New NICE guidance on type 1 diabetes
The new NICE guidance on the management of type 1 diabetes is now available. The ABCD writing group (Rob Gregory, Patrick Sharp, Anne Kilvert, Emma Bingham and Umesh Dashora) is working to develop a position statement from ABCD to complement this new guidance.
http://bit.ly/1OUbflo
NICE and basal insulin in type 1 diabetes
The new NICE guidance recommends twice-daily Levemir® (insulin detemir) as the basal insulin of choice for newly diagnosed type 1 diabetes patients. This has attracted interest and a survey of ABCD members for existing practice is being undertaken by Helen Hopkinson, Chair of the UK_DAFNE executive board.
http://svy.mk/1RF38uM
Type 2 diabetes guidance
A second consultation on the controversial type 2 diabetes guideline has been held, and the outcome is awaited. Dinesh Nagi, ABCD Secretary, prepared the submission from ABCD.
New leadership and management course for SpRs and consultants
Dev Singh and YDEF colleagues have conceived, launched and filled a new leadership and management course for 2015 to replace the King’s Fund course. The course will be for SpRs in November, but from 2016 it will be delivered as a series of one day modules. A similar course for consultants is in development by the education and professional subcommittee of ABCD.
The second Rowan Hillson Award for the best hypo reduction initiative launched
Umesh Dashora, Mike Sampson and team have announced this national competition and award to identify and encourage initiatives to reduce inpatient hypoglycaemia. JBDS-IP and ABCD invite your entries detailing initiatives like hypo education, safer prescription charts, meal type and time initiatives, hypo boxes etc.. The data from the Mortality and Morbidity Project and NaDIA might help teams to submit evidence of benefit from their initiatives. Contact Christine Jones (christine.jones@nnuh.nhs.uk) or see the announcement on the ABCD website for details of how to apply.
Diabetes Morbidity and Mortality (M&M) Project moves into the next phase
The findings from this project have been incorporated into a proposal for National Confidential Enquiry into Patient Outcome and Death projects in 2016. NaDIA 2015 included a question on whether a trust conducts diabetes M&M meetings, and if not, CQC inspectors are likely to want to know why not. ABCD would like all departments in the UK to establish such meetings. Abstracts are invited at the next Diabetes UK professional conference describing any action developed from this project in trusts in the UK. Four abstracts will be selected for oral presentations.
ABCD in International Metabolic Surgery meeting
ABCD research fellow Piya Sen Gupta presented data showing dramatic reductions in hepatic fat four months following insertion of Endobarrier® at the 3rd World Congress on Interventional Therapies for Type 2 Diabetes and the 2nd Diabetes Surgery Summit. ABCD members Stephanie Amiel and Gerry Rayman are involved in the development of recommendations in this area. Bob Ryder was a guest delegate to contribute to the proceedings.
Dialogue with the SAC for Endocrinology and Diabetes
ABCD will be discussing credentialing in diabetes with Asif Ali, the new Chair of the Speciality Advisory Committee for Endocrinology and Diabetes. If you have any strong views, please discuss these with our Chair.
YDEF position on the proposed new contract for junior doctors
The YDEF have highlighted their concerns to the relevant political bodies, see links below:
Joint position statement: http://bit.ly/1Rdgg9t
YDEF resource for junior doctors: http://bit.ly/1NeO0CM
News from the All Party Parliament Group for Diabetes
Keith Vaz MP chaired a meeting of the All Party Parliament Group for Diabetes which questioned Simon Stevens, CEO of NHS England, about his intentions for diabetes. He identified some areas of importance, including the diabetes prevention programme, food industry changes to tackle obesity and variations of diabetes care across the country (as demonstrated in the NHS Atlas of Variation 2015, see next item).
