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 news.
This week Simon reports on the latest research and initiative updates.
Healthy New Towns
This month NHS England announced a new Healthy New Towns initiative, working with ten housing developments to shape the health of communities, and to rethink how health and care services can be delivered. This is another initiative from the NHS Five Year Forward View, with a commitment to dramatically improve population health, and integrate health and care services, as new places are built and take shape.
The plan covers more than 76,000 new homes with the potential capacity for approximately 170,000 residents. The NHS will help shape the way these new sites develop, in order to test creative solutions for various health and care challenges including obesity, dementia and community cohesion. NHS England is bringing together renowned clinicians, designers and technology experts to reimagine how healthcare can be delivered in these places, to showcase what’s possible by joining up design of the built environment with modern health and care services, and to deploy new models of technology-enabled primary care. The idea is to ‘design out’ the obesogenic environment, and ‘design in’ health and wellbeing.
Expressions of interest in the Healthy New Towns programme were invited last summer, and attracted 114 applications from local authorities, housing associations, NHS organisations and housing developers.
The ten Healthy New Towns demonstrator sites are:
- Whitehill and Bordon, Hampshire – 3,350 new homes on a former army barracks.
- Cranbrook, Devon – 8,000 new residential units.
- Darlington – 2,500 residential units across three linked sites in the Eastern Growth Zone.
- Barking Riverside – 10,800 residential units on London’s largest brownfield site.
- Whyndyke Farm in Fylde, Lancashire – 1,400 residential units.
- Halton Lea, Runcorn – 800 residential units.
- Bicester, Oxon – 393 houses in the Elmsbrook project, part of 13,000 new homes planned
- Northstowe, Cambridgeshire – 10,000 homes on former military land.
- Ebbsfleet Garden City, Kent – up to 15,000 new homes in the first garden city for 100 years
- Barton Park, Oxford – 885 residential units
Online access to GPs
The success of NHS England’s Widening Digital Participation scheme was announced this month, with nearly 200,000 homeless, older and vulnerable people being given lessons on how to get online and contact their doctor. The aim of the scheme was to reduce GP visits and costs to the NHS.
In the first two years of the NHS England pilot scheme 14,000 people registered with a GP and looked online first before contacting the doctor. The results of the review showed that half of those who would have gone to the GP or A&E said they would now use NHS Choices, 111 or a pharmacy first. In a survey of 1,000 participants, 83% said they felt more confident about using online health tools to manage their health as a result of the training, with 34% saying they made fewer visits to a doctor as a result of finding the information they needed online.
The scheme is run by the Tinder Foundation for NHS England and works with the hardest-to-reach communities giving them the skills and confidence to access online health information. Apparently 12.6 million people in the UK do not have basic digital skills – which is roughly 20% of the population. The Tinder Foundation has 5,000 UK online centres which use outreach events and community activities like exercise or cookery classes, introducing an extra digital element such as finding nutritional advice, recipes and new exercise programmes online. The programme also promotes the ‘Learn My Way’ website where people can learn how to find out more about their conditions, how to interact with the NHS online, and how to choose and rate services.
Unhappy with apps
A small study from the University of Washington has found that HCPs don’t always have the capacity or knowledge to interpret data from the many lifestyle, fitness or food tracking mobile apps that people often use.
With more people bringing this type of information into clinics, HCPs are often left feeling overwhelmed by the sheer amount of data. This was improved if people used tools recommended by their HCPs, as the HCPs were more confident with the apps and what they could record. Apps that they were not familiar with, especially those that then provided some type of analysis of the data, were not always trusted. HCPs wanted to find validated apps that they felt more comfortable using and recommending.
Work on this idea of health and medical app validation is currently being undertaken both so that users know which apps are the best to use but also so that HCPs can feel confident of the data provided. One thing that came out strongly for the HCPs was the need for a summary page which presented all the available data in a simple way that was easy to read and interpret. This idea of standardising an approach to data presentation is currently happening with most of the CGM/Flash monitoring or blood glucose data download systems which are moving towards the Ambulatory Glucose Profile (AGP) which presents the data from each system in a similar format, making it easier for HCPs to interpret downloads from a variety of devices.
