Dr Adrian Heald

Consultant Diabetologist, Salford Royal Hospital

Personalised plans of care and support, created as part of a shared decision-making process with healthcare professionals have been shown to improve outcomes and empower people with type 2 diabetes in a recently published innovative new study.

Proactive personalised care is about enabling people to understand the set of health choices that are available to them and empowering them to make those choices. This is true whether we are talking about medication, medical services, community-based services, healthy food options or lifestyle choices.

The NHS Long Term Plan’s ambition is to make personalised care and support planning ‘business as usual’.

There are however significant financial, organisational and time barriers amongst disparate teams of healthcare professionals, to provide joined-up care, support and education to people living with type 2 diabetes.

The role of technology

Well-designed care and support planning software can enable healthcare professionals working across primary, secondary and community settings to create digital plans of care in partnership with patients who are living with type 2 diabetes that can be accessed at any time through a mobile app. This is a convenient and secure way for patients to track and monitor their health and to access support, education and advice from their GP surgery to manage their diabetes.

A key challenge in diabetes management is to motivate and support individuals with diabetes to make healthy choices.

Evaluating the benefits

A study was funded by Innovate UK and supported by the NIHR involving 250 people with type 2 diabetes across 12 GP surgeries who were trained to use the Healum app and care-planning software. The project has so far been a great success, with clear benefits for both patients and clinicians.

“A key challenge in diabetes management is to motivate and support individuals with diabetes to make healthy choices, positive lifestyle decisions and to understand how to best manage their diabetes in a way that means something to them,” says Dr Adrian Heald, Consultant Diabetologist at Salford Royal and Chief Investigator of the study in Eastern Cheshire. 

Health outcomes so far

The preliminary results of an 18-month trial presented at the Diabetes UK Annual Professional Conference in March 2022 showed that people who used it had an average 9.5% reduction in the HbA1c blood glucose average control measure compared with a 2% reduction in the comparable control group.

These promising outcomes bode well for the future, as more people living with type 2 diabetes find the path to a healthier future.

Healum has just launched a research network with the aim of providing people living with type 2 diabetes choice and control over how they share their health information with healthcare professionals and researchers who are seeking to improve personalised care.

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A new CGM system can help train users to keep their blood glucose levels within healthy ranges without the use of a needle.

Needles are a part of the daily routines of a person living with diabetes, for checking blood glucose levels in Type 2 Diabetes, their continuous use can be challenging for many. Whilst continuous glucose monitors (CGM) do not replace use of needles, they have proved beneficial in monitoring blood glucose levels more regularly. Now, in the latest of new technology advancements, a new CGM is set to launch which involves no needles.

Skin patch to monitor glucose levels

“MySugarWatch (MSW) is a needle-free daily disposable skin patch that links to your mobile phone and monitors your glucose levels every five minutes,” says Jenny Wilkinson, one of the diabetes specialist nurses working with MSW. “It’s the only CGM that is needle-free.”

The package, which includes the device, the app that allows you to view your blood sugar levels, plus access to video coaches who will give individual advice about diet and lifestyle, is set for launch late this autumn. It is aimed at people with type 2 diabetes (T2D), people with pre-diabetes and anyone who wants to see the effects of their lifestyle and diet on their blood glucose levels.

The aim is to educate members so that they can easily keep within their ideal blood glucose range.

Creating trending blood patterns

Jenny says: “It uses a patented skin patch sensor that measures your glucose levels via the interstitial fluid that surrounds the cells.

Currently, users will calibrate the system by making one fingerpick test a day, but this is far less than would be necessary using non-continuous monitoring.

Education around healthy ranges

The aim is to educate members so that they can easily keep within their ideal blood glucose range and can quickly spot the high spiky patterns of blood glucose levels that can be dangerous.

MSW believes that using the CGM monitor for three to four days a month can be enough to help people to reverse the effects of Type 2 Diabetes and pre-diabetes as well as help high-risk individuals reduce their chances of developing the condition.

