BJD

ABCD News

From the desk of the Chairman, Dipesh Patel

Oh boy, what a year! 2021 has been a challenge for us all. Having recovered from the first lockdown, we started this year with another lockdown and stark pressures on NHS services as COVID-19 once again took hold in the UK. Thankfully, as I write this update, the success of the vaccine programme and the hard work of colleagues and peers has paid dividends and the future is looking much brighter with more than 30 million UK citizens vaccinated and COVID-19 cases down substantially. We have learned many salutary lessons over the course of the pandemic; in particular, many of our patients were vulnerable to severe illness and death and current systems of healthcare need alteration if we are to keep these patients safe. Our hearts go out to other global areas such as India where this terrible virus is causing much havoc and suffering.

ABCD has fortunately been able to react to the challenges in the UK and, moreover, has worked hard to bring colleagues and members new and innovative digital learning, tools and materials to support professional roles.

Our COncise adVice on Inpatient Diabetes (COVID) guidance led by Professor Gerry Rayman continues to be a key resource for services up and down the UK and beyond, as demonstrated by the number of downloads and page visits (https://abcd.care/coronavirus). Existing resources are updated regularly with new resources added to keep up to date with the latest COVID and diabetes guidance. The COVID-19 Audit team comprises a team of leading specialists who are working on a dataset of over 3,000 patients provided by busy colleagues up and down the country, some in adverse circumstances. I am sure this will bring further learning for UK clinicians and result in worthy academic output. I am very grateful to all those involved and colleagues who were able to provide important clinical data for this. Furthermore, I am extremely proud how we, as a body of specialists, can pull together and learn together in the most difficult of times. I am very aware diabetes specialist colleagues have made major contributions to life-preserving acute medical care during the pandemic and now are busy rebooting services and making them fit for any future adversity.

In the first quarter of this year we continued to run our educational programme of free monthly high-quality webinars featuring a wide range of topics including do-it-yourself artificial pancreas systems (DIY APS), ‘The challenges of delivering person-centred care in the virtual world’ and ‘The use of contemporary diabetes’ apps to help with diagnosis and treatment decisions. We will be continuing these webinars every month with a short break over summer, so make sure you register for upcoming webinars (see https://abcd.care/abcd-webinars-series for details). I am delighted to see we have contributed to an excellent Diabetes Masterclass series aimed at diabetes trainees in collaboration with YDEF with the support of Eli Lilly. We have plans to focus on training of our future diabetologists who should help shape the future of ABCD. I hope our membership will reflect this in due course. Annual membership has recently been reduced to £25, which we should highlight to our trainees.

We have three regional meetings scheduled to take place virtually this year: our Scottish regional meeting spanning both Diabetes and Endocrine hot topics on 19th and 26th May 2021 (https://abcd.care/events/abcd-regional-meeting-scotland-collaboration-sfe), our Yorkshire regional meeting on 17th June 2021 (https://abcd.care/events/abcd-regional-meeting-yorkshire-2021) and our South East regional meeting on 2nd December 2021. These educational meetings are open to everyone, not just those from the region.

Our first face-to-face event will be our Consultant Development Programme which runs from 5–9th July and is already fully subscribed.

The annual conferences for both DTN-UK (https://abcd.care/events/abcd-dtn-uk-meeting-2021) and ABCD (https://abcd.care/events/abcd-conference-2021) will need to take place virtually this year on 13th and 14th October, respectively. Please save the date. The conferences will once again be hosted on the vFAIRS platform, so you can expect a high-quality visual experience with interactive parallel sessions, an interactive poster display, virtual exhibition and virtual ‘swag bag’ to download free resources. The platform will run live on 13th/14th October and be available for on-demand viewing for registered delegates for 28 days following the events. We see ABCD as the ‘home’ for specialist diabetes learning, so please do join us and contribute with your colleagues.

Make sure you also save the date of 11th January 2022 for our meeting to commemorate the centenary of the first administration of insulin into a human. ABCD has grand plans for this special event, which will be held in person at the Royal College of Physicians in London to celebrate the occasion.

The ABCD Diabetes Technology Network (DTN) continues to grow and thrive with even more valuable resources and is fast becoming the go-to place for everything you or your patients need to know about diabetes-related technology. The website now includes open access to the DTN AcademyTM featuring a wide array of CPD-accredited education and the Virtual Consulting Learning zone, with some amazing tips and advice for healthcare professionals in introducing, learning and using diabetes technology. There is also a series of educational resources for people living with diabetes including flash glucose monitoring, continuous glucose monitoring, pumps and sensor-augmented pumps.

