Diabetes campaign 2017 by Mediaplanet UK&IE

NOVEMBER 2017

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Diabetes

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Natalie Balmain, model and designer shares her journey with type 1 diabetes GET ACTIVE

Three steps to help prevent type 2 diabetes P6 ONLINE

Discover what the future of diabetes looks like

PHOTO: LEE JOHNSON

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IN THIS ISSUE

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Diabetes is a problem that healthcare professionals are struggling to keep pace with. According to research from Cardiff University, the number of people living with type 2 diabetes in the UK has trebled in the last 20 years; a problem that is further compounded by the fact that more people with the condition are also living longer. The pressure this places on healthcare professionals from a whole range of disciplines is unprecedented. The National Diabetes Inpatient Audit confirms that less than a quarter of hospitals have a diabetes specialist inpatient nurse to co-ordinate diabetes patient care. Many hospitals must rethink how they train a broad range of healthcare professionals who work together to support individual patients.

Multi-disciplinary approach For the last ten years, through their MSc and Postgraduate Diploma in diabetes, which now has over 1,000 graduates, Cardiff University have been helping hospitals respond to this growing need by providing innovative training that promotes a multi-disciplinary approach to learning. “Patients with a serious condition like diabetes need a seamless pathway of care. Individuals need to know what components of care other healthcare

professionals are giving, hence the need for interprofessional education programmes” explains Professor Ann Taylor, Postgraduate Taught Programmes Director at Cardiff University. “If you want a multidisciplinary approach, then it’s a nobrainer to educate as a team. Many who study the course are already leaders in their field and we hope that the practical knowledge and management skills they gain will help influence wider change. ” The courses welcome students from a range of disciplines so GPs, paediatricians, wound care specialists and many other professionals can study side-by-side. The university have also built diabetes modules into courses that focus on areas like wound care, pain relief, ageing health and disease, in response to the increasing contact professionals within these sectors have with diabetes patients. In doing so, students not only learn about diabetes care, but also gain a unique perspective into the roles, responsibilities and challenges of other healthcare professions.

Flexible learning The diabetes epidemic isn’t just impacting qualified health professionals. Outside the hospital setting, the Care Quality Commission have also stipulated that all staff caring for people with diabetes in nursing and residential care homes require adequate training. “Within the NHS now, we have non-qualified healthcare assistants right through to highly specialised senior doctors caring for those with diabetes, so it’s a challenge finding a flexible pathway of training programmes that suit everyone,” says Prof. Taylor. Healthcare providers certainly

Professor Ann Taylor Postgraduate Taught (PGT) Programmes Director, Cardiff University

stay up-to-date and collaborate with their peers across the globe. Distance learning opportunities have expanded exponentially in recent years and now virtually anyone with an internet connection can access learning at a time and place that’s convenient for them. Online chat rooms, webinars and conference call facilities are making it possible for healthcare professionals around the world not only to receive training but also to share that all important evidence-based practice, which Cardiff University hope will not only shape their own learning, but the future of diabetes care across the world.

Learning for the future don’t have excess spare cash to throw at training programmes and neither do already overstretched healthcare professionals have hours of spare time to absorb themselves in study. Thus, a range of flexible learning opportunities is vital. In response, Cardiff University is offering module-based, distance learning options, one-off accredited sessions and even free lectures alongside their postgraduate studies, to meet the varied needs, budgets and time constraints of the students.

Global response Of course this is not just a UK problem; the global prevalence of diabetes has nearly doubled since 1980, rising from 4.7 per cent to 8.5 per cent among adults, according to The World Health Organisation. Regardless of where they are in the world, healthcare teams are facing the same problems. Thankfully, technological advances are helping them access the all-important training they need to

With the National Diabetes Inpatient Audit reporting that as many as one in six inpatient beds in the UK is occupied by someone with diabetes, the need to train more healthcare professionals has never been greater. But we must also plan for the future. The number of people living with diabetes and its co-morbidities means that more complex healthcare needs are presenting themselves. Regardless of the budgetary and time constraints, one thing is certain; we need to ensure that healthcare teams are trained to cope with the changing needs of patients. With flexible approaches to study being offered for those who cannot undertake full-time education, there is potential to develop a comprehensive global body of evidence-based practice that could inform and shape future diabetes care– something that is vital with the condition showing little sign of decline. Read more at cardiff.ac.uk

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INSPIRATION COLUMN

Natalie Balmain Designer, Activist and Founder, Type 1 Clothing

How I turned my type 1 into my career Fashion and health rarely go hand in hand, but Natalie Balmain wants to change all that with her clothing line designed specifically for those with diabetes.

