As I write this update it appears, at long last, as if we are making the start of a return to normal life, with face-to-face meetings and conferences resuming and staff being able to take long overdue and most welcome holidays. The pandemic has left a deep scar that will take a long time to heal, of course; with many of our colleagues and friends continuing to be burdened by illness, the impact of the pandemic on their mental health and workforce shortages. There is continued need within our service to deliver compassionate leadership and support for all our colleagues and ancillary staff. I would like to extend my heartfelt thanks to all members and colleagues for all your hard work supporting patients. There are uncertain times ahead, brought about by war, inflation and perturbed energy markets, which remind us to be mindful and grateful for what we have and charitable towards people who are suffering.
One clear silver lining of the pandemic has been the far greater acceptance of digital delivery of learning programmes. Here at ABCD our widely respected programme of webinars will continue as part of our core programme of services. To date this year, we have delivered four webinars and our extensive library of digital learning is accessible for all members to support their continued professional development. You can access the library at https://abcd.care/abcd-webinars-series.
We are delighted that our full programme of face-to-face events has now resumed. The first event, the ABCD DTN Educators Day, took place on 24th May, 2022. We are all extremely excited to be celebrating the centenary of the first administration of insulin with an absolutely extraordinary event on 4th and 5th July, 2022 at the RCPL. We’ve got a fantastic programme and, with more than 200 attendees booked to attend so far, we know that this is going to be a unique and exciting event. Both the ABCD and DTN annual meetings will be making a strong return to in-person events this year. They take place on 7th and 8th September, 2022 – register now for special anniversary rates.
Our Association reaches a quarter of a century this year and is going from strength to strength. Some of this history, and indeed the future, will be showcased at our conference on 8th September, so I urge you to join us and be a part of this. This also marks a great time to listen to our members to help shape the Association and its activities for the next decade and beyond.
There is a whole range of other events being planned throughout the year, with several regional meetings and more partnerships with other organisations to help bring you top-quality diabetes-related learning from a network of national and international experts.
ABCD, as a National Nominating Organisation for the new National Clinical Impact Awards (formerly ACCEA) will be able to support a small number of applications this year. The application process closed on 25th May, 2022, I hope your applications were submitted. Find out more at https://abcd.care/announcement/national-clinical-impact-awards-2022-open-applications.
Research and audit are at the heart of what we do to help inform and challenge practice. We were delighted to launch the ABCD audit for the Omnipod insulin pump earlier in the year. You can find out about all the audits being delivered by ABCD directly through our website. We encourage all members to participate.
Last year, we introduced a new clinical grant offering in partnership with Diabetes Care Trust. We are delighted to announce that we are once again offering grants of up to £50,000 for high-quality clinically based studies relating to the management and care of people with diabetes. We particularly welcome applications from those at an early stage of their clinical and academic training. Find out more at https://abcd.care/research-grants. The deadline for applications is 1st July, 2022. Thanks to the academic subcommittee for their work in supporting this.
I’m pleased to report that our membership continues to grow and thrive and we have a strong voice and presence with policymakers and stakeholders in the diabetes community. We have been considering increasing our international footprint via collaboration with a number of partner organisations.
At home we are keen to encourage and support Specialist Registrar (SpR) membership. We are in the process of developing new programmes to support SpR members, with specific reference to the diabetes curriculum. We continue to work with and provide input to other organisations, including the RCP, NICE, NHS and JBDS, and to the NHS. Our participation with these organisations helps us to ensure that the voice of the specialist diabetes physician is heard and considered in new guidance and reports.
Our flagship journal, the British Journal of Diabetes, continues to grow and mature. As part of our preparations for PubMed application we have updated the BJD website so that at Online First you can read articles ahead of print. You can also read there our journal policies and information on how to submit your work. Do consider sending us your original research, audits and case studies to help support our society journal, which has a healthy readership. Credit to the editorial team for the ongoing groundwork.
There is an excellent collection of resources available via the ABCD Diabetes Technology Network (DTN) web pages. These include educa-tional resources from a virtual showroom demonstrating devices and their use, expert views on devices, educational resources for patients, a virtual academy and a series of videos on virtual consulting. The committee met recently to consider new and innovative programmes and we look forward to seeing plans this year. The DTN have an in-person conference on 7th September for which you will be able to register soon. Our thanks go to Pratik Choudhary and Alistair Lumb for their vision and enthusiasm about this important and thriving network which involves the whole MDT.
We hope you continue to enjoy our fortnightly newsletters which help keep you abreast of new developments, news, events and other diabetes-related information. If you have news to share with the membership please simply drop us a line at info@abcd.care.