The British Journal of Diabetes is reassuringly going from strength to strength with a growing reputation for publishing high-quality research and reports as well as ABCD popular position statements. If you haven’t read an issue recently I urge you to visit the website as I am sure you’ll find many interesting articles relevant to improving knowledge and practice in specialist diabetes care (https://bjd-abcd.com/index.php/bjd/index).

In the last six months our academic sub-committee has been reinvigorated and we are delighted to announce that, in partnership with Diabetes Care Trust (DCT) charity, we will shortly be promoting a new research grant award scheme. Accompanied by new guidance and stringent procedures, the programme offers grants to new and aspiring diabetes researchers. Watch this space for more information. In addition, the ABCD audits continue at pace under the stewardship of Dr Bob Ryder and team. We urge anyone who has not yet signed up to our nationwide audits to do so; find out more at https://abcd.care/abcd-nationwide-audits.

I would like to take this opportunity to thank all ABCD committee members, both past and present, for their time, dedication and spirit in supporting the development of our programmes and new resources. There is opportunity for ABCD to work with more international partners and I feel this potential should be seized.

As Chair of the ABCD committee, I would like to take this opportunity to thank all our corporate sponsors of both ABCD and DTN-UK without whom our programmes and supporting activities would not be possible. Sponsors include AstraZeneca, Lilly, Novo Nordisk Ltd, Abbott Laboratories Ltd, Roche Diabetes Care, Insulet International Ltd, Medtronic Ltd, Medtrum Ltd, ViCentra, Advanced Therapeutics (UK) Ltd, Air Liquide Healthcare Ltd, CamDiab and Dexcom. I urge you all to support us by visiting their stands when you come to our conference.

Finally, I wish you all a happy, healthy and fun summer and hope that you are able to spend time with friends and loved ones as lockdown continues to ease.

Dipesh Patel, ABCD Chair


From the desk of the News Editor, Umesh Dashora

JBDS News (Ketan Dhatariya)

  • New guideline on the management of diabetes in patients with cancer will soon be online
  • We are in the process of refreshing some of the older guidelines, so watch this space
  • JBDS also now had a twitter feed @JBDSIP and a Facebook page www.facebook.com/JBDSIP

Results of Rowan Hillson Inpatient Safety Award 2021 award postponed

This JBDS–IP award for 2021 is postponed due to the COVID-19 second wave. The project is led by Umesh Dashora and Erwin Castro.

In view of the second wave and on the suggestion of Dr Rowan Hillson, the subject of the award will be modified to include the fantastic innovations that people have made during this pandemic. The title for the 2022 award will be ‘The Rowan Hillson Inpatient Safety Award – The best interventions: Redesigning, rebuilding and maintaining safe inpatient diabetes care during COVID’. Entries are welcome from September with the last date in February 2022. Please prepare for a submission in September from your team.

RT-CGM and flash glucose monitoring not recognised by DVLA for G2 drivers with insulin-treated diabetes (Dinesh Nagi)

Flash glucose monitoring (FSL) is allowed for clinical use in a selected group of individuals with type 1 diabetes in the UK. In GB there are 1,428 drivers with type 1 diabetes who currently hold a Group 2 (lorry and bus) driving licence. The regulation to allow insulin-treated individuals with diabetes to drive Group 2 vehicles was allowed several years ago when the UK was an EU member. Group 2 drivers are required to have 3 months’ worth of blood glucose readings when they see the independent assessor; this evidence must be recorded on a blood glucose monito, through finger prick tests. As the use of technology is expanding, more and more drivers with type 1 diabetes are eligible for access to FSL and are using this to monitor their diabetes. However, these individuals are not being informed that FSL is not recognised for driving purposes for Group 2 licence holders. By law, Group 2 drivers must continue to finger prick test twice a day even when they do not drive. For those Group 2 drivers who use FSL, DVLA guidance recommends that these individuals must also continue to finger prick test glucose for driving purposes. In addition to this, some of these drivers are also being denied test strips by their GPs, unaware of the DVLA guidance. ABCD would like to urge specialist diabetes teams to ensure that this guidance is made clear to people who are being given access to FSL for monitoring purposes and primary care colleagues to ensure that an ample supply of test strips is being made available.

https://abcd.care/announcement/rt-cgm-and-flash-glucose-monitoring-not-recognised-dvla-g2-drivers-insulin-treated

ABCD COVID-19 Audit (Dinesh Nagi)

ABCD has undertaken a nationwide audit of people admitted to hospital with diabetes and COVID-19. This Audit is being conducted by a group of clinicians and researcher in the field of diabetes. Since February 2021, data collected from 3,542 patients with type 1 or type 2 diabetes and COVID-19 have been submitted by a total of 42 NHS centres around the UK. The data include outcomes to discharge or death for up to 70 days from admission, reflecting the prolonged hospital course of many patients with severe COVID-19. Several interesting publications are planned to understand the impact of COVID-19 on diabetes and outcomes such as admission to ICU and factors associated with poor outcomes. ABCD would like to thank clinicians who have taken time out of their busy clinical schedule to contribute to this important nationwide initiative.