NHS Atlas of Variation continues to show care is patchy in England
The new report shows significant variations in the quality of diabetes care across CCGs. The percentage of patients achieving HbA1c, BP and cholesterol targets range from 28% to 48%. For major lower limb amputations when the six CCGs with the highest relative risks and the six CCGs with the lowest relative risks are excluded, the range is 2.60–10.12, and the variation is 3.9-fold.
http://bit.ly/1Kq1l74
New analysis of amputation rates in England
Diabetes UK report (based on Public Health Data) that 135 patients/week underwent an amputation in 2011–2014, up from 116/week for 2007–2010. Eight in every ten of these are considered avoidable. See also the article in this issue on an initiative to reduce the rate of amputations in Portsmouth.
http://bit.ly/1SmJh2b
Hello and goodbye
Barbara Young has stepped down, and Chris Askew is the new CEO of Diabetes UK. Adrian Jennings has been elected to the RCP London Council. Steve Olczac has agreed to join the select list of ABCD Ambassadors. Alison Gallagher, Marc Atkin and Karen Adamson have joined the ABCD committee. Jyothis George has moved on for a career opportunity in industry.
Gestational diabetes guide from Diabetes UK
(Emma Bingham)
Gestational diabetes now affects 5% of pregnancies and is becoming more common. It increases the risk of macrosomia, polyhydramnios, difficult labour, admission to specialist care baby unit and the child developing diabetes (six-fold increase) later in life. A new guide from Diabetes UK aims to promote better management of patients with gestational diabetes.
http://bit.ly/1jmgv7Q
ABCD response to the NICE guideline, ‘Care of the dying adult’ (Prof Alan Sinclair)
NICE has produced new draft guidelines on the care of dying adults, which promise to be very useful for patients, families and health professionals alike. The guidance unfortunately does not address the management of issues related specifically to conditions, and diabetes is distinctly absent in the document.
Guidance: http://bit.ly/1IriS1U
ABCD's response: http://bit.ly/1Mwujb2
Financial incentives to GPs to reduce referrals
A recent report in Pulse states that GPs are being paid to reduce referral for chronic conditions including diabetes. Details at:
http://bit.ly/1MvWvuP
New report shows high rate of diabetes complications
Diabetes UK has published a report which shows that there were 199,537 cases of diabetes-related complications (amputations, heart attacks and strokes) in England and Wales in 2012/13. The report also exposes huge variations in the quality of care for people with diabetes in the country with only 36% of people meeting their recommended targets for blood glucose, BP and cholesterol (although as many as 48% achieve these targets in some areas).
http://bit.ly/1JU3uhj
New CQC guidance on diabetes management in care homes
‘Guidance for CQC staff: Inspecting the quality of care for residents with diabetes mellitus living in care homes’ has been developed by the CQC in collaboration with Prof Alan Sinclair (representing Diabetes Frail) and the Joint British Diabetes Societies Task Group. Rob Gregory has welcomed this development on behalf of ABCD, which is working with the CQC to develop an assessment framework for diabetes care in community settings.
http://bit.ly/1NaUxhE
Five million people in England are at high risk of developing type 2 diabetes
Accordingly to a new Public Health England (PHE) report, five million people in England have elevated blood glucose that indicates a high risk of developing diabetes and other complications. PHE has also published evidence that a diabetes prevention programme can be successful in preventing development of diabetes in 26% of people at risk. PHE plan a national programme for rollout with 100,000 patients annually from 2016.
http://bit.ly/1EVIWNX
http://bit.ly/1NBdm05
Rising prescribing trends for diabetes
This Health and Social Care Information Centre report covers the trends in diabetes prescribing for 2005–2015. Diabetes prescriptions accounted for 10% of total NHS medication costs, and drugs used in diabetes accounted for the highest cost of all sections in the British National Formulary. In 2014/15, 47.2 million items were prescribed for diabetes at a net ingredient cost (NIC) of £868 million, with insulin accounting for 14% of these items. There has been a 74% increase in the number of items prescribed over the last 10 years, with a 69% increase in the NIC. Comparative figures for all medicines were 47% and 11.3%.
http://bit.ly/1KhnOn4
60% more people have diabetes
A new report shows that the number of people with diabetes in the UK increased by nearly 60% between 2005–2014. There are now 3.3 million people diagnosed with diabetes, an increase of more than 1.2 million compared with 10 years ago. Additionally, about 590,000 adults with diabetes are yet to be diagnosed. Only 60% of people with diabetes in England and Wales are receiving the eight care processes recommended by NICE.
http://bit.ly/1MsS2Ik
A new survey on diabetes and severe mental illness
A new survey is likely to help develop services in this area. Please complete it at:
https://goo.gl/hMYIeO
The birth of IPN-UK
ABCD is pleased to announce the formation of a new National Insulin Pump Network, called IPN-UK, hosted by ABCD. Its inaugural conference will be in Manchester on 21st April 2016, immediately before the ABCD spring conference. Emma Wilmot and team are preparing the programme.
