Only 20% of people diagnosed with type 2 diabetes in the last 4 years have good control of their glucose, cholesterol and blood pressure and only 14% of patients were offered education shortly after diagnosis of type 2 diabetes. Diabetes UK is supporting a series of educational events at 80 locations across the UK for people with type 2 diabetes and is expecting 10,000 people to attend them over the next 2 years. (http://www.diabetes.org.uk/About_us/News/Just-one-in-five-recently-diagnosed-with-Type-2-diabetes-have-it-under-control/)
An inexpensive finger prick test to diagnose type 1 diabetes, which uses microchip technology to identify the presence of diabetes-related auto-antibodies, has been reported in Nature Medicine. (http://www.nature.com/nm/journal/vaop/ncurrent/full/nm.3619.htm).
NICE guidance suggests more evidence is needed to support the routine use of VibraTip to detect peripheral neuropathy either alone or in addition to existing technologies. Umesh Dashora of ABCD is a lead expert advisor in the guidance. To contribute to the consultation, see the NICE website: http://www.nice.org.uk/Guidance/GID-MT211/Consultation
The NICE guidance, currently in draft stage, might lower the threshold BMI at which obese patients with recent onset type 2 diabetes can be considered for weight loss procedures from BMI 35 to 30. Certain ethnic groups may qualify for this surgery at even lower BMI. This could mean about half a million eligible people may access the option leading to a potential cost of £6 to £15 billion to the nation. The recent three-year STAMPEDE results showed that obese diabetic patients with BMI <35 enjoyed the same benefit of surgery as those with BMI >35. The NICE draft for consultation can be accessed on the NICE website http://www.nice.org.uk/guidance/gid-cgwave0682/resources/obesity-update-draft-guideline-nice2
Novartis is going to develop Google's Smart Lens which measures glucose in the wearer’s tears and wirelessly relays the information (one reading per second) to a mobile phone or a personal computer. (http://www.diabetes.co.uk/news/2014/jul/novartis-to-work-on-googles-diabetes-smart-contact-lenses-90977329.html).
The 2014 ABCD membership survey closed on 1st August – thanks to all who participated – the collated responses will be used by the ABCD committee to plan the coming year’s activities. If you’re unsure of the range of ABCD activities, check them out on the first page of the survey: https://www.surveymonkey.com/s/WLRJMBT
For some diabetologists the highlight of this year’s meeting of the ADA was an ‘escape from Alcatraz’. On a breezy June morning 20 intrepid swimmers braved the strong currents and chilling waters of San Francisco Bay. The first two to shore were Team GB’s Rob Andrews (Bristol) who was soon joined by John Wilding (Liverpool), and BJDVD’s associate editor Parth Narendran (Birmingham) completed the line-up. The trio raised £1180 for the Diabetes Research and Wellness Foundation; there is still time to donate: (https://www.justgiving.com/RobJohnandParthEscapefromAlcatraz).
In July the RCP published a position statement on the care of young adults (20-25yrs) and adolescents (10-19yrs), noting the need for developmentally appropriate approaches and individualisation of care. https://www.rcplondon.ac.uk/sites/default/files/yaa_position_statement_-_final_endorsed_by_council_ july_2014.pdf
The Rowan Hillson insulin safety award for the ‘best in class’ insulin prescription chart was a Joint British Diabetes Societies for Inpatient Care initiative to promote safer insulin prescribing practice. Dr Hillson chaired the judging panel which considered all charts to be of a high standard. The winning chart was submitted by Dr Jenny Clayton, Nottingham University Hospitals NHS Trust. For full results and charts see http://www.diabetologists-abcd.org.uk/JBDS/insulin_chart_winners.pdf
A series of annual checks for people with diabetes has been proposed by NICE in its latest QOF indicator menu. The bundled indicator of 8 checks includes routine measurements, recording of smoking status and foot examination. http://www.nice.org.uk/media/default/Standards-and-indicators/Summary-QOF-menu-August-2014.pdf
The Children and Families Act 2014 comes into effect for the new school year. Under this new law schools in England will have a legal duty to support children with long-term health conditions. Schools will need to have a medical conditions policy in place, an individual healthcare plan (developed in association with parents and healthcare professionals) tailored to meet each child’s needs and ensure staff are trained to provide appropriate support. To help schools implement the new ruling when supporting children with type 1 diabetes, Diabetes UK has produced free advice packs which can be ordered from: www.diabetes.org.uk/schools
There is no statistically significant increased risk of bladder cancer among patients ever exposed to pioglitazone according to data from a large 10-year epidemiology study which has been submitted to the American, European and Japanese regulatory authorities. Concerns were initially raised on publication of the 5-year interim analysis (Diabetes Care 2011; 34:923-9) showing an increased risk amongst those taking pioglitazone for at least 2 years. Publication of the 10-year data is due later this year.