http://www.diabetologists-abcd.org.uk/Coronavirus/COVID-19_Diabetes_Nationwide_Audit.htm

Papers published around this audit are:
https://www.bjd-abcd.com/index.php/bjd/article/view/741
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8106514/

The first ABCD/DUK joint position statement on the use of SGLT-2 inhibitors in people with type 1 diabetes on SGLT-2 inhibitors

ABCD has produced updated guidance on the use of SGLT-2 inhibitors in people with type 1 diabetes, which is simultaneously published in BJD and Diabetic Medicine.

Dashora U, et al. Association of British Clinical Diabetologists (ABCD) and Diabetes UK joint position statement and recommendations on the use of sodium–glucose cotransporter inhibitors with insulin for treatment of type 1 diabetes (updated October 2020). Diabet Med 2021;38(2):e14458. https://doi.org/10.1111/dme.14458

National training programme to support people living with diabetes in care homes

Sanofi have partnered with EDEN (Leicester Diabetes) to deliver a national training programme called SANOFI CARES to support people living with diabetes in care homes. The online training and additional virtual mentoring support launched in April is available to registered and non-registered practitioners who look after people with diabetes in our care homes. Currently it is estimated that approximately 25% of all care home residents have diabetes and the data show that many people with diabetes in care homes suffer unnecessarily.

For further information see www.diabetesmatters.co.uk/sanoficares or email sanoficares@sanofi.com

CaReMe group produces guidance on SGLT-2 inhibitors and patient leaflet

A newly formed group by specialists from cardiac, renal and diabetes and primary care societies is working together to improve care of people with multiple co-morbidities. It has produced excellent guidance on heart failure and cardiovascular risk reduction for healthcare professionals who are not diabetes specialists along with leaflets for people with diabetes.

https://www.britishcardiovascularsociety.org/__data/assets/pdf_file/0021/21963/CaReMe_T2DM_CVD_2020.pdf

https://www.britishcardiovascularsociety.org/__data/assets/pdf_file/0014/23333/ABCD_A4_Leaflet_Final.pdf


From the desk of Rebecca Reeve (Sanofi)

Scientists and researchers to get an extra £250m this year

The Department for Business, Energy and Industrial Strategy has confirmed that UK scientists will receive additional public funding, taking total Government investment in R&D to £14.9bn in 2021–2022. As part of the Trade and Cooperation Agreement with the European Union, the UK will associate with Horizon Europe, which is expected to be 20% larger than the previous funding framework.

https://www.gov.uk/government/news/250-million-additional-funding-to-boost-collaboration-and-protect-ongoing-research

High risk, high reward research agency by 2022

To help the UK retain its position as a ‘global science superpower’, Secretary of State for Business, Energy and Industrial Strategy Kwasi Kwarteng MP has announced the launch of ARIA, the Advanced Research and Invention Agency. Similar in underlying concept to the US DARPA, and backed by £800m, ARIA is intended to fund high risk, high reward research with a high tolerance for failure. ARIA is expected to be operational by 2022.

https://www.gov.uk/government/news/uk-to-launch-new-research-agency-to-support-high-risk-high-reward-science

UKHSA launched last week

The UK Health Security Agency (UKHSA) was launched last week with Dr Jenny Harries as its first Chief Executive. The Government states that the new agency will work to protect the country from future health threats and ensure the country can respond to pandemics quickly and at a greater scale.

https://www.gov.uk/government/news/work-begins-for-uk-health-security-agency-to-protect-the-nation

135 CCGs to become 106 CCGs

NHS Digital reports that 38 Clinical Commissioning Groups (CCGs) have conditional approval to merge into nine CCGs in April. The HSJ observes that there has been a surge in CCG mergers over the past 2 years – partly due to budget cuts and partly due to anticipated restructuring. Over one-third of potential Integrated Care Systems are anticipated to contain more than one CCG in their territories in 2022.

https://digital.nhs.uk/services/organisation-data-service/change-summary-reconfiguration-2021-ccg-mergers

https://www.hsj.co.uk/commissioning/number-of-ccgs-to-be-cut-by-a-fifth-next-month/7029613.article

A new policy paper

The Government published its White Paper on Health and Care titled ‘Integration and Innovation: Working together to improve health and social care for all’, describing legislative plans for the Health and Social Care Bill expected to be introduced in Parliament in Summer 2021. In addition to giving the Secretary of State for Health and Social Care more powers to intervene in how NHS England operates, the White Paper proposes substantial legislative changes which aim to:

  • Make permanent the innovations that COVID-19 has accelerated and encourage the system to improvise new and better ways of working.
  • Integrate healthcare in England by enshrining Integrated Care Systems in law.
  • Reduce bureaucracy and create flexibility.
  • Improve NHS England accountability and enhance public confidence.

https://www.gov.uk/government/publications/working-together-to-improve-health-and-social-care-for-all


Interesting recent research

(Umesh Dashora)

A rapid-fire collection (extract) of interesting recent developments in diabetes

Dashora 1

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ABCD News

DTN-UK Update


DTN-UK Header

This has been a really busy time for the DTN group with a number of projects on the go. 