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One hundred years on from the first patient receiving insulin injections, scientists’ continued research is helping people with diabetes better manage their condition, reducing the burden of existing treatments and improving quality of life.

Diabetes has reached pandemic levels, with 537 million people living with diabetes worldwide. In the UK, 4.9 million people have diabetes, predicted to reach 5.5 million by 2030.

The daily challenge for anyone with diabetes is to maintain their blood glucose within a healthy target range. Even with gold standard insulins available today, there remains a need for faster acting insulins to counteract the swift rise in blood sugar that happens at mealtimes. This is important as time outside of the healthy target range leads to the serious disease complications associated with diabetes that bring long-term morbidity and healthcare costs.

The NHS spends at least £10 billion a year – about 10% of its entire budget – on diabetes, with almost 80% of it treating serious complications.

Driven by the obesity epidemic, a growing number of people with diabetes are becoming insulin resistant and to manage their blood glucose will often need multiple types of insulin and to inject large volumes more often, which is a heavy daily burden.

Once considered science fiction, technology now plays an increasing part in healthcare.

New treatment options

At Arecor Therapeutics, our scientists are developing faster acting and concentrated insulins to enable a new frontier in diabetes management. These offer the potential to better control blood glucose and can be used in ultra-concentrated formulations, enabling reduced injection volumes, fewer injections per day and the next generation of miniaturised insulin pumps.

Our faster acting insulins may also facilitate a fully closed loop artificial pancreas, a potentially life changing approach to living with diabetes. The NHS is conducting a 900-patient trial of this technology using a sensor to continually monitor blood sugar, and a pump to automatically adjust and deliver the insulin required. Ultra-rapid acting insulins will be a critical enabler to their success.

Once considered science fiction, technology now plays an increasing part in healthcare. Perhaps, 100 years on from that first insulin injection, artificial pancreas systems are no longer the unattainable Holy Grail of diabetes management.

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Chronic kidney disease is a common complication of type 2 diabetes, yet many patients and healthcare practitioners do not understand it.

There are now around 4.4 million people with type 2 diabetes (T2D) in the UK, including an estimated 1 million who are undiagnosed. About one in ten of the over 40s have it – and yet, there is still widespread misunderstanding of the disease’s complications.

“Many people, including some healthcare practitioners, don’t fully appreciate the complications that T2D often leads to,” says Dr Patrick Holmes, a GP who also works alongside the Primary Care Diabetes Society. He explains: “Diabetes is a serious condition where the blood glucose level of the body is too high. Over a long period, high glucose levels can lead to complications, including serious damage to the heart, eyes, feet and kidneys.”

Chronic kidney disease

“Chronic kidney disease (CKD) is already the leading cause of kidney failure in the UK and the leading cause of death among people with T2D,“ says Dr Holmes. Up to 40% of people with T2D could eventually develop CKD, which reduces kidney performance. This can increase the risk of cardiovascular events, such as heart attacks and strokes.

Most CKD symptoms do not appear until it is well-advanced and the rate of death from heart attacks and strokes increases as it progresses. People with T2D who develop CKD early in life can lose up to 16 years of their potential lifespan.

Early detection of CKD associated with T2D is key

There are ways to manage the progress of CKD, including eating healthily, staying fit and controlling blood pressure and blood sugar, plus cholesterol-reducing treatments. But management is more effective if started early.

We need more healthcare practitioners and patients to understand the importance of having both tests. Together they can detect CKD and tell us how quickly it will progress.

Importance of testing

For CKD associated with T2D, guidelines recommend using two main tests (eGFR and UACR) together to determine how well the kidneys are functioning and the level of damage (i.e., how much protein is leaking into the urine).

The eGFR (estimated glomerular filtration rate) is measured by a blood test, typically given to patients annually, while the UACR (urine albumin-to-creatinine ratio) requires a urine test, typically administered to only about 60% of patients each year. The two tests should be repeated after three months.