What inspired you to set up Type 1 Clothing? I was diagnosed with type 1 diabetes when I was 20. I should have been having the time of my life, but I didn’t feel glamourous and I didn’t feel good about myself. I have to inject anywhere upwards of six times a day, so when I was out I’d often have to go to public toilets and they’re not always the nicest places. I found myself falling into a rut of wearing leggings and jumpers because they were the easiest. In September 2015, I was sitting on the sofa wearing an old pair of leggings with a hole in and had the idea of creating clothes that made it easy for people with diabetes. Fashion has never considered health and wellbeing, quite the opposite in fact, but why can’t you have something that looks good and serves a purpose?

How do you hope it will improve people’s lives? When I got my diagnosis I was devastated. I consider myself to be quite confident, but I became very depressed. I can’t imagine what it must be like for a young girl in her teens. Feeling confident in yourself really matters. Sometimes we trivialise things and presume that people just cope, but these things are important. When your emotional wellbeing is not 100 per cent, then you don’t feel like looking after yourself properly, but you can’t afford not to look after yourself when you have a life threatening condition like diabetes. On a practical level, I hope my range solves a problem, but I also hope it will be a catalyst to start discussions and raise awareness about what is one of the most common, but least understood conditions. Read more on diabetesadvice.co.uk

Misunderstandings and misinformation about type 1 diabetes By Dan Farrow

Type 1 diabetes can be a tough condition to live with. It has an impact on many aspects of life and yet its effects are often invisible.

Misunderstandings and ignorance about the causes of type 1 are faced by those with the condition all too often. These misunderstandings can make living with it tougher still.

Dan Farrow Senior Manager, Community Engagement and Volunteering, JDRF

So what are the facts? Type 1 diabetes occurs when, for reasons we don’t yet fully understand, the body’s own immune system attacks and destroys the insulinproducing beta cells in the pancreas. This leaves you having to inject insulin every day for the rest of your life. Type 1 can strike at any age. A child diagnosed at the age of five can need more than 19,000 insulin injections before their 18th birthday. There are no days off. Type 1 diabetes cannot be prevented, and is not linked to lifestyle. There’s no way to avoid it. But many are treated as if they either deserved or didn’t deserve their diagnosis. One young woman wrote a blog for the JDRF website on the reactions of people discovering she has type 1 diabetes. They include “but you’re not fat!”, “but you’re only young” and “are you allowed to eat that?”

She often has to say “no, it’s not because I ate too much sugar”. Sadly, 67 per cent of adults living with type 1 diabetes feel judged when eating sugary food or drinks. No person should ever face a culture of blame for their health condition and this is true for all types of diabetes. An average member of the public with no friends or family living with type 1 diabetes probably doesn’t know much about the condition, or that there are different types of diabetes. Considering how the media often speak about ‘diabetes’, perhaps many misunderstandings can be forgiven. Newspapers covering stories on type 2 diabetes rarely specify in the headline that they’re referring to type 2 (which is not always linked to lifestyle factors). When the headline is as sensational as

“Sickly sweet: how diabetes conquered the world” (Telegraph) or “Get fit to cure diabetes” (Express) it is little wonder there is such confusion. It’s not just the newspapers. A 2016 episode of EastEnders caused frustration when a character uttered the phrase “if the kids don’t give themselves diabetes it’s not a good party is it?”. JDRF, and our incredible supporters, are doing what we can to raise awareness of the true nature of type 1 diabetes and bust myths. Despite the challenges of living with type 1 diabetes, it doesn’t have to hold anyone back – people with the condition can achieve anything. People living with type 1 diabetes have represented England at Six Nations championships and Rugby World Cups, scored while representing the England national football team, achieved great things in stand-up comedy, taken leading roles in Hollywood blockbusters and even become Prime Minister of the United Kingdom . As a type 1 diabetes charity, JDRF is proud to shine a light on everyone affected by it and their achievements, from youngsters and their incredible parents, to those recently diagnosed as adults or who’ve had type 1 almost all their life.

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New HbA1c test kit could boost diabetes control SPONSORED

A new test kit could make it easier for patients and medical staff to control diabetes, reducing the chance of complications.

