Diabetes UK Annual Professional Conference 2006

Control of fasting and postprandial blood glucose is important
Diabetes specialists attending the Diabetes UK Annual Professional Conference called for the need to control both fasting blood glucose (FBG) and postprandial blood glucose (PPBG) in people with type 2 diabetes. The comments came during a symposium, sponsored by Lilly, in which delegates debated different strategies used to gain optimum control of type 2 diabetes.

The audience (which comprised GPs, diabetologists and nurses) agreed that both FBG and PPBG are important contributors to overall glycaemic control, and that while patient choice is a vital consideration when selecting the preferred insulin, as Professor Stephen Gough (Professor of Medicine and Honorary Consultant Physician at the University of Birmingham) said: ‘The worst thing we can do is put patients on insulin and they don’t achieve glycaemic control.’

Clinical studies have indicated that insulin regimens that regulate FBG and PPBG levels can provide tighter control of diabetes than regimens that focus on FBG alone. Tight glycaemic control in people with type 2 diabetes has been shown to reduce the risk of long-term complications associated with diabetes.

Professor Gough concluded that: ‘We already know of the healthcare benefits for patients if we tightly control their blood glucose levels. […] We need to actively help manage both FBG and PPBG in our patients.’

At the same symposium Lilly celebrated the tenth anniversary of the launch of its first insulin analogue, insulin lispro (Humalog), in the UK.

Caring for the forgotten older generation with diabetes
Research presented at the Diabetes UK Annual Professional Conference shows that many older people with diabetes are ending up in hospital unnecessarily. Research in nine care homes in East Staffordshire showed that 37 residents with diabetes spent 236 days a year in hospital – 93% of these days were emergency admissions. Around the UK, this equates to around 250 000 hospital days a year.

A study presented also showed how a pilot scheme introducing a diabetes specialist nurse to provide structured education to care home residents and staff reduced emergency admissions by 75%. Hypoglycaemic episodes also decreased by 86% and over a third of residents achieved improved blood glucose levels.

Douglas Smallwood, Chief Executive at Diabetes UK, said: ‘Local services need to ensure that such [innovative schemes are] adopted across the board to reduce inequalities.’

Changes to the drug tariff system raises concern
The British In Vitro Diagnostics Association(BIVDA) has raised concerns that changes to the drug tariff system, following the Department of Health’s consultation exercise, will have a significant negative impact on patient welfare for people with diabetes and lead to a reduction in innovation within the industry. Doris-Ann Williams, Director General of BIVDA, called on the Department of Health to ensure that any restructuring of the drug tariff would take into account the level of investment in research and development and support services delivered annually by providers of diabetes-related products.

Speaking at the Diabetes UK Annual Professional Conference, she said: ‘Our members supply 98% of diabetes testing products and they provide an extensive range of complementary support free of charge to people with diabetes and primary care facilities […] We answer over 600 000 calls which would otherwise be handled by non-specialists at NHS Direct each year and in 2004 we invested £140 million in research and development. Whilst we accept that there is a need to review the status quo, a “one size fits all” solution in relation to the products contained in part IX [of the drug tariff] is simply not workable and would restrict patient choice whilst being detrimental to patient welfare in the long term.’

Weight loss drug helps people get onto transplant list
According to research presented at the Diabetes UK Annual Professional Conference, orlistat (Xenical; Roche) can help improve cardiometabolic risk factors, including diabetes, in obese Asian people and in those with chronic kidney disease.

A study demonstrated that treatment with orlistat led to significant reductions in weight and improvements in inflammatory markers, such as adiponectin and endotoxin. Professor Sudhesh Kumar, from the University of Warwick, said the results of this study were particularly promising in light of the high rates of obesity and associated co-morbidities among British Asian people.

A second study focused on achieving weight loss in obese people with chronic kidney disease, some of whom had type 2 diabetes, in order to become eligible for renal transplant. The results showed that orlistat, in combination with a diet and exercise programme, helped people to achieve reduction in body weight, waist circumference and weight loss-related cardiometabolic risk factors. In the sub-group with type 2 diabetes decreased HbA1c levels and reduced insulin requirements were observed. One-fifth of study participants achieved sufficient weight loss to be listed for renal transplantation. Dr Iain MacDougall of King’s College London said orlistat could be a valuable adjuvant for such people.