Dr Holmes says: “The shortfall in people with T2D taking the urine test is an issue, because it spots the development of CKD earlier than the blood test. By the time the blood test identifies CKD, about half the potential damage to the kidneys is done – and it cannot be reversed.

“We need more healthcare practitioners and patients to understand the importance of having both tests. Together they can detect CKD and tell us how quickly it will progress. Patients should ask about the tests and ensure they are repeated.”

Next steps

In the past GPs used to refer patients for dialysis once kidney function had dropped to 25% normal capacity, but a new tool called the Kidney Failure Risk Equation (KFRE), used in primary care can help predict which patients need hospital care. It takes into account a patient’s age, gender and the results of the urine and blood tests. Dr Holmes urges patients to ask about it.

A new website that allows patients and healthcare practitioners online access to the KFRE is now open. It’s aimed mainly at people with kidney function below 60% who already know the results of their blood and urine tests, but it can be accessed by anyone. “It tells you your risk of kidney failure in the next two to five years and whether a referral to a kidney specialist should be considered,” says Dr Holmes.

Saving lives, money – and cut carbon footprint

Understanding how to recognise and delay CKD progression in people with T2D can save lives, save money for the NHS from dialysis or transplants and contribute to the NHS’s carbon net zero goal.

“About 80% of the cost of type 2 diabetes to the NHS comes from dealing with complications – CKD is one of the costliest,” says Dr Holmes. “Greater awareness of CKD in type 2 diabetes benefits everyone.”

This article was developed and sponsored by Bayer.
PP-KER-GB-0152 / June 2022

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Skye, an adventurous 11-year-old Omnipod® user shares her experience identifying the signs of type 1 diabetes. She started her diabetes management during the global pandemic and faced a diagnosis challenge.

It can be easy to miss the signs and symptoms of diabetes. It’s even easier to miss them in the middle of a global pandemic, as Kelly Niblock and her daughter, Skye, know only too well. In fact, Skye became so poorly with undiagnosed type 1 diabetes that she developed severe diabetic ketoacidosis (DKA), a serious complication of the disease, which resulted in her being rushed to hospital.

Skye had been a bubbly, sports-loving 11-year-old. But in 2020, just as COVID-19 appeared and lockdowns and home-schooling began, she started to feel unwell. “The trouble was so many things were happening at the same time,” says Kelly. “Rather than being her usual active self, Skye became tired and would lay around watching television. That wasn’t like her. She also became anxious about everything — but I thought she was feeling isolated and depressed because of the pandemic.”

The tell-tale signs of type 1 diabetes that can be overlooked

When lockdown restrictions relaxed, Kelly tried to gee Skye up by taking her and her brothers out for walks. On one of these occasions, she noticed that Skye was constantly gulping down water. “Again, it was the hottest day of the year,” says Kelly. “So although the signs and symptoms were there, there was always another reason for them.”

It wasn’t until the week before Skye’s diagnosis in July 2020 that symptoms began to manifest more alarmingly. Skye started to complain of a headache and she needed to go to the toilet more frequently. “Then Skye complained that she couldn’t breathe properly, and we wondered if it was COVID-19,” says Kelly. “I said we should go to the hospital, but she said: ‘No, I think I’m all right.’”

Type 1 diabetes hasn’t stopped me from doing anything I want to do.

Skye Niblock

But later that night Skye began to projectile vomit, so Kelly immediately phoned 111, described Skye’s symptoms and was told that an ambulance was on its way. At the hospital, doctors immediately diagnosed type 1 diabetes — and it soon became clear that Skye’s DKA was extremely serious. “I asked a doctor if Skye was going to be OK and she didn’t give me a definite answer,” remembers Kelly. “She said: ‘This is a really dangerous situation and you’re very lucky to have got here when you did.’ If it had been five minutes later, Skye wouldn’t be here now.”

Managing diabetes with modern technology

Thankfully, Skye’s condition stabilised and she was told about type 1 diabetes. “I only knew about type 2,” says Skye, who is feeling like her old self again and approaching her 12th birthday. “So at first I was confused, then I got scared.” Initially, Skye had to get to grips with a new regime of healthcare, which involved constant finger pricking and injecting insulin regularly, which she often found inconvenient and uncomfortable.