ABCD, Diabetes UK, the National Diabetes Inpatient Audit Advisory Group and the National Clinical Director for Obesity and Diabetes are jointly co-ordinating the Diabetes Morbidity and Mortality (M&M) project. The project aims to identify the causes of the currently unacceptable levels of hospital harms experienced by people with diabetes, collate the lessons learned and facilitate events to share experiences and develop action plans.
The project will be launched 1st September, and is seeking local identification and root cause analysis of at least 6 cases of serious diabetes harms (2 deaths, 4 morbidities) over the next 3 months. All completed data forms must be returned by 9th January 2015 so that further analyses can be undertaken prior to the roll out of the learning events in February. To provide meaningful outcomes the project needs the input of as many hospitals as possible. For more information on participating in this audit go to http://www.diabetologists-abcd.org.uk/Documents/diabetes_MandM_project.pdf or email DiabetesMM@ diabetes.org.uk
The programme for the Autumn meeting (6th-7th November at Royal College of Physicians, London) is now available: http://www.diabetologists-abcd.org.uk/Shared_Documents/ABCD_meetings/Autumn2014_Programme.pdf
The Spring meeting (23rd-24th April 2015) will be held in Cardiff in association with the Welsh Endocrinology and Diabetes Society in Cardiff.
Learning about new therapies in ‘real world’ clinical use (as distinct from clinical trials) through sharing collective experiences has become a core ABCD activity.
GLP-1 receptor agonists
ABCD members will remember how much was learned from the ABCD exenatide and liraglutide audits: how these agents are actually used in real clinical practice and extending information from that reported in the clinical trials.
In March 2014 the ABCD nationwide exenatide QW Audit was launched – to join the audit enter data using the N3 link (http://www.diabetologists-abcd.org.uk/n3/ExenatideQW_Audit.htm ).
SGLT2 inhibitors
Dapagliflozin is the first SGLT2 inhibitor to become available in Europe and the ABCD nationwide dapagliflozin audit – due to launch September 2014 – will be the first audit of this first-in-class drug in real clinical practice. This will be an opportunity to pool nationwide experiences regarding safety and efficacy as we start using this new type of therapy. For more information and to join the audit contact abcd.audits@diabetologists.org.uk
Very long-acting insulin analogues
Insulin degludec is the only very long-acting insulin analogue currently available. Clinical trials have suggested that it is associated with less hypoglycaemia than other insulins and has allowed for flexible dosing. Trials have also suggested that there is less intra-subject variability than with glargine. We hope that pooling national experience - commencing September 2014 - we will gain insight into whether these potential advantages translate in real clinical practice. For more information and to join the audit contact degludec.audit@diabetologists.org.uk
September launch
All of the new audit tools have bespoke facilities that make it very easy to analyse your own local data and all contributors to the audits will be acknowledged in the publications. (http://www.diabetologists-abcd.org.uk/n3/future_audits.htm)
More information on the dapagliflozin and degludec audits will be published on the ABCD website as they go live in September.