve blood sugar levels in people at high risk of type 2?

Adult over 18 with prediabetes could help contribute to research to test a new type of diet that might improve blood sugar levels and potentially prevent the development of type 2 diabetes in this population. The new diet is tailored to a person’s particular genetic makeup- a DNA-based diet.

Researchers at Imperial College are looking for participants who will be randomised to three different groups: one group will receive special dietary guidelines via an app and wearable wristband or via a dietitian, or usual care which is standard dietary advice for people at risk of developing type 2 diabetes the study will run for 26 weeks.

Further information is available from Diabetes UK
 

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

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

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

Severity and mortality of COVID 19 in patients with diabetes, hypertension and cardiovascular disease: a meta-analysis

Severity and mortality of COVID 19 in patients with diabetes, hypertension and cardiovascular disease: a meta-analysis | Diabetology & Metabolic Syndrome | Full Text

de Almeida-Pititto, B., et al. Severity and mortality of COVID 19 in patients with diabetes, hypertension and cardiovascular disease: a meta-analysis. Diabetol Metab Syndr 12, 75 (2020). https://doi.org/10.1186/s13098-020-00586-4

A study has examined the impact of ACEI inhibitors (medications for hypertension as well as heart and kidney problems) in patients with COVID-19. It finds that conditions such as high blood pressure, diabetes and cardiovascular disease are risk factors for both severity and mortality

Abstract

Background

The aim of this study is to evaluate the impact of diabetes, hypertension, cardiovascular disease and the use of angiotensin converting enzyme inhibitors/angiotensin II receptor blockers (ACEI/ARB) with severity (invasive mechanical ventilation or intensive care unit admission or O2 saturation < 90%) and mortality of COVID-19 cases.

Methods

Systematic review of the PubMed, Cochrane Library and SciELO databases was performed to identify relevant articles published from December 2019 to 6th May 2020. Forty articles were included involving 18.012 COVID-19 patients.

Results

The random-effect meta-analysis showed that diabetes mellitus and hypertension were moderately associated respectively with severity and mortality for COVID-19: Diabetes [OR 2.35 95% CI 1.80–3.06 and OR 2.50 95% CI 1.74–3.59] Hypertension: [OR 2.98 95% CI 2.37–3.75 and OR 2.88 (2.22–3.74)]. Cardiovascular disease was strongly associated with both severity and mortality, respectively [OR 4.02 (2.76–5.86) and OR 6.34 (3.71–10.84)]. On the contrary, the use of ACEI/ARB, was not associate with severity of COVID-19.

Conclusion

In conclusion, diabetes, hypertension and especially cardiovascular disease, are important risk factors for severity and mortality in COVID-19 infected people and are targets that must be intensively addressed in the management of this infection.

The full study is available from BMC

Metformin Should Not Be Used to Treat Prediabetes

Davidson, M.B. (2020)| Metformin Should Not Be Used to Treat Prediabetes | Diabetes Care| DOI: 10.2337/dc19-2221

Abstract

Based on the results of the Diabetes Prevention Program Outcomes Study (DPPOS), in which metformin significantly decreased the development of diabetes in individuals with baseline fasting plasma glucose (FPG) concentrations of 110-125 vs. 100-109 mg/dL (6.1-6.9 vs. 5.6-6.0 mmol/L) and A1C levels 6.0-6.4% (42-46 mmol/mol) vs. less than 6.0% and in women with a history of gestational diabetes mellitus, it has been suggested that metformin should be used to treat people with prediabetes. Since the association between prediabetes and cardiovascular disease is due to the associated nonglycemic risk factors in people with prediabetes, not to the slightly increased glycemia, the only reason to treat with metformin is to delay or prevent the development of diabetes. There are three reasons not to do so. First, approximately two-thirds of people with prediabetes do not develop diabetes, even after many years. Second, approximately one-third of people with prediabetes return to normal glucose regulation. Third, people who meet the glycemic criteria for prediabetes are not at risk for the microvascular complications of diabetes and thus metformin treatment will not affect this important outcome. Why put people who are not at risk for the microvascular complications of diabetes on a drug (possibly for the rest of their lives) that has no immediate advantage except to lower subdiabetes glycemia to even lower levels? Rather, individuals at the highest risk for developing diabetes-i.e., those with FPG concentrations of 110-125 mg/dL (6.1-6.9 mmol/L) or A1C levels of 6.0-6.4% (42-46 mmol/mol) or women with a history of gestational diabetes mellitus-should be followed closely and metformin immediately introduced only when they are diagnosed with diabetes.

Rotherham NHS staff can request a copy of this article from the Library