However, she now manages her condition with some diabetes technology; a tubeless and wireless insulin pump called the Omnipod DASH® Insulin Management System. She showed me her Pod, which she was wearing discreetly under her upper arm*. Skye programmes the PDM (Personal Diabetes Manager) to deliver the insulin she needs in precise doses via the Pod. Apart from being more convenient, it means she rarely has to inject.

Skye is now living life to the full again. “Type 1 diabetes hasn’t stopped me from doing anything I want to do,” she says. Skye’s favourite hobbies are all possible, helped by her Omnipod DASH® System and her healthcare team. “I’ve figured out a way to do sports and everything I loved before.”

Text BoxKelly’s message for parents is that a diabetes diagnosis is daunting and overwhelming at first. “But management soon becomes second nature,” she says. “I made a promise to Skye that she would have the same life as everyone else. Diabetes can be a challenge, but it never stops us from having adventures.”

*The Pod has many approved sites on the body and site rotation is recommended.

INS-ODS-05-2022-00071 V1.0

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According to recent research, following a low calorie diet through meal replacements can contribute to sending type 2 diabetes into remission.

The ‘Diabetes Remission Clinical Trial’ (DiRECT study) has been investigating the impact of low-calorie diets on those living with type 2 diabetes. The latest findings have shown that over a third of people who took part are in remission two years after. Early results from another recent trial also show that remission may be possible for people with a BMI of 27 or less.

Potential benefits of low-calorie diets

Low calorie diets are designed to result in significant weight loss. This is because they help to reduce the levels of visceral fat (fat surrounding the liver, pancreas and other organs), which may improve pancreatic function and the production of insulin. Excessive amounts of visceral fat are associated with insulin resistance, so following a low-calorie diet may also prevent diabetes.

exante offer simple and convenient diet plans designed to help people reach their goals quickly, safely and effectively. With 27 vitamins and minerals in each meal replacement, the range is a perfect, nutritious option for weight loss, maintenance or even just a convenient meal on-the-go.

The wide range of bars, shakes, meals and even soups contain a third of our nutrient reference values and are packed with protein and fibre.

Since finding the plan, I’ve lost over 10 stone and now weigh 11 stone 7lbs.

Managing weight loss and diabetes

Christine explains how the 800 plan helped her lose weight: “Before I started exante, I was around 21 stone 13 lbs. I suffered with type 2 diabetes and high blood pressure which needed to be managed with a lot of medication.

“I knew I had lots of weight to lose before my diabetes worsened, I opted for the 800-calorie plan; with this plan I used three meal replacement products a day alongside a 200 calorie healthy meal or snack.

“Since finding the plan, I’ve lost over 10 stone and now weigh 11 stone 7lbs. I can’t describe how much of an impact it has had on my life; I’m so much more confident and happier in myself and I’m off all my medication. Better yet, I managed to put my type 2 diabetes into remission, something I never imagined could happen.”

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Updated NICE guidelines aim to help people with diabetes get access to the right technology, resources and information and improve the management of their condition.

Daniel Newman knows all about the challenges of living with type 1 diabetes: he was diagnosed with diabetes when he was just 10 years old.

Now, 25 years later, he serves as a patient representative on the committee that recently updated National Institute of Health and Care Excellence (NICE) guidelines regarding access to diabetes technology.

Whenever national guidelines are reviewed or developed, it’s vital to listen to the patients’ point of view, he insists. “Someone who has lived experience of a health condition has real, day-to-day insight to offer,” says Daniel. “That’s my function on the committee. Nevertheless, it’s a big responsibility to be involved with a prestigious organisation such as NICE, representing a community of people living with type 1 diabetes.”