Great news for corporate supporters
There is a new opportunity for the industry (both pharma and pump/device companies) to support and get involved with the work of ABCD in 2016. Tony Robinson (ABCD Treasurer) has designed corporate membership packages, each of which include entitlements to advertise in, and purchase reprints from, BJDVD.
Joint conference with RCP London
ABCD and RCP London will hold a joint conference on 18th February 2016 ‘Managing Multi-morbidity’. Please register via the RCP website if interested.
National Audit Office preparing a follow-up report
We await publication of this follow-up report on the state of diabetes care in England soon. The NAO has taken evidence from a wide range of stakeholders, including ABCD.
Obesity services in England
New Tier 3 obesity services are being supported and developed all over the country. More help may be available from Rob Gregory (ABCD) and John Wass (RCP London) if any team has any problems in establishing these models locally.
Degludec (Tresiba®) and degludec-aspart (Ryzodeg®) get FDA approval
The FDA approved these two insulin products for use in people with diabetes on 25th September 2015.
Endocrine disrupting chemicals may cause diabetes and obesity
A recent Scientific Statement in Endocrine Reviews suggests that chemicals that disrupt the endocrine system promote the development of obesity and diabetes.
Executive summary: http://press.endocrine.org/doi/10.1210/er.2015-1093
A rapid-fire collection of interesting recent developments in diabetes
Degludec-aspart beats premix as first insulin in type 2 diabetes
Twice-daily insulin degludec/aspart provided superior FPG control (by 1 mmol/L on average) and a reduced rate of overall and nocturnal hypoglycaemia, compared with biphasic insulin aspart 30 in a 26-week RCT in insulin-naïve adults with type 2 diabetes. A non-inferior reduction in HbA1c was observed.
Diabet Med 2015 Oct 4. doi: 10.1111/dme.12982.
Structured diabetes education improves outcomes in type 2 diabetes
In this study of over 24,000 patients, those who received an education programme benefitted by fewer hospitalization events (22 vs. 25%), fewer emergency department visits (40 vs. 44%) and fewer hospitalizations (17 vs. 200 per 100 patients).
Diabet Med 2015 Oct 3. doi: 10.1111/dme.12969.
Over-diagnosis of depression in type 1 diabetes
Diagnosis of depression based on a health questionnaire led to higher false-positive diagnoses compared with a structured clinical review (52 vs. 71%). Many of these cases were related to diabetes- related distress rather than clinical depression.
Diabet Med 2015 Oct 3. doi: 10.1111/dme.12973.
Hypoglycaemia and increased mortality in hospital
Of 921,306 people with diabetes hospitalised in Spain, 46,408 developed secondary hypoglycaemia; these people were at increased risk for mortality (OR=1.24), early readmission (OR=1.20), and increased length of stay (OR=1.24), compared with those free of hypoglycaemia.
Endocr Pract 2014;20:870-5. doi: 10.4158/EP14006.OR.
Need for improved management in diabetes with coronary artery disease
The care of people with coronary artery disease in relation to glucose management was investigated in 24 European countries in a cross-sectional survey (EuroAspire IV). The combined use of all four cardioprotective drugs in patients with new or known diabetes was 55–60%. BP <140/90 mmHg was achieved in 54–60%, LDL-C <1.8 mmol/L in 18–28%. HbA1c <7.0% (53 mmol/mol) was achieved in 53% of people with known diabetes and 11% of patients had HbA1c >9.0% (>75 mmol/mol).
Cardiovasc Diabetol 2015;14:133.
doi: 10.1186/s12933-015-0296-y.
Insulin resistance in type 1 diabetes
The article reports 12–61% lower whole body and hepatic insulin sensitivity in type 1 diabetes. Mechanism and relevance is discussed.