This year we welcomed Dr Hermione Price to the Executive Team of ABCD as Honorary Secretary. We are currently seeking applications for an education lead for ABCD and committee membership. This may be your opportunity to shape the Association and work with our fantastic committee. See https://abcd.care/abcd-committee-position-applications-2022
As chair of the ABCD committee I would like to take this opportunity to thank all our corporate sponsors of ABCD and DTN, without whom none of these programmes and supporting activities would be possible. Sponsors include Boehringer Ingelheim & Eli Lilly & Alliance, Lilly, Novo Nordisk Ltd, Abbott Laboratories Ltd, Dexcom, Insulet International Ltd, Medtronic Ltd, Medtrum Ltd, Air Liquide Healthcare Ltd, CamDiab and Roche Diabetes Care.
I wish you all a happy, healthy and warm sun-filled summer and I hope you all get a chance to take that well deserved and long overdue holiday. I also look forward to seeing you in person at an ABCD event in 2022 and beyond.
Dipesh Patel, ABCD Chair
Please look out for a questionnaire coming out soon to assess the use of devices and electronic medical records. This will help inform a new document we are currently putting together.
New JBDS guidelines published:
Updated diabetes module on RCM website (Umesh Dashora and Dinesh Nagi)
The highly successful ABCD collaboration with the Royal College of Midwives, which led to the development of an online training module for diabetes midwives (Diabetes I-Learn), has now been revised in view of the new JBDS guidance. The updated module is live on the RCP website. The previous version (2019-2022) had 1,563 members enrolled (of whom 965 have downloaded their certificate). The updated version went live three weeks ago: so far there have been 41 participants and 15 certificates have been downloaded.
The Rowan Hillson Inpatient Safety Award for “The best interventions: redesigning, rebuilding and maintaining safe inpatient diabetes care during COVID” attracted many innovative entries from all over the country. The winner was the team from University Hospitals Birmingham NHS Foundation Trust led by Dr Punith Kempegowda for their innovative quality improvement project across hospitals during COVID to improve diabetes related keto- acidosis management. The Kings College NHS Foundation Trust team led by Adrian Li and colleagues received the highly commended award for their innovative project of remote blood glucose (BG) monitoring which improved diabetes control and tackled health inequalities. The Norhampton General Hospital NHS Trust team led by Dr Sowmya Gururaj-Setty and Mr Thomas Williams was commended for their project of a new diabetes in-reach service during COVID-19 pandemic. The team from East and North Hertfordshire NHS Trust led by Shelley Hodgins was commended for their project on teaching video that was focussed on the treatment of hypoglycaemia. Guy’s and St Thomas’ Hospital team led by Elizabeth Camfield received a commended award for their project of a multi-disciplinary inpatient service for safe discharges in the pandemic. The project is led by Umesh Dashora and Erwin Castro. The winners will receive their awards during the ABCD meeting in October.
EndoBarrier is a 60 cm impermeable sleeve implanted during a simple endoscopy procedure into the first part of the small intestine such that the food passes through it rather than the small intestine. It is left in place for up to one year. Whilst in situ it leads to considerable weight loss and improvement in glycaemic control. In 2014, Dr Bob Ryder from Birmingham set up an NHS service providing EndoBarrier to patients with long-standing diabesity – patients who remained poorly controlled and obese despite years of advice about lifestyle and all available medications. In 2017 various hospitals in the UK were set to start similar services when unfortunately, EndoBarrier lost its CE mark.
Recently, the latest data regarding the NHS EndoBarrier service in Birmingham were published in Diabetic Medicine (https://doi.org/10.1111/dme.14827 ). The patients had a median duration of diabetes of 14.4 years and their mean BMI was 41.7 kg/m². During the year with EndoBarrier the mean HbA1c fell from 76.8 mmol/mol (9.2%) to 56 mmol/mol (7.3%) and they achieved a mean weight loss of 17.3 kg. There was a considerable improvement in the need for insulin and one third of the insulin-treated patients were able to discontinue insulin. Two years after removal of the EndoBarrier three quarters of the patients were able to maintain the considerable improvements they achieved during the treatment with EndoBarrier.
The makers of EndoBarrier, GI Dynamics, Boston, USA, have applied for restoration of the CE mark for EndoBarrier and they are hoping this will be achieved during 2022.
The Remote DAFNE course, which was launched in July 2020, was developed to enable continued access to DAFNE education during the COVID pandemic. More than 2,000 adults with type 1 diabetes have completed a Remote DAFNE course, with 93% that commence a course completing it.
Paired baseline and after-course data for 313 participants show outcomes comparable to face-to-face DAFNE courses, with a mean 7.7mmol/mol decrease in HbA1c 12 months after completion of the course for those with pre-course HbA1c >58mmol/mol. The percentage with a HbA1c of <58mmol/ mol increased from 40.5% at baseline to 52% after the course. Feedback from participants is identical to the feedback from face-to-face courses.