The updated NICE guidelines recommend wider access to flash and continuous glucose monitoring (CGM) for people living with diabetes on the NHS. This technology — along with an insulin pump — has certainly revolutionised Daniel’s life. “I’d have been about 12 when I received my first glucose monitor,” he says. “Before that, I was still managing my diabetes with constant finger pricking and using test strips however now the process was quicker. The sensor I currently use is on the back of my upper arm which monitors my glucose levels. I can view my levels on my phone after scanning the sensor. The alarms on my sensor alert me when my levels are higher or lower than I’d like them to be.”

Challenges in accessing the right diabetes technology

Constant management of diabetes can be a weary and exhausting responsibility that either falls on those individuals living with the condition or their parents and carers, says Daniel. But technology such as flash glucose monitoring — where glucose levels are checked with a simple scan of a sensor placed on the back of the upper arm — makes management easier.

It’s a big responsibility to be involved with a prestigious organisation such as NICE, representing a community of people living with type 1 diabetes.

There are a number of barriers that still exist for those managing their diabetes. One being accessing this type of innovation, which isn’t always straightforward. Daniel points out that people from lower socioeconomic and/or ethnic minority backgrounds, or those who don’t speak English as their first language, may face significant challenges in accessing diabetes tech. “If you don’t know what is available to you, or how to get it, you can be at a disadvantage,” he says. “I’m hopeful that as policies have changed, the disadvantages will be removed too.

Stigma is another challenge faced by those living with type 1 or type 2 diabetes, admits Daniel. “There’s a blame culture around both types of diabetes — a feeling that a person somehow caused their own condition. That’s unfair. People need to better understand this condition, and also recognise that it isn’t just a physical condition. There is a mental and emotional aspect to it, which must also be taken into consideration.”

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Ellen Watson

Social Media content creator & Diabetes UK supporter

Two girls share their experiences of living with their diabetes and how their online presence has helped to connect people living with diabetes.

Q: When were you diagnosed with diabetes and how did you and your friends/family react?

Ellen – I was diagnosed with type 1 diabetes the week before I turned seven, so it wasn’t the best birthday present. I was very young but my mother is a nurse, so she fortunately noticed the symptoms I had (extreme thirst and irritability) and took me to the doctors. Due to my age, my family were devastated by the news as they feared my life could be very challenging.

Beth – I have a very different diagnosis story from Ellen as I was diagnosed at 20 years old. This was a huge shock for me as I was just entering my adult life when I received this diagnosis due to a temporary loss in vision. My family and friends have been so supportive and have made this journey so much easier.

Q: Once you were diagnosed, how quickly did you start sharing your diabetes journey online?

We both only began to share our diabetes journey together in October 2019 on TikTok, when it was an extremely new platform. We recorded a ‘night out’ transformation video, not related to our diabetes, which blew up due to our CGM (continuous glucose monitor) devices on our arms.

After the positive reaction, we decided to roll with it and that is how The Diabetic Duo was created. Since then we create fun, light-hearted, big sister advice-style videos for people with diabetes and their friends and families.

We hope we can inspire other people with diabetes to live their best lives!

Q: What have you found out about the diabetes community since teaming up online?

We never realised how huge the online diabetes community was until we began The Diabetic Duo. It is amazing to see how many people with diabetes are proudly living their lives online which we know massively helps others who are maybe struggling. We have both met amazing charities and organisations like Diabetes UK who provide amazing support and care for other people with diabetes.

Q: How do you hope to inspire others living with diabetes in the future?

We hope we can inspire other people with diabetes to live their best lives! Diabetes does not hold you back from your dreams. Yes, you do have to be more organised and make hundreds of extra decisions a day all while looking after your diabetes, but as long as you keep a positive attitude, nothing can stop you.

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Researchers show that vision loss due to diabetes can be largely prevented with culturally and linguistically appropriate information.

Many people with diabetes know that blindness is a major risk of uncontrolled diabetes. People of Asian and Black ethnicities, older people and those who have had diabetes for a long time, have an even higher risk.

It’s tempting to assume that the higher risk for South Asian and Black people is genetic in origin, but now we know it’s not necessarily the case.