Metab Clin Exp 2015
doi: http://dx.doi.org/10.1016/j.metabol.2015.09.002.
Thiazolinediones increase bone fat in mice
Rosiglitazone increased bone fat and risk of fractures, an effect partially countered by physical activity.
Endocrinology 2015;156:2753-61.
doi: 10.1210/en.2015-1213.
4-MU prevents type 1 diabetes in mice
A drug that is used to prevent gall bladder spasms has the potential to prevent the development of type 1 diabetes. It blocks hyaluronan, which builds up in pancreatic β-cells and is believed to damage them. Data are from mouse models so far.
J Clin Invest 2015;125:3928-40. doi: 10.1172/JCI79271.
A new drug to reduce hepatic glucose production
New research in mice suggests that a drug (MSDC-0602) that blocks a protein in liver that increases hepatic glucose production (mitochondrial pyruvate carrier 2) may help glucose control in people with diabetes.
Cell Metab 2015;22:682-94.
doi: 10.1016/j.cmet.2015.07.028.
Making insulin-secreting cells from pancreatic duct cells
Over-expression of MAFA (a pancreatic transcription factor) is sufficient to drive human pancreatic duct-derived cells toward a β-cell-like phenotype, as shown in a presentation at the 54th Annual European Society for Pediatric Endocrinology Meeting, Barcelona, Spain, October 2015.
Abstract at: http://bit.ly/1GFXmCA
A new study shows link between sedentary behaviour and NASH
In a recent study researchers have shown a link between sedentary behaviour and fatty liver. This is unlikely to be reversed by exercise.
J Hepatol 2015
doi: tp://dx.doi.org/10.1016/j.jhep.2015.07.010
Take your antihypertensive at night to reduce diabetes risk
An antihypertensive administered at night reduces the risk of developing diabetes by over 57% compared with taking it on waking up.
Diabetologia 2015. doi: 10.1007/s00125-015-3749-7.
Day time sleepiness and long naps increase the risk of diabetes…
…by as much as 46–57%, according to a poster presented at the EASD this year.
Abstract at: http://bit.ly/1PrbkPW
|
|
||
In addition to the number of courses that YDEF specifically offers its members, one of the other benefits of membership is the opportunity to attend national and international conferences via travel scholarships. The YDEF-Lilly EASD scholarship is one such opportunity and this year, with the support of Lilly Diabetes, we took 20 members to the beautiful city of Stockholm for EASD 2015. Thousands of delegates travelled from all corners of the globe to share, discuss and debate what's new in diabetes research. Hot topics included old and new glucose-lowering therapies, diabetes genetic and epigenetic breakthroughs, exciting cardiovascular outcomes, important gut physiology, diabetes and the brain, complication prevention and management and individualisation of treatment. Hellerström Hall hosted the most popular session of the conference: the EMPA-REG OUTCOME™ study, which was greeted with loud applause and cheers as positive cardiovascular outcomes were revealed. You can experience this all yourself by heading to www.easdvirtualmeeting.org. See you next year! YDEF Retinopathy 2015 Next on the horizon in YDEF endeavours is the YDEF Retinopathy 2015 course, to be held on December 7–8th in Birmingham. This course is designed to update members on this devastating and often lesser addressed complication of diabetes. The course has been oversubscribed with almost 35 people applying for 25 places, highlighting the eagerness of trainees to develop this area of knowledge. This year’s course promises to continue the high quality of previous years with a mixture of lectures and practical sessions on diagnosing and managing all aspects of retinopathy. The guest lecture, delivered by Dr Abd Tahrani, will focus on the implications of bariatric surgery on microvascular complications and promises to be insightful and topical. This course is supported by the BI-Lilly alliance. |
|
|
|
YDEF is dedicated to all diabetes and endocrine trainees and is open for new members to register on our website. Take advantage of our regular newsletters and up to date advertising of a wide variety of courses, jobs and meetings to complement your training. As always, we are continuously looking to develop and propagate our specialty so do not hesitate to contact us if you have any suggestions or questions! www.youngdiabetologists.org or tweet us @youngdiab |
||