The key to controlling diabetes is not a magic bullet, but information. The more information that patients and clinicians have about the patient’s blood glucose levels, the better they are able to monitor the progress of the condition and to prevent deterioration and complications. However, the HbA1c test, which is the best way of monitoring average

levels accurately over a 2-3 month period, is only offered to diabetes patients by the NHS once a year. “As a result, a patient could go for months before poor control or deterioration is detected,” says Professor Ponnusamy Saravanan, Professor of Diabetes, Endocrinology and Metabolism and Honorary Consultant Physician at the University of Warwick. “We need to be more proactive in the use of these tests. Carrying out the HbA1c test more frequently would give a better picture of the patient’s overall control of their blood glucose levels, giving them better feedback about their skills in managing their condition and empowering them to have a better control of their diabetes. Any deterioration will also be revealed sooner, so earlier action could be taken to prevent any resulting complications.”

Professor Ponnusamy Saravanan Professor of Diabetes, Endocrinology and Metabolism and Honorary Consultant Physician in Diabetes, University of Warwick bhr.co.uk

Short-term blood glucose test strips are not enough Many patients are already being prescribed blood glucose test strips that allow them to monitor their own blood glucose levels daily – but these only reveal variations on a short-term

basis. “The HbA1c test can show average deterioration over a longer period, which is far more significant,” says Saravanan. At present, the HbA1c test is ordered by GPs and requires the patient to attend a clinic and return for the results, which can be timeconsuming and potentially expensive for patients and medical staff. However, portable point-of-care devices are now available that enable the test to be carried out in five minutes using one drop of blood. “This technology could be supplied to GP surgeries, pharmacies, and even – with guidance in interpreting the results – direct to patients,” says Saravanan. “This could empower patients to better control their condition, reduce the likelihood of deterioration and complications and ultimately save money and time for the NHS and the private sector.”

6 DIABETESADVICE.CO.UK

INSPIRATION COLUMN

Professor Keith Harding Professor of Wound Healing, Cardiff University School of Medicine

Better diabetic wound care can save lives For people with diabetes, a small, undetected foot wound can quickly lead to infection, amputation and even death. Better wound care and new therapies can save lives.

Diabetic foot ulcers can kill. “Internationally, 50 per cent of people who have amputations as a result of diabetes die within five years, compared with 18 per cent of breast cancer patients over the same period,” says Professor Keith Harding, Professor of Wound Healing, Cardiff University School of Medicine. Most of these amputations are avoidable. “The road to amputation can start with just a small foot wound,” says Harding. Diabetes damages the nerves, so patients may feel no pain, and have cracked, infection-prone skin. Peripheral arterial disease, seen in a third of patients with diabetes, means that small blood vessels do not supply wounds with enough oxygen, leading to ulcers that do not heal. With diabetes, the immune system is also compromised, so the body’s immune response does not kick in at the wound site. “A diabetic wound can go from uninfected to life-threatening within a week,” says Harding. “Better oxygenation would help wounds heal faster and probably cut infection risk.” This might be achieved by putting patients in hyperbaric oxygen units, though the evidence for its effectiveness is disputed. Direct application of oxygen is also being trialled in diabetic foot wounds, he says. “There are many potentially valuable therapies but we do not have robust evidence of their effectiveness because wound care is starved of research, funds and facilities. “Diabetic foot problems are not just about scabby feet – the amputation and death rates show that this area needs urgent attention.” More data online at diabetesadvice.co.uk

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3 steps to help prevent type 2 diabetes By Linda Whitney Boosting your activity levels and eating healthily can help you prevent type 2 diabetes. Here’s some tips to increase your chances of success.

popcorn. “If you snack on chocolate or cereal bars, swap to dark chocolate rice cakes,” says Elvin.

Give yourself an incentive

“Set yourself a small achievable goal that can be met quite soon so you get the reward of success quickly. Celebrate with a nonEmma Elvin food treat such as a night out. Then set your next achievable Clinical Advisor, Diabetes goal. This is more motivating UK than setting yourself one great challenge which is harder to achieve,” says Elvin. The stories of others’ success can be motivating. Bob Swindell, 48, was diagnosed with type 2 diabetes in 2013. Determined to lose weight and reduce his need for medication, he started running, using the Couch to 5K programme on the NHS Choices website. “At first, the thought of running for just a couple of Bob Swindell lost 50kg after he started running Get active minutes seemed extreme, Diabetes UK recommends (as and I struggled to believe running 5K continuously was even does the Government) spendapps that monitor your level of ing less time sitting down, at possible for me,” says Bob. At physical activity and exercising least 30 minutes of moderate first, he ran furtively and soon with friends can help. activity five times a week, and his motivation was drifting Eat a healthy diet muscle-strengthening exercise away. Eat plenty of fruit and veg, lean on at least two days a week. Then he discovered parkrun protein such as beans, pulses, “Moderate activity makes your events, local running sessions fish and white meats, low-fat, heart beat faster and make undertaken with others. “Running with others inspired me to low sugar dairy, and some you slightly out of breath. says keep it up – I’ve been a regular wholegrain carbs. Avoid large Elvin. “If you are pretty inactive now, start by spending less ever since,” says Bob. “Running amounts of red meat, and especially processed meat products time sitting own and more time has helped me lose 50kg and I such as pies and sausages. walking – gradually build up to have reduced the medication Reduce your consumption 10,000 steps a day.” needed to keep my blood glucose levels within my target of salt, saturated fat and added Choose an activity that fits range. I wouldn’t choose to sugar and read the labels on easily into your lifestyle, such have type 2 diabetes but discovprocessed foods. Going for more as swimming, going to the gym ering running has been my ‘greens’ than ‘reds’ on traffic or walking. “Almost everyone silver lining.” light labels can help making should be aiming to increase healthier food choices. their activity levels, though if Try food swaps. Select a food you have a medical condition, you enjoy and eat often, such as check with your doctor first,” Check your risk at diabetes.org.uk crisps, and swap them for plain says Elvin. Step counters and Your risk of developing type 2 diabetes may be higher than you think – but reducing your risk could be easier than you imagine. “Many people do not realise that they are at risk of developing type 2 diabetes,” says Emma Elvin, clinical advisor at the charity Diabetes UK. “Some risk factors, such as ethnicity and family history, cannot be changed, but others, such as poor diet or low levels of physical activity, can be addressed relatively simply. Addressing these can also help manage your weight, which is one of the main reasons people develop type 2 diabetes”

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INSPIRATION COLUMN

Chris Askew Chief Executive, Diabetes UK

2017 Future of Diabetes report launches today Diabetes affects more than 4.5 million people in the UK, more than any other serious health condition. The number of people living with diabetes is rising fast and, every day, around 700 people are diagnosed. That is one person every two minutes.

Diabetes is devastating and can affect all aspects of someone’s life. It can also lead to serious complications including amputations, kidney disease and strokes. Diabetes UK is committed to making the lives of people with diabetes easier, and this year we heard from over 9,000 people living with or affected by diabetes to find out what it is like both to live with the condition today, and their hopes and fears for the future. It was one of the biggest engagement initiatives we have ever undertaken, and we heard from people with different forms of diabetes, from different backgrounds and from all parts of the UK. What they told us forms the basis of our new Future of Diabetes report, which we’re launching today at events across the UK. Read more on diabetesadvice.co.uk

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Increasing evidence to support VLCDs for type 2 weight loss An astonishing surge in cases of diabetes in the UK could be stopped in its tracks if more people considered a VLCD (verylow-calorie diet) By Dr Matt Capehorn

n just over 20 years, type 2 diabetes mellitus in the UK has more than doubled. Around 3.2 million people now have type 2 diabetes with a new case diagnosed every two minutes. In addition, there are an estimated 1.1 million undiagnosed and 11.9 million at-risk individuals. 85 per cent of these cases are caused by excess weight, and it is in targeting this excess weight that breakthroughs are coming, particularly with the use of formula-based, very-low-calorie diets (VLCDs), which have been used to successfully treat obesity in the UK since the mid-90s.

Reversal and remission The notion that type 2 is progressive and irreversible was challenged in 1999, when the Swedish Obese Subjects (SOS) study reported a significant reduction in type 2 diabetes following post-bariatric-surgery weight loss. The next game-changer came in 2011, when Lim et al demonstrated an 800 kcal/day VLCD could put type 2 diabetes into remission. After eight weeks on the 800 kcal VLCD, participants’ hepatic and pancreatic triacylglycerol stores had decreased enough to restore beta-cell function and insulin sensitivity. Three months later, most still had normal blood-glucose control. More recently, early research from a trial

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* Eligibility criteria apply. Only one meter from the Contour® range per person every twelve months. 1. Christiansen M et al. Accuracy and user performance evaluation of a new blood glucose monitoring system in development for use with CONTOUR™NEXT test strips. Poster presented at the 15th annual meeting of the Diabetes Technology Society (DTS); October 22–24, 2015; Bethesda, Maryland. USA. 2. International Organization for Standardization. In vitro diagnostic test systems Requirements for blood glucose monitoring systems for self-testing in managing diabetes mellitus. Geneva, Switzerland: International Organization for Standardization; 2015. Ascensia Diabetes Care UK Ltd. Ascensia House, Albert Road, Newbury, Berkshire RG14 1DL. Ascensia, the Ascensia Diabetes Care logo, CONTOUR and the CONTOUR Diabetes app are registered trademark of Ascensia Diabetes Care Holdings AG. © 2017 Ascensia Diabetes Care. All rights reserved. Apple and the Apple logo are the trademarks of Apple Inc., registered in the US and other countries. App Store is a service mark of Apple Inc. Google Play and the Google Play logo are trademarks of Google Inc.

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using VLCDs to treat obese people with insulin-dependent type 2 diabetes has also shown they were better able to lose weight, reduce insulin requirements and manage blood-glucose levels than controls on standard NHS type 2 treatment.

Post-VLCD weight loss maintenance is possible Those with type 2 find it twice as hard to lose weight on ‘standard’ weight loss diets – not least because diabetic medications, including insulin therapy, are strongly associated with weight gain. This only goes to further demonstrate the impressive efficacy

Dr Matt Capehorn GP and Clinical Director, Rotherham Institute for Obesity

Read more on diabetesadvice.co.uk

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of VLCDs for weight loss in obesity associated with type 2 diabetes. Analysis of weight-loss data by Rolland et al in 2013 from 600 weight-matched obese people, half with type 2 and half without, who completed 12 weeks on a VLCD with concomitant cognitive behavioural therapy and small group support, found weight loss in the type 2 group was more than 90 per cent of that in the non-type 2 group. This is a highly clinically significant result. Furthermore, it is consistent with other research citing the benefits of group support and behaviour-change therapy in weight-loss regimen.

A recent review of VLCD use in individuals with type 2 confirmed that such diets were associated with significant weight loss and improvement in cardiovascular risk factors and blood glucose, while being well tolerated. Furthermore, despite the commonly-held belief that rapid weight loss on VLCD is associated with rapid weight regain, trials have shown that long-term weight-loss maintenance is possible post-VLCD. The increasing evidence around the efficacy of VLCDs for treatment of type 2 with obesity suggests they could play an increasingly important role in stemming the diabesity tide.

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INSPIRATION

Detecting signs of diabetes through regular sight tests An estimated 415 million people worldwide are affected by diabetes and this number expected to hit 642 million by 2040 – globally, it is the fastest growing chronic disease1.

ype 1 diabetes accounts for around 10 per cent of people in the UK with the condition. It occurs when the body’s immune system destroys the cells that make insulin, which is vital in helping us get energy from the food we eat. Type 1 is the most common type of diabetes in children.

PHOTO: SPECSAVERS

Type 2 diabetes is more common in adults, and accounts for most people who have the condition. In Type 2 diabetes, the body either doesn’t make enough insulin, or the insulin it does make doesn’t work properly. One of the most significant implications of living with diabetes is an increased risk of sight loss. People with diabetes are 25 times more at risk of going blind than those without the condition, making it the

leading cause of preventable sight loss in the UK.

Diabetes and eyesight

Dr Nigel Best Clinical Spokesperson and Optometrist, Specsavers

Diabetic retinopathy is caused by high blood sugar levels affecting blood vessels in the retina – the lightsensitive tissue that lines the back of the eye – where images are formed. While it may not cause any problems in its early stages, if left untreated it can lead to blurring of vision and

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Eye tests check more than how well you can see. They can als your eyes healthy and detect a range of health conditions.

At least 50% of sight loss is avoidable. Book an eye test online at specsavers.co. Source: RNIB and Specsavers State of the Nation Eye Health 2017: A Year in Review. A regular eye tests is at least once every two years. ©2017 Specsavers. All rights reserved.

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even blindness. Specsavers clinical spokesperson, Dr Nigel Best, says: ‘As diagnoses continue to escalate year-on-year, early detection of diabetes is essential in managing the symptoms and preventing serious, long-term complications like retinopathy. ‘Regular eye examinations form a crucial part of this. As optometrists, we can spot initial signs that a

patient may have diabetes, and support patients with diabetes in managing the impact of the disease on their eye sight.’ One of the ways Specsavers helps detect possible indicators of diabetes is through digital retinal photography, which is included as part of every standard eye examination for customers over 40 (as well as others where it is considered appropriate).

Specsavers’ opticians use a digital retinal camera which can detect changes in the retina that might indicate diabetes, glaucoma, inflammatory disorders, age-related macular degeneration and vascular occlusions. These retinal photographs can then be compared to photographs taken at subsequent visits to allow any changes to be monitored. Specsavers, Diabetes UK and Royal

National Institute of Blind People (RNIB) are working together to transform the nation’s eye health and combat avoidable sight loss. 1

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