Professor Shahina Pardhan, from the Vision and Eye Research Institute at Anglia Ruskin University says: “Our research shows that sight-threatening retinopathy is higher in South Asians, even when age and duration of diabetes are taken into account. We have shown that the high risk in South Asians and Black people is less genetic in nature and more to do with lifestyles. Once we knew this, we decided to research the causes and take action to tackle them.”

For people with diabetes, it is important that good diabetic control is maintained in order to reduce the risk of complications such as blindness. Regular retinal screening is also vital as it will reduce the risk of blindness by 60-90%.

Barriers preventing actions

Professor Pardhan explains: “We found that people of South Asian origin reported a number of barriers that influenced their capacity to maintain good diabetic control. These included lower awareness of the fact that uncontrolled diabetes increases the risk of blindness, as well as lower literacy around physical activity and diet.”

Very few patients who were at higher risk of diabetic-related blindness had attended the existing diabetic training programmes, citing language barriers and the fact that they were not culturally appropriate. Other barriers included a lack of awareness that diabetes could still be affecting the eyes despite good vision, as well as the idea that attending retinal screening appointments would lead to having to buy new spectacles.

“This suggests that the current diabetes training programmes are not ‘fit for purpose’ for everyone,“ says Professor Pardhan.

Creating a more accessible campaign

Professor Pardhan decided to launch a campaign programme to tackle the issue. She says: “We have worked with multi-disciplinary teams to develop linguistically appropriate video-based training programmes delivered in Urdu, Nepali and Hindi. Using community champions, these have been delivered at grassroot levels in mosques, community centres, temples and on radio and TV programmes in the UK and overseas. It is also used in hospitals on newly diagnosed people with diabetes.”

“To date they have helped over 125,000 people globally, by improving health literacy and changing behaviour, including improved uptake of retinal screening. Health literacy using culturally-appropriate training helps to reduce the risk of blindness due to diabetes.”

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There is an immense backlog facing diabetes care. We need to do more to help tackle it and make diabetes a greater priority within the healthcare agenda.

Diabetes cannot be switched on and off. It’s a serious condition and it is with you constantly. Imagine not being able to get the essential checks, care and support you need to get by day to day. Imagine not being able to get an appointment which could prevent you from developing a devastating, life-altering complication – a stroke or a heart attack, or a foot problem which could lead to amputation. A complication which could, ultimately, result in early death.

Yet that’s what some of the 4.9 million people living with diabetes in the UK are facing right now, due to a backlog in routine yet vital diabetes care caused by the COVID-19 pandemic.

It’s why we took our Diabetes Is Serious campaign to Parliament in April because, despite the tireless efforts of the NHS through the pandemic, something needs to be done – before it’s too late.

Just 36% of people with diabetes in England received all their recommended checks in 2020/21, compared with 57% in 2019-20.

Preventing the mounting crisis

Our latest report on the backlog, titled Recovering Diabetes Care: Preventing the Mounting Crisis, was informed by a survey of more than 10,000 people living with and affected by diabetes. It reveals:

• Almost half (47%) had experienced difficulties managing their condition in 2021.   
• We found 63% of people attributed this in part to not having sufficient access to their healthcare team, rising to 71% in the most deprived areas of the country.  
• One in six people reported no contact whatsoever about their diabetes with their healthcare team since before the pandemic.

These findings are backed up by NHS figures which show that just 36% of people with diabetes in England received all their recommended checks in 2020/21, compared with 57% in 2019-20.   

The lack of priority and urgency given to recovering diabetes care is, quite simply, not acceptable or sustainable. By speeding up recovery of diabetes care to make sure everyone gets the care and support they need, we can prevent longer-term harm, help more people to live well and address health inequalities.

Calling for change and support

Our key calls to UK Government are for them to support the urgent restoration of routine diabetes care, and to recommit to improving outcomes for people with and at risk of diabetes in the updated NHS Long Term Plan.

We’ll continue to press for this renewed focus on diabetes to get this essential, life-saving care back on track.

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