NHS spends around £3bn a year on ‘avoidable’ treatment for diabetes

ITV | September 2019 | NHS spends around £3bn a year on ‘avoidable’ treatment for diabetes

An analysis of hospital treatment in 2017/18 highlights that approximately £5.5bn each year is spent on treatment of diabetes, of this an estimated £3bn is on ‘potentially avoidable’ treatment. The authors of the research explain that this equates to around one-tenth of the NHS budget; compared to people without diabetes, the average annual cost of planned care was over twice as high for those with Type 2 diabetes and the average cost of emergency care was three times higher, once age was taken into account.

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Study author, Dr Adrian Heald from Salford Royal Hospital, said: “People with diabetes are admitted to hospital more often, especially as emergencies, and stay on average longer as inpatients.

“These increased hospital costs, 40% of which come from non-elective and emergency care, are three times higher than the current costs of diabetes medication.

“Improved management of diabetes by GPs and diabetes specialist care teams could improve the health of people with diabetes and substantially reduce the level of hospital care and costs.” (Source: ITV News)

The team’s finding will be presented this week at the European Association for the study of Diabetes (EASD)  annual meeting in Barcelona.

Read the full story from ITV News

See also:

BT NHS spends around £3bn a year on ‘avoidable’ treatment for diabetes

 

NICE: Dapagliflozin with insulin for treating type 1 diabetes

NICE | August 2019| Dapagliflozin with insulin for treating type 1 diabetes

Today (28 August 2019) has published  final guidance on an innovative treatment for type 1 diabetes. Dapagliflozin is the first licenced oral add-on therapy to insulin in type 1 diabetes

Dapagliflozin (brand name Forxiga) with insulin is available on the NHS. It is a possible treatment for type 1 diabetes in adults with a body mass index (BMI) of at least 27 kg/m2, when insulin alone does not control blood sugar levels well enough, if:

  • you are on insulin doses of more than 5 units per kilogram of body weight per day and
  • you have done a structured education programme that includes information about diabetic ketoacidosis, and
  • treatment is started and supervised by a consultant physician specialising in endocrinology and diabetes.

Further details are available from NICE

Fish oil pills ‘no benefit’ for type 2 diabetes

Brown, T., Brainard, J., Song, F., Wang, X., Abdelhamid, A. & Hooper, L. | 2019| Omega-3, omega-6, and total dietary polyunsaturated fat for prevention and treatment of type 2 diabetes mellitus: systematic review and meta-analysis of randomised controlled trials | BMJ|  366 | l4697|  doi: https://doi.org/10.1136/bmj.l4697 :

Research that investigated whether omega-3 and other fatty acids were beneficial to people with type 2 diabetes has found that increasing long chain omega-3 intake had little or no effect on diagnosis or glucose metabolism; the study’s authors also report that there may be  negative outcomes at high dose. 

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Abstract

Objective To assess effects of increasing omega-3, omega-6, and total polyunsaturated fatty acids (PUFA) on diabetes diagnosis and glucose metabolism.

Design Systematic review and meta-analyses.

Data sources Medline, Embase, Cochrane CENTRAL, WHO International Clinical Trials Registry Platform, Clinicaltrials.gov, and trials in relevant systematic reviews.

Eligibility criteria Randomised controlled trials of at least 24 weeks’ duration assessing effects of increasing α-linolenic acid, long chain omega-3, omega-6, or total PUFA, which collected data on diabetes diagnoses, fasting glucose or insulin, glycated haemoglobin (HbA1c), and/or homoeostatic model assessment for insulin resistance (HOMA-IR).

Data synthesis Statistical analysis included random effects meta-analyses using relative risk and mean difference, and sensitivity analyses. Funnel plots were examined and subgrouping assessed effects of intervention type, replacement, baseline risk of diabetes and use of antidiabetes drugs, trial duration, and dose. Risk of bias was assessed with the Cochrane tool and quality of evidence with GRADE.

Results 83 randomised controlled trials (mainly assessing effects of supplementary long chain omega-3) were included; 10 were at low summary risk of bias. Long chain omega-3 had little or no effect on likelihood of diagnosis of diabetes or measures of glucose metabolism. A suggestion of negative outcomes was observed when dose of supplemental long chain omega-3 was above 4.4 g/d. Effects of α-linolenic acid, omega-6, and total PUFA on diagnosis of diabetes were unclear (as the evidence was of very low quality), but little or no effect on measures of glucose metabolism was seen, except that increasing α-linolenic acid may increase fasting insulin (by about 7%). No evidence was found that the omega-3/omega-6 ratio is important for diabetes or glucose metabolism.

Conclusions This is the most extensive systematic review of trials to date to assess effects of polyunsaturated fats on newly diagnosed diabetes and glucose metabolism, including previously unpublished data following contact with authors. Evidence suggests that increasing omega-3, omega-6, or total PUFA has little or no effect on prevention and treatment of type 2 diabetes mellitus.

Systematic review registration PROSPERO CRD42017064110.

 

The full article is available from the  BMJ

In the news:

BBC News Fish oil pills ‘no benefit’ for type 2 diabetes

Using pharmacists to help improve care for people with type 2 diabetes

drug-1674890_1280The Royal Pharmaceutical Society (RPS) has published Using pharmacists to help improve care for people with type 2 diabetes.  This document is aimed at policy makers and education/service commissioners within the NHS in England and makes recommendations for how pharmacists can play an increasing role in the prevention, early detection, care and support of people with type 2 diabetes.

To improve care for people with type 2 diabetes, the RPS are calling for:

  1. Pharmacists should work in collaboration with other healthcare professionals to play a greater role in prevention and detection services for type 2 Diabetes
  2. Pharmacists should play an active role in optimising medicines, improving the health, wellbeing and safety of people with type 2 diabetes across the NHS
  3. Pharmacists in specialist and generalist roles should be given access to the most up to date education and training to support people with multiple conditions
  4. NHS organisations need to establish and embed the role of consultant pharmacists in diabetes across the NHS should ensure improved outcomes in the management of people with type 2 diabetes, promote collaborative practice, multidisciplinary team working, quