Diabetes developments – by Simon O’Neill
In a regular blog series, Simon O’Neill, Diabetes UK’s Director of Health Intelligence and Professional Liaison, rounds up the latest diabetes research. This week Simon reports on the latest healthcare and research updates.
Split of newly diagnosed Type 1 diabetes by age and %
We regularly hear that Type 1 diabetes is most common in children between the ages of about 10-15 years of age. While this is the most likely age for diagnosis, it actually doesn’t tell the whole story.
Looking at data from two years of the National Diabetes Audit (2011-13), we can see a slightly different picture emerging. Although 10-19 is the age band with the highest concentration of diagnoses of Type 1 diabetes each year, the data actually shows that more people over the age of 20 are diagnosed with Type 1 diabetes each year – around 57% of all diagnoses but split over 70 years of life
And, as we get better at preventing complications and premature deaths, we see a similar picture if we look at all people with a diagnosis of Type 1 diabetes, with nearly 87% of cases over the age of 20.
Age: % of all with Type 1 diabetes % of newly diagnosed Type 1 diabetes.
|Age:||% of all with Type1
|% of newly diagnosed Type 1 Diabetes|
Access to your medical record
Many GP practices already offer some online services, including appointment bookings, repeat prescriptions and access to the summary information in your medical record – but this will extend to all practices in England by 31 March this year at the latest. The plan is that these online services will be in addition to traditional face-to-face and telephone services that already exist.
The big change here is that practices will have to offer access to more than just the summary information. This means that individual people should be able to view more things like their test results, current medication and a record of diagnoses of conditions or current health problems. Practices don’t have to show letters, attachments or notes of correspondence between the practice and other medical centres – but they can choose to do so if they wish.
The rather sad thing is that some of the commonly used systems, such as EMIS, have been able to do this for years, but Practices have been slow or reluctant to allow people to see their records. As someone who has been able to do this for many years, it is a really helpful option, to be able to download results and share them with diabetes clinics for example. Hopefully people will take up this opportunity and really reclaim their own data.
Although most people are familiar with the common complications of diabetes (sight loss, nerve damage, kidney failure, amputation, heart disease and stroke), there is evidence that other parts of the body may also be affected by diabetes.
Hearing loss is common with ageing. It is estimated that 35% or more of people in their 60s and 50% of those in their 70s experience hearing loss sufficient to cause difficulties in daily life. A study looked at 37,773 people with diabetes who had undertaken health screening examinations during a six year period, including a hearing test. Hearing loss was defined as mild, moderate, moderately severe, or severe based on the sound frequencies an individual could or could not hear.
Interestingly, those with diabetes experienced a greater frequency of hearing loss than those without. Mild hearing loss was present in 4.95% of people with diabetes in their 30s compared to 1.3% of people in their 30s without diabetes. Overall, hearing loss was present in 17.3% of the people with diabetes, and only 6.5% of the general population.
In the US, dental problems are commonly cited as a complication of diabetes. A study of 716 people looked to see whether the level of dental problems was linked to blood glucose levels. Of the 716 only 151 reported that they had diabetes at the beginning of the study. 528 people were found to have some degree of periodontitis (which can lead to shrinking of the gums and tooth loss). Of these 187 (35.4%) had mild periodontitis, 286 (54.2%) had moderate periodontitis, and 55 (10.4%) had severe periodontitis. But what was interesting was that those with mild disease had a mean blood glucose of 6mmol/l, those with moderate had a mean blood glucose of 7.6 mmol/l and those with the most severe disease had a mean blood glucose of 8.7 mmol/l – there were also more people in that group who had blood glucose levels of 11 mmol/l.
The interesting thing in this study was that about 30% of people with high blood glucose levels reported no history of diabetes – so is there a role for dentists in testing people with moderate or severe periodontitis for diabetes?
NHS Health Checks
A review of the first few years implementation of the NHS Health Check has been published. Although slow to get off the ground, the Health Check is now being better delivered and will be part of the referral pathway to the new National Diabetes
The new study shows that, of the 1.68 million people eligible for an NHS Health Check between 2009-12, 214 295 attended but attendance quadrupled as the programme progressed, from 5.8% in 2010 to 30.1% in 2012. Unsurprisingly older people were more likely to attend (19.6% of those eligible at age 60–74 years compared with 9.0% at age 40–59. The programme was supposedly targeted at all people without a pre-existing history of CVD, diabetes or kidney disease, but interestingly groups at higher risk of CVD, such as the more socially disadvantaged, were more likely to attend (14.9% compared with 12.3% of more affluent people) but that may have been due to local decision making, targeting more at risk communities.
In this study there were 7844 new cases of high blood pressure (38/1000 Checks), 1934 new cases of T2D (9/1000 Checks) and 807 new cases of chronic kidney disease (4/1000 Checks). Of the 27 624 people found to be at high CVD risk 19.3% (5325) were newly prescribed statins and 8.8% (2438) were newly prescribed antihypertensive therapy.
The study concluded that, though coverage was lower than expected, statin treatment at national scale for 1 in 5 attendees at highest CVD risk is likely to have contributed to important reductions in their CVD events.
Is obesity contagious?
Some new research from the US has found that when human stem cells were exposed to a common virus they turned into fat cells and began to store fat. Earlier research in animal studies had shown that adenovirus-36 (a common cause of chest and eye infections) caused cells to store more fat. In a follow up study, people with obesity were three times as likely to have been infected with that virus.
The new study examined what happened when human adult stem cells were exposed to the same virus. After one week, most of the infected stem cells developed into fat cells, while the uninfected cells were unchanged.
The researchers explained that adenovirus-36 is just one of 10 pathogens linked to obesity and that further research might find more. The virus is unlikely to be the sole cause, but it may play in part in why some people are more susceptible to becoming obese.
What exercise is best?
Researchers from the University of Leicester and the National Institute of Health Research Leicester-Loughborough Diet, Lifestyle, and Physical Activity Biomedical Research Unit have done a meta-analysis of 50 studies that compared the effects of High Intensity Interval Training (HITT) and regular, continuous training, looking at the impact on outcomes related to Type 2 diabetes.
High-intensity interval training (HIIT) involves bouts of maximum effort, with only a short period of rest in between. For example, instead of running for an hour, a person might run 20 meter sprints for 15 minutes with small rest periods in between. Depending on how much effort a person puts into their workout, HIIT can result in as many as 22 calories burned per minute.
The studies looked at 2,033 participants aged 21 to 68, with 1,383 of them undergoing a HIIT intervention. The fitness levels of the participants ranged from very active to sedentary but healthy to overweight or obese.
They found that HIIT caused a reduction in insulin resistance, weight loss of just over 2 pounds, and lower levels of blood glucose. The meta-analysis also found respiratory fitness improved to a greater level than it did in those who took part in continuous training. The results, in the cases of insulin resistance and aerobic fitness, were also superior to the effect of traditional continuous training.
However, before you jump off the sofa and start sprinting, if you are not used to any exercise, then HIIT may not be the best place to start and you should always consult your HCPs when planning to get active.
GLP-1 analogues for Type 1 diabetes?
GLP-1 analogues are currently only licensed for people with Type 2 diabetes who have sub-optimal glycaemic control on other glucose lowering agents, but could they also be of benefit in Type 1 diabetes?
A small study of 33 people with Type 1 diabetes, who had high HbA1c and were obese (about 25% of all people with Type 1 diabetes have a BMI over 30) looked to see if adding GLP-1 to their insulin regime would improve both HbA1c and weight.
Overall, there were significant improvements in both targets – with HbA1c falling by about 0.5% (5mmol/mol) and weight falling by 12% (around 12 Kgs). The best results were in those who were less obese (between 30-35 BMI) and three people pulled out because of the gastrointestinal side effects of the drugs
Other drugs used in Type 2 diabetes, such as SGLT2 inhibitors, which cause the body to pass out excess glucose in the urine and can help with weight loss, are also being trialed in people with Type 1 diabetes. Hopefully it will add some more tools to our medicinal arsenal.