Notes from the Diabetes UK conference

From the desk of the Honorary Meeting Secretary of ABCD, Dr Umesh Dashora

It was a pleasure to attend the Diabetes UK (DUK) conference between 27th March and 1st April, 2022 virtually. Here, to stimulate interest, discussion and further reading, are the points that I thought were either important or new for me. I hope you will enjoy these as top tips from DUK and that you will read the relevant papers or guidelines in full if these points interest you. These are my recollections, and they may be biased, but they can still serve as a starting point to stimulate your interest. Additional information may be found in the papers and links given here.

Finererone is a selective mineralocorticoid receptor antagonist (MRA) compared to spironolactone and eplerenone, with low risk of hyperkalaemia compared to non-selective MRAs. It should be added to ACEIs/ARBs to help reduce the progression of kidney disease and adverse cardiovascular outcomes. Additional information can be found in the following papers:

Diabetes is no longer the leading cause of blindness due to advances in treatment like anti-VEGF injections for diabetic macular oedema. Other treatments are in the pipeline such as fully human antibody therapy.

In people with T2DM mortality from CVD is reducing but mortality from liver disease, cancers and infections is increasing.

Closed-loop systems
These are being tried, and may help. The NHS is starting a pilot.

Non-alcoholic fatty liver disease (NAFLD)

Diabetes is of five different phenotypes, not just type 1 and type 2. Some people with type 2 diabetes may be insulin-deficient. Others with type 2 may be insulin-resistant, obese, and it may be age-related. The approach to treatment will differ according to the phenotype. Beta cell dysfunction is an essential part of type 2 diabetes.

Lyumjev insulin

Flash Libre
A Flash Libre trial shows RCT evidence for Libre versus self-monitoring of blood glucose (SMBG), with a greater reduction in HbA1c.

Patch pump and Pod therapy pumps may become more popular.

Bolus news

Foot ulcers
UrgoStart dressings are now recommended by NICE. LeucoPatch and placental membrane products (Grafix) may be useful in some other people. UrgoStart for treating diabetic foot ulcers and leg ulcers NICE MTG42, published January 2019.

Saturated fats in foods such as yogurt might be good for people with diabetes but if in foods like red meat they may increase cardiovascular risk.

Grade 4 evidence: adjust insulin for CH content.

Mediterranean diet, low energy, low carbo-hydrate, low fat diets are better.

CVD risk reduction
Mediterranean diet has good evidence.

Remission of diabetes
Aim for 15kg weight loss; individualise.

CVD risk reduction in T2DM

Technology assistants
Diabetes technology assistants for the diabetes team can help the rest of the team to concentrate on clinical aspects. Diabetes inpatient healthcare assistants and weekend diabetes reviews will also improve outcomes. SystmOne can help join up tasking between primary and secondary care.

25% of children with type 1 DM present with DKA but screening has the potential to reduce this.

Flash monitoring
More than 45% of people with type 1 DM are using flash monitoring.

Amputation rates in the UK vary from one CCG to another, from 3.5 to 16 per 10,000 patient years. Rates have increased in 20 CCGs over time.

Diabetes: some statistics

Budgeting issues

New NICE guidelines
The new NICE guidelines recommend that:

Saving money
We have to save money somewhere.

Other points

Correspondence: Dr Umesh Dashora
Br J Diabetes 2022;22:52-53