More than 600 educators have been trained to deliver the Remote course and 197 doctors have completed Remote DAFNE doctor training, which is offered free of charge and is open to any consultant diabetologist or trainee (ST3 onwards) and GPSI. Further information is available at www.dafne.nhs.uk
During the centenary of the first use of insulin to treat type 1 diabetes, Diabetes UK announced that £50 million – the largest ever single philanthropic gift in the UK for diabetes research – has been donated by the Steve Morgan Foundation (SMF) for type 1 diabetes research.
Diabetes UK and JDRF UK have partnered with the Foundation to invest £50 million over five years in the “SMF Type 1 Diabetes Grand Challenge”, with the shared aim of developing new treatments and ultimately finding a cure for type 1 diabetes. Diabetes UK will administer the SMF funding alongside its usual research budget, which will continue to support scientists working in all areas of diabetes through existing Diabetes UK funding schemes.
The SMF Type 1 Diabetes Grand Challenge will focus on:
At the end of February 2022, some 62.6% of patients waiting to start treatment through consultant-led elective care were waiting up to 18 weeks, thus not meeting the 92% standard. The number of patients waiting for treatment was 6.1 million, with 311,528 patients waiting more than 52 weeks, and 23,281 patients waiting more than 104 weeks.
https://www.england.nhs.uk/statistics/statistical-work-areas/rtt-waiting-times/rtt-data-2021-22/
The NHS and the Government have published plans that set out how the backlogs built up during the COVID-19 pandemic and long waiting lists for care will be handled over the next three years. This plan aims to deliver around 30% more elective activity by 2024/5 than before the pandemic. NHSE Chief Executive Amanda Prichard and Health and Social Care Secretary Sajid Javid MP have announced plans to build dozens more community diagnostic centres as part of the new elective recovery plan. This would require a commitment to increasing specialised workforce.
Record levels of health and social care funding have been allocated to help deliver up to 160 community diagnostic centres across England by 2025. The Health and Social Care Levy began on 6th April and will aim to raise over £36 billion over the next three years to help tackle the COVID backlog and reform services in the UK. The Government states that implementation of the Health and Social Care Levy will enable the NHS to offer more appointments, checks, scans and operations and reform the way that services are delivered so that the NHS is fit for the future.
NICE have opened a consultation to gather feedback on the real-world evidence framework. This comes after the NICE Strategy 2021-2026 stating their ambition to use real-world data to resolve gaps in knowledge and drive forward access to innovations for patients. This framework will describe the best practices for the planning, conduct and reporting of real-world evidence studies. The framework aims to improve the quality of real-world evidence that informs NICE guidance. The consultation ends on 29th April 2022, and the revised version of the real-world evidence framework will be published on 23rd June 2022.
https://www.nice.org.uk/about/what-we-do/real-world-evidence-framework-feedback
changes to the delivery of diabetes care to reduce the variation of care and outcomes? Do you work in a UK or Ireland team that has made an outstanding contribution to the treatment and management of people with diabetes? Have you made positive changes to diabetes services? If the answer to any of these is “yes” then please enter QiC Diabetes this year and let your efforts be applauded, shared and disseminated.
Entry closes 1st July and the awards ceremony will be held at Sanofi HQ on 13th October.
http://qicdiabetes.awardsplatform.com
NICE has recommended the use of real-time continuous glucose monitoring (rtCGM) for adults and children living with type 1 diabetes for the first time. It will give them a continuous stream of real-time information on a smartphone about their current blood glucose level. Alongside new rtCGM technology, the use of intermittently scanned glucose monitoring (isCGM) devices – also known as flash monitoring – has been expanded to the whole of the type 1 diabetes patient population. Patients will now be able to choose the technology which is right for them in discussion with their diabetes team. NICE has recommended extending the use of flash monitoring to adults with type 2 diabetes who are on insulin therapy. This recommendation makes the technology available to around 193,000 people.
Published on 20th April 2022, Diabetes UK’s report Recovering diabetes care: preventing the mounting crisis sets out the urgent action needed by the Government, NHS England and Integrated Care Systems to reduce the long-term harm from missed routine diabetes care. The report includes findings from a survey of more than10,000 people with diabetes, which shows that:
The report was launched at a parliamentary reception on April 20th 2022. The Minister for Public Health and Primary Care was speaking at the event, alongside Diabetes UK’s Chief Executive, Chair of Trustees and Gary Mabbutt MBE, Former Premier League footballer and long-term Diabetes UK supporter.
The 15th International Conference on Advanced Technologies and Treatments for Diabetes (ATTD) took place in Barcelona on 27-30 April 2022, bringing together more than 4,000 delegates in person and many more online to watch the first ATTD hybrid event. All abstracts are published in the Diabetes Technology and Therapeutics journal and the ATTD yearbook is available free on the website together with programme highlights. See www.attd.kenes.com You can find information from the meeting’s tweets as though you were there using #ATTD2022. Next year’s meeting will take place in Berlin 20-25 February 2023.
HARPdoc, a parallel randomised controlled trial of the Hypoglycaemia Awareness Restoration Programme for adults with type 1 diabetes and problematic hypoglycaemia despite optimised self-care, was presented at the ATTD 2022 and simultaneously published in Nature. The HARPdoc intervention significantly reduced diabetes distress, anxiety and depression.
A rapid-fire collection (extract) of interesting recent developments in diabetes
We have finished all the post-production on the connective pens module within the ACADEMY programme and this will be launched shortly. Please log in to see how you can use connective pens in different situations to help with your clinical care of people with diabetes.
We launched ACADEMY in Ireland at the DICE 2022 meeting hosted by Diabetes Ireland on Friday 6th May. This is our first step outside the UK and we are very excited to take this work to our colleagues across Ireland. We hope to bring them into the DTN network.
We are now almost six months out from the start of the NHS England-funded Hybrid Closed Loop pilot. All of us involved have seen amazing results. We see many patients who have never had an HbA1c below 10% for the past two years achieve almost normal control. It has been transformative for those who have been able to access this technology. We urge any people who did not submit data before May 20th to do that so we can analyse the findings and send them to NICE. We hope these data will support access to this technology for a much wider population.
We would be very interested to hear from colleagues about their challenges, but also their successes, in implementing the latest NICE guidance. In particular we would be interested to hear from people where access to rt-CGM according to the new guidance (for those on insulin pumps or with hypo unawareness) has already been approved to showcase how this can be done. We are also very keen to hear from people who have a protocol in place that allows primary care initiation of Flash monitoring. I hope we can make the DTN a great forum to share the successes but also to highlight areas where there are challenges and support colleagues.
For those of you who have not heard, CamAPS have announced a collaboration with Ypsomed insulin pumps and Libre 3 sensors. This may be available clinically towards the end of 2022 on Android, with iOS connectivity following in 2023.
The UK made a big splash at the ATTD conference in Barcelona in April. Professor Kar highlighted the progress made in accessing technology in the UK. UK policy, and in particular the session on inequalities, was one of the highlights of the meeting. We also saw the results of the ADAPT study, showing a 1.4% reduction in HbA1c with the Medtronic 780 G system. A host of real-world data really indicated that in a diverse population the various closed-loop systems could get 70-80% of people to target. There were also presentations on connected pens and pen caps from Medtronic, Sanofi and Lilly, and we expect to see this market segment grow in the next few months.
GlucoRx, Libre 3, DexcomOne
The technology market is becoming increasingly competitive and diverse. It is really important to keep abreast with the different products so that we can provide our patients with choice. At the same time we should make sure that our choices are backed up by the appropriate evidence and that we are comfortable using the technology. It is a tricky balance. Keep an eye out for expert opinions and device news on the DTN website. We will be adding videos on the new devices in the coming months.
Dr Pratik Choudhury
Diabetes Technology Network UK
Contact: pratik.choudhary@leicester.ac.uk
The last few months have seen plans for multiple courses coming together. The YDEF (Young Diabetologists and Endocrinologists’ Forum) technology course is scheduled for June and the new and innovative two-day residential obesity course is due to go ahead in July. Both these courses are sold out; their popularity proves the need for us to keep running our courses, and face-to-face too.
We also welcome back YDEF Day on July 6th following the ABCD 100 years of insulin event. We hope specialist registrars (SpRs) can make it to both meetings. YDEF Day is free to attend; sign-up began on May 17th. We look forward to welcoming the winners of the Marjorie Prize to YDEF Day – future Diabetes and Endocrine SpRs in the making who submitted their reflections on health inequalities in diabetes. The prizewinners will be attending both events, fully funded by the YDEF, as their prize. They will be presenting their reflections in brief at these events, and we look forward to hearing their insights.
We have launched a bursary to support anyone who failed their first attempt at the Specialty Certificate Examinations (SCE). This bursary will be offered again after the next round of results in July. If you know of someone who might benefit from this support, please let us know.
Finally, we continue to advocate for trainees in our roles on multiple committees. We are due to see a change in curriculum and the new Annual Review of Competency Progression (ARCP) decision aid is being finalised. All trainees who are not yet in their final year will need to transition to the new curriculum. If there are concerns around this and how it might be completed with limited training time then please ensure a gap assessment is completed – this is important for supervisors and trainees to know.
We would like to congratulate our YDEF/BJD QIP prizewinners and runners-up. Their work will be published in the next edition of the British Journal of Diabetes. The 2022 prize will be launching in the coming months so watch this space.
As always, if anyone needs any help or support please reach out.
Tom Crabtree on behalf of YDEF Committee
Contact: T.Crabtree@nhs.net
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 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!