ACADEMY

We have been really pleased with the response to ACADEMY. For those who are not aware, this is a CPD-certified, ABCD-endorsed education programme for HCPs around diabetes technology. In total there are just over 25 hours of educational content over seven different courses ranging from virtual consults, through basics of multiple daily injections (MDI), all the way to sensor augmented pumps. Since the launch at the end of November, we have had 17,600 views of the videos with over 775 hours of content watched and 297 courses completed. Through our collaboration with Diasend, we have the ability to view courses completed in different regions and have 3-monthly reporting meetings with NHS England. Our desire is that this becomes an integral part of training for SPRs coming through diabetes and endocrinology training, as well as for specialist nurses and dietitians looking to enhance their skills.

For those of you who are experienced, you can always add the DTN-ACADEMY certificates to your portfolio by just taking the assessments. Have a quick peek at the summary videos that capture key aspects of the topics, and do get in touch with any feedback on the courses.

A key desire of this project is to get a common theme running through teams, so that people with diabetes get a uniform message from their healthcare team.

To access the ACADEMY programme you will need to sign into Diasend using your individual log-in. If you don’t have this, speak to your team Diasend administrator and activate your account, Don’t worry if your clinic does not use Diasend – you can create a free ACADEMY account through Diasend if you need to.

Patient education videos

One of the unique elements of this project was that we negotiated with Glooko, who funded the project, to allow us to have all our educational content available free of charge to people with diabetes and their carers on the DTN website. One of the underlying ideas was that, if the HCPs and people with diabetes had the same information, they would be effectively speaking the same language, which should help them get the most from the technology to which they have access.

Educational videos on Freestyle Libre 2

Given the recent launch of the Freestyle Libre 2, the DTN committee has produced some guidance on how to set up the alarms. We have also filmed two videos on how to set up the alarms and how to use them, which will be available on the DTN website soon.

Pump choice videos

The choice of insulin pumps is now so wide that it can sometimes be challenging for HCPs as well as people with diabetes to look through the different options. Certainly, during these COVID times with virtual working, the ability to show people different pumps and explain the pros and cons of different systems is reduced. To try and support teams with this and help people with diabetes make their decision a little easier, we have filmed a series of short videos talking about how to choose a pump and highlighting key features of the different systems. Check out the DTN website and use this resource to signpost people who are deciding on which pump to use.

Dr Pratik Choudhury
Diabetes Technology Network UK
Contact: pratik.choudhary@leicester.ac.uk

YDEF NEWS Young Diabetologists logo


The YDEF committee thoroughly enjoyed the recent DUKPC 2021 online and we are looking forward to what the rest of 2021 will now bring with the pandemic subsiding (hopefully for good!).

On behalf of the rest of the committee, I would like to thank our outgoing chair Najaf Haider for all his efforts, guidance and leadership during what has been a very turbulent year for YDEF and the NHS as a whole. We wish our new chair, Giulia Argentesi, the best of luck taking over the role for the next year.

We hope to begin hosting some courses face-to-face in the next year with provisional plans in place to run our highly commended Diabetes Technology course in the autumn. We also look forward to hosting our Northern European colleagues at the Northern European Young Diabetologists’ meeting which we are hosting in May, potentially with some in-person content. Finally, we hope to run our YDEF day in- person, this year asynchronous with the Diabetes UK Professional Conference as a one-off. Watch this space for more information.

Virtual opportunities remain available. ABCD and Lilly have kindly supported the Diabetes Masterclass series which has been incredible with fantastic attendance. The Obesity course held its first of three webinars in the last few weeks and was very well received and over-subscribed.

We hope to keep developing these opportunities and welcome any suggestions. Furthermore, if anyone wishes to join the committee, we will be opening applications in the next few weeks.

Dr Tim Robbins on behalf of YDEF Committee
University Hospitals Coventry & Warwickshire NHS Trust, UK
Contact: drtrobbins@gmail.com

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!

www.youngdiabetologists.org.uk @youngdiab on twitter

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The Journal of the Association of British Clinical Diabetologists