New data shows NHS weight loss programme enables patients to lose half a stone

NHS England | Flagship NHS Type 2 Diabetes Prevention Programme exceeds expectations as patients shed the weight of 15 double cheese burgers |

A flagship diabetes prevention programme supporting overweight patients to lose weight has exceeded expectations with over half of the participants losing eight pounds. Results published from the first wave of the scheme show patients were half a stone lighter (3.17kg) if they completed the majority of sessions during the nine month programme. However, when those with a normal weight and BMI but on the programme due to other health and lifestyle risks associated with developing Type 2 diabetes, this increased to 3.7kg.

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Image source: NHS England

Since the programme began  three years ago, over 154,000 people have been referred, with around 66,000 of these taking up places. The programme has attracted a higher proportion of male patients than typically attend such weight loss programmes.

In addition, a further 5,000 people are also expected to benefit from a recently launched digital support to patients.  The pilot project comprises five companies and eight areas of the country are test driving a range of apps, gadgets, wristbands and other innovative digital products.

Professor Jonathan Valabhji, National Clinical Director for Diabetes and Obesity, at NHS England said: “While it is early days, this data from several thousand people is very promising. Not only is our prevention programme exceeding the initial targets set for referrals and equity of access, what we are now starting to see is the first set of encouraging weight loss results too. Type 2 diabetes is heavily linked to obesity and if those on our programme continue to lose weight, as this snapshot suggests, then it is a step in the right direction and this programme can be an effective part of the solution.”

The full news story is available from NHS England here 

More information on the Digital Prevention Programme can be found at NHS England 

Diabetes diagnosis has doubled since 1998

The incidence of diabetes has doubled in the last twenty years according to figures released by Diabetes UK, the leading UK diabetes charity.   This analysis shows 1.9 million more people living with a diagnosis of the condition in the UK, since 1998.  The number of individuals diagnosed with Type 1 or Type 2 diabetes has increased by almost 100,000 since last year to 3,689,509.   (Diabetes UK)

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Image source: diabetes.org.uk

Nationally, 6.6 per cent of the population live with the condition.  In Bradford, West Yorkshire over 1 in 10 people have diabetes, this is  the highest incidence  according to the figures. Richmond, London had the lowest at 3.6 per cent.

Diabetes UK calls on the Government to introduce stricter restrictions on junk food advertising to children and on supermarket promotions of unhealthy foods. Chief Executive Chris Askew said: “We want the Government to recognise the seriousness of the growing diabetes crisis, take action to help those at increased risk, and help us turn the tables on this devastating condition.”

To support this Diabetes UK partners the NHS Diabetes Prevention Programme in England. This programme supports adults who are at high risk of Type 2 diabetes to make lifestyle changes that could reduce their risk.

The full news story can be read at Diabetes UK 

Related:

The Royal College of General Practitioners  Doubling of diabetes cases could reflect better early diagnosis, but is still ‘dramatic and disappointing’, says RCGP

 

In the media:

The Guardian: Diabetes diagnoses have more than doubled in 20 years, UK analysis suggests

The Pharmaceutical Journal:  Diabetes diagnoses have almost doubled in the last 20 years, says leading UK charity

 

Obesity and diabetes both linked to caner

Diabetes and high BMI are leading causes of death and ill health globally and are on the increase in most countries. In 2014 9% of men and 8% of women worldwide had diabetes; 38.5% of men and 39.2% of women had high Body Mass Index (BMI), a figure equivalent to approximately 2 billion adults. 

A high BMI was responsible for almost twice as many cancers as diabetes. Over 5% of cancers worldwide were attributable to diabetes or high BMI in 2012, it is estimated that this proportion may increase by 25% by 2035 as a result of the global increase in obesity. 

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For countries such as the UK, an estimated 15% to 16% of cancers could be avoided by preventing diabetes, obesity or excess weight (defined as a BMI  greater than 25). A high BMI was responsible for almost twice as many cancers as diabetes.

Although the links between high BMI, diabetes and cancer have been known for some time, this study presents the first calculations of attributable risk for 175 countries. This represents the proportion of cancers that could be prevented if the risk factors were eliminated.  (The National Institute of Health Research NIHR)

The abstract is taken from NIHR

Abstract
Background
Diabetes and high body-mass index (BMI) are associated with increased risk of several cancers, and are increasing in prevalence in most countries. We estimated the cancer incidence attributable to diabetes and high BMI as individual risk factors and in combination, by country and sex.