At the same time another small study reviewed the accuracy of a blood pressure monitoring app (AuraLife), which was used by 85 adults—over half of whom had high blood pressure. Once downloaded, the app asked participants to hold their smartphones up to their chest while placing an index finger in front of the device’s camera. However, it then underestimated higher BPs and overestimated lower BPs, with clinically significant difference of 12.4 mm/Hg for systolic measurements (the top number) and 10.1 mm/Hg for diastolic (the bottom number) readings. The app also had a low sensitivity, meaning that 80% of people with high blood pressure would have been falsely reassured that their BP was normal. The researchers called for such apps to be regulated in a much more formal way.
Such work will become increasingly important. New data from the US suggests that there the use of health apps and wearable technology has increased from 16% to 33% since 2014 with 40% of users taking that data to share with their HCPs.
Researchers at the University of Buffalo have developed a necklace that could help passively track nutrition by listening to the sound of the wearer chewing.
The device, called AutoDietary, has a small microphone on the back that records the sound of people eating food. The sounds are sent to a smartphone via Bluetooth and compared against a database of chewing and swallowing sounds for different foods, including biscuits, peanuts, and apples.
AutoDietary has been used in a study of 12 people where each person was given water and different foods (apples, carrots, crisps, biscuits, peanuts and walnuts) to eat. The system was able to identify the correct food 85% of the time. One problem is that the system can’t always tell between similar foods – such as cornflakes and Frosties – so that the wrong nutritional information might be recorded.
Obviously more work needs to be done to see whether this can really help but Buffalo are not alone in their research in this area. Other developers have looked at sensors that can monitor vibrations from jaw movements and a microwave that can assess calories in the food it heats.
Surgery v Diet
A study from Washington has compared the outcomes of using bariatric surgery (a Roux-en-Y gastric bypass) with intensive lifestyle and medical intervention on people who are obese and have Type 2 diabetes. The lifestyle/medical intervention was a 12-month, in-person and telephone-based programme that included behaviour modification skills counseling combined with diet and exercise training.
After a year, 60% of those undergoing gastric bypass were in diabetes remission compared with only 5.9% of people in the lifestyle/medical group. HbA1c in the bypass group fell from 7.7% to 6.4% whereas those in the lifestyle/medical group only saw a fall from 7.3% to 6.9%. Interestingly the bypass group saw HbA1c fall progressively over the year whereas the other group decreased only for the first 6 months and then tended to increase back to baseline. The bypass group also used fewer diabetes medicines at the end of the year to manage their diabetes.
The bypass group also lost more body weight compared with the lifestyle/medical group (25.8% compared with 6.4%) although lean body mass remained stable in the lifestyle/medical group and decreased by 10% in the surgical group.
However we also know that a very low-calorie diet can help adults with T2D reverse their diabetes, and those who keep their weight down may remain free of diabetes, according to Roy Taylor’s research. In his study weight fell from a mean of 98 kg to 83.8 kg and HbA1c reduced from 7.1% to 5.8%. But this is a very different intervention with a much more radical approach to weight loss.
Don’t just sit there……
A new study has shown that sitting for more than 3 hours daily is responsible for around 3.8% of all-cause deaths. Previous studies have shown that sitting for long periods can increase the risk of heart disease, diabetes, cancer and premature death, regardless of physical activity status in between.
This study analyzed 2002-2011 behavioral survey data of more than 1.1 billion adults over 54 countries – representing around 25% of the global adult population, including American, European, Eastern Mediterranean, Southeast Asian and Western Pacific populations, where sitting time had the biggest impact on mortality. However, they also found that reducing sitting time – even slightly – had an immediate impact on rates of all-cause mortality across all countries. Life expectancy could be increased by 0.2 years if sitting time was reduced to less than 3 hours daily, regardless of physical activity.
This research was echoed by a presentation at the Diabetes UK Professional Conference from Dr Thomas Yates of Leicester University. He highlighted that for many people 60% of the day was sedentary. Data had shown that for every hour spent watching TV, the risk of T2D increased by 10%. But the most interesting data he presented was comparing people sitting with those standing up for 5 minutes twice an hour. Interestingly those who simply stood initially had a 34% lower plasma glucose level than those who just sat – though taking some exercise too had the best long term effects on plasma glucose levels.
Ironically, this information was presented during a 90-minute session where the audience sat for the entire time!