New website to help in the care of people with diabetes launched
The Strategic Alliance for Diabetes, a venture in which Diabetes UK works in partnership with a number of pharmaceutical organisations, launched a new website (http://www.diabetesplanning.org [accessed 09.05.2006]) at the Diabetes UK Annual Professional Conference.

The website aims to support diabetes leads by being a comprehensive resource of all the information they need to prioritise diabetes and deliver change at a local level by focusing on the commissioning process and the implementation of clinical care pathways.

Diabetes-related limb loss can be prevented
Research, presented at the conference, evaluating the care of people with diabetes prior to lower limb amputation found that over a third did not have any kind of diabetes review to assess diabetes management and development of other complications prior to amputation.
    Douglas Smallwood, Chief Executive at Diabetes UK, said: ‘It is shocking that some people with diabetes are getting sub-standard specialist foot care, or even none at all, if they are at high risk of amputation. We know that the rate of amputation may be reduced by 40% or more through effective care. All people with diabetes should receive at least a yearly foot check. Those who have problems need to be provided with a foot care plan which incorporates specialist care and education on what to look out for and how to avoid infections.’
    Baldev Singh (Consultant Physician at Wolverhampton Diabetes Centre), who carried out the research said: ‘This research clearly shows that care for high risk patients is inadequate. Mandatory foot care plans should be put in place to ensure that all people get the right care and education.’

Urban kids in diabetes timebomb
Survey results released at the meeting show that children living in inner city areas are at a hugely increased risk of becoming obese and developing type 2 diabetes.

The study, conducted by researchers in Leicester, showed that only 37% of children in an urban area walked to school, compared with 67% of suburban children (latter figure from a previous study). The study also showed that, of the children who responded to the survey, 47% admitted to spending more than 4 hours per day watching television or videos, or playing computer games.

Eighty-six per cent of those surveyed were from a South Asian background. People from South Asian communities are up to six times more likely to develop type 2 diabetes and have an increased risk of developing cardiovascular disease.

Lead researcher Kamlesh Khunti, GP and a Senior Lecturer at the University of Leicester, said: ‘It is quite clear that children living in urban areas are not doing enough exercise. These dire levels of physical activity in urban youngsters need to be addressed, particularly with South Asian children who we know are already more genetically prone to obesity, cardiovascular disease and type 2 diabetes.’

Douglas Smallwood, Chief Executive at Diabetes UK, said: ‘This research confirms a very worrying trend and highlights issues that are of crucial importance to today’s youth.’

People with type 2 diabetes’ beliefs about their medications
In a study exploring the relationship between beliefs about medication, personal models of care and adherence of people with type 2 diabetes to their medication, it was found that, of 113 participants with type 2 diabetes, 90% believed that the specific medicines prescribed for their diabetes were effective and necessary. However, 60% were worried about the potential long-term effects of the medications, and 25% felt that some medications were over-prescribed by doctors.

OTHER MEETINGS
Russian endocrinologists visit to learn care practices from UK centre
In a recent meeting between endocrinologists visiting from St Petersburg, Russia, and those from Bournemouth Diabetes Centre, the Russian doctors were able to see first-hand how a centre of excellence that utilises modern technologies and established strategies, such as educational ones, can improve the care of the person with diabetes. The visitors hope to implement similar strategies in their own centre. This meeting was made possible by financial support from Sanofi-Aventis.

Risk of diabetes higher in shoppers at Aldi compared with Waitrose
People who shop at Aldi are more likely to develop type 2 diabetes than those who frequent more ‘upmarket’ establishments such as Waitrose, according to Bill O’Leary, Head of Communications for the National Diabetes Support Team. Speaking at the 2006 Novo Nordisk Symposium on Diabetes Care, Bill explained that low-income individuals are at greater risk of developing the condition than their wealthier counterparts. A full list of ‘key facts for diabetes’ can be found at www.yhpho.org.uk.

At the same meeting, Mike Crooks, Sales and Marketing Director at Novo Nordisk, spoke about the many studies the company had initiated recently, including PREDICTIVE, 4T and CHOICE. In addition, he pointed to a strong pipeline of Novo Nordisk product developments, including new insulins and a GLP-1 analogue.