Methods We estimated population attributable fractions for 12 cancers by age and sex for 175 countries in 2012. We defined high BMI as a BMI greater than or equal to 25 kg/m2. We used comprehensive prevalence estimates of diabetes and BMI categories in 2002, assuming a 10-year lag between exposure to diabetes or high BMI and incidence of cancer, combined with relative risks from published estimates, to quantify contribution of diabetes and high BMI to site-specific cancers, individually and combined as independent risk factors and in a conservative scenario in which we assumed full overlap of risk of diabetes and high BMI. We then used GLOBOCAN cancer incidence data to estimate the number of cancer cases attributable to the two risk factors. We also estimated the number of cancer cases in 2012 that were attributable to increases in the prevalence of diabetes and high BMI from 1980 to 2002. All analyses were done at individual country level and grouped by region for reporting.

Findings We estimated that 5·6% of all incident cancers in 2012 were attributable to the combined effects of diabetes and high BMI as independent risk factors, corresponding to 792 600 new cases. 187 600 (24·5%) of 766 000 cases of liver cancer and 121 700 (38·4%) of 317 000 cases of endometrial cancer were attributable to these risk factors. In the conservative scenario, about 4·5% (626 900 new cases) of all incident cancers assessed were attributable to diabetes and high BMI combined. Individually, high BMI (544 300 cases) was responsible for twice as many cancer cases as diabetes (280 100 cases). 26·1% of diabetes-related cancers (equating to 77 000 new cases) and 31·9% of high BMI-related cancers (174 040 new cases) were attributable to increases in the prevalence of these risk factors from 1980 to 2002.

Interpretation A substantial number of cancer cases are attributable to diabetes and high BMI. As the prevalence of these cancer risk factors increases, clinical and public health efforts should focus on identifying optimal preventive and screening measures for whole populations and individual patients.

Full reference:  Pearson-Stuttard, J. et al |Worldwide burden of cancer attributable to diabetes and high body mass index: a comparative risk assessment|The Lancet Diabetes & Endocrinology|2017

The article can downloaded from The Lancet here 

Type 2 diabetes can be reversed with very low-calorie diet

Study shows that it is possible to achieve remission from type 2 diabetes by dieting | The Lancet | via National Institute for Health Research

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Type 2 diabetes is a growing epidemic, costing the NHS £23.7 billion per year. By 2016 there were nearly 3.6 million people diagnosed with diabetes in the UK and a further one million estimated to have undiagnosed type 2 diabetes. Rates of diabetes appear to be increasing.

This study aimed to see if a very low-calorie diet program delivered in primary care could lead to at least 15kg weight loss and remission of type 2 diabetes.

The study found that by 12 months:

  • Weight loss of 15kg or more was achieved by 24% of the intervention group compared to none of the usual care group. Average weight loss was 10kg in the intervention group versus 1kg in the usual care group.
  • Diabetes remission occurred in 46% of the intervention group compared to 4% of the usual care group. It only occurred in people who had lost weight.
  • Remission was 20 times more likely with the intervention.
  • Better adherence to the regime increased the amount of weight loss and the chance of diabetes remission.
  • Diabetes medication did not need to be reintroduced for 74% of the intervention group. This was compared to 18% of the usual care group who were able to stop them. Blood pressure tablets were also no longer required for 68% of the intervention group compared to 39% of the usual care group.

Full reference: Lean MEJ, Leslie WS, Barnes AC, et al. |  Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial.  | Lancet. 2017. [Epub ahead of print].

A new mechanism for regulating glucose uptake by the liver has implications for type 2 diabetes and its treatment

 Japanese researchers have  identified a sirtuin enzyme (Sirt2) as a key player in regulating hepatic glucokinase. 

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Abnormalities in glucose uptake by the liver (or hepatic glucose uptake; HGU) cause elevations in blood glucose levels following meals, a state that is known as postprandial hyperglycemia. Such abnormalities are observed in obesity and type 2 diabetes and result in an increased risk of cardiovascular complications. Although the exact mechanism of HGU impairment is unknown, there is evidence that it is mediated by abnormal regulation of the enzyme hepatic glucokinase and the glucokinase regulatory protein (GKRP).

 

This new  research shows that diminished hepatic Sirt2 activity impairs HGU in obese diabetic mice.  Through modifying the glucokinase regulatory protein (GKRP,)  the researchers suggest that this mechanism offers a potential therapeutic target for type 2 diabetes.

Full story at Science Daily

 

The full text article is available from Nature Communications

Full reference: Watanabe, H., et al.|Sirt2 facilitates hepatic glucose uptake by deacetylating glucokinase regulatory protein| Nature Communications|Vol. 9| 30| 2018 | doi:10.1038/s41467-017-02537-6

 

NHS Diabetes Prevention Programme

A report published in the journal Diabetic Medicine indicates the ‘Healthier You: Diabetes Prevention Programme’ has signed up significantly more people than expected.  Progress of the Healthier You: NHS Diabetes Prevention Programme: referrals, uptake and participant characteristics summarises the positive impact made by the programme during the early phase of its roll-out.  Characteristics of attendees suggest that the programme is reaching those who are both at greater risk of developing Type 2 diabetes and who typically access healthcare less effectively. Additional link: NHS England press release