Why gluten-free food is not the healthy option and could increase your risk of diabetes

New research from Harvard University has found a link between gluten-free diets and an increased risk of developing type 2 diabetes | Brown, J. for The Conversation

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Image source: Whatsername? – Flickr // CC BY-SA 2.0

There is evidence that the popularity of gluten-free diets has surged, even though the incidence of coeliac disease has remained stable. This is potentially due to increasing numbers of people with non-coeliac gluten sensitivity. In these cases, people exhibit some of the symptoms of coelaic disease but without having an immune response. In either case, avoiding gluten in foods is the only reliable way to control symptoms, which may include diarrhoea, abdominal pain and bloating.

Without any evidence for beneficial effects, many people without coeliac disease or gluten sensitivity are now turning to gluten-free diets as a “healthy” alternative to a normal diet. Supermarkets have reacted to meet this need by stocking ever growing “free from” ranges. The findings of this recent study, however, suggest that there could be a significant drawback to adopting a gluten-free diet that was not previously known.

Read the full blog post here

Read the original research abstract here

National Diabetes inpatient audit

The Healthcare Quality Improvement Partnership has published National Diabetes Inpatient Audit, England and Wales 2016.

The report finds that the prevalence of all hypoglycaemic episodes in hospital, both mild and severe, has decreased from 26 per cent in 2011 to 20 per cent in 2016. It also highlights that there has been an overall reduction in the prevalence of the most severe, life-threatening hypoglycaemia which requires injectable rescue treatment for inpatients with diabetes. This has fallen from 2.2 per cent in 2011 to 1.7 per cent in 2016.

Full report and findings available here

Transformation fund call to bid

To support the implementation of the Five Year Forward View vision of better health, better patient care and improved NHS efficiency, NHS England has created a transformation fund | NHS England

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The interventions for which transformation funding are available are:

Sustainability and Transformation Plans (STPs) are central to this process and all bids should be explicitly linked to the relevant local STP plans. This process is open to any STP, although individual organisations or alliances may bid on behalf of an STP for this funding; submission of applications must be via STPs.

Read the full overview here

Diabetes UK nursing survey

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Diabetes UK has published Diabetes specialist nursing 2016 workforce survey: a workforce in crisis.   This survey found that nearly four out of five Diabetes Specialist Nurses (78%) voiced concerns that their workload is having an impact on patient care and/or safety and almost four in ten respondents (39%) said they considered their current caseload ‘unmanageable’.

Additional link: Royal College of Nursing

Treatment adherence, thresholds for intervention and disparities in treatment in people with type 2 diabetes

McGovern, A. et al. (2016) BMJ Open. 6:e012801

Purpose: The University of Surrey-Lilly Real World Evidence (RWE) diabetes cohort has been established to provide insights into the management of type 2 diabetes mellitus (T2DM). There are 3 areas of study due to be conducted to provide insights into T2DM management: exploration of medication adherence, thresholds for changing diabetes therapies, and ethnicity-related or socioeconomic-related disparities in management. This paper describes the identification of a cohort of people with T2DM which will be used for these analyses, through a case finding algorithm, and describes the characteristics of the identified cohort.

Findings to date: A cohort (N=58 717) of adults with T2DM was identified from the RCGP RSC population (N=1 260 761), a crude prevalence of diabetes of 5.8% in the adult population. High data quality within the practice network and an ontological approach to classification resulted in a high level of data completeness in the T2DM cohort; ethnicity identification (82.1%), smoking status (99.3%), alcohol use (93.3%), glycated haemoglobin (HbA1c; 97.9%), body mass index (98.0%), blood pressure (99.4%), cholesterol (87.4%) and renal function (97.8%). Data completeness compares favourably to other, similarly large, observational cohorts. The cohort comprises a distribution of ages, socioeconomic and ethnic backgrounds, diabetes complications, and comorbidities, enabling the planned analyses.

Read the full abstract and article here

NICE recommends new triple therapy option for type 2 diabetes

Wise, J. (2016) BMJ.355:i5472

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Image source: NICE

Dapagliflozin (marketed as Forxiga) has been recommended as part of triple therapy for patients with type 2 diabetes, giving doctors another prescribing option for patients with uncontrolled blood sugar.

Draft guidance from the National Institute for Health and Care Excellence (NICE) has recommended dapagliflozin in combination with metformin and a sulfonylurea as an option for treating type 2 diabetes in adults. NICE said that it had fast tracked appraisal of the drug so that final guidance could be published sooner and benefit people more quickly.

Dapagliflozin is already recommended as monotherapy when metformin is contraindicated and as dual therapy with metformin. It is a selective sodium glucose cotransporter 2 (SGLT-2) inhibitor, which blocks reabsorption of glucose in the kidneys and promotes excretion of excess glucose in the urine. Two other drugs in the same class, empagliflozin and canagliflozin, are already recommended for triple therapy.

The clinical experts said that in addition to lowering HbA1c, SGLT-2 inhibitors also lowered blood pressure. Another benefit of the SGLT-2 inhibitors was weight loss, they said. This is particularly important given the strong association between type 2 diabetes and excess body weight, and some treatments, such as insulin, can also result in weight gain.

Read the full commentary here

Read the draft NICE guidance here

I Should but I Can’t: Controlled Motivation and Self-Efficacy Are Related to Disordered Eating Behaviors in Adolescents With Type 1 Diabetes

Eisenberg, M.H. Journal of Adolescent Health. Published online: August 2016

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Purpose: Among adolescents with type 1 diabetes, disordered eating behaviors (DEBs) are more prevalent and have more serious health implications than in adolescents without diabetes, necessitating identification of modifiable correlates of DEB in this population. This study hypothesized that (1) autonomous motivation and (2) controlled motivation for healthy eating (i.e., eating healthfully because it is important to oneself vs. important to others, respectively) are associated with DEB among adolescents with type 1 diabetes. The third hypothesis was that baseline healthy eating self-efficacy moderates these associations.

Methods: Adolescents with type 1 diabetes (n = 90; 13–16 years) participating in a behavioral nutrition intervention efficacy trial reported DEB, controlled and autonomous motivation, and self-efficacy at baseline, 6, 12, and 18 months. Linear-mixed models estimated associations of controlled and autonomous motivation with DEB, adjusting for treatment group, body mass index, socioeconomic status, age, and gender. Separate models investigated the interaction of self-efficacy with each motivation type.

Results: Controlled motivation was positively associated with DEB (B = 2.18 ± .33, p < .001); the association was stronger for those with lower self-efficacy (B = 3.33 ± .55, p < .001) than those with higher self-efficacy (B = 1.36 ± .36, p < .001). Autonomous motivation was not associated with DEB (B = −.70 ± .43, p = .11).

Conclusions: Findings identify controlled motivation for healthy eating as a novel correlate of DEB among adolescents with type 1 diabetes and show that self-efficacy can modify this association. Motivation and self-efficacy for healthy eating represent potential intervention targets to reduce DEB in adolescents with type 1 diabetes.

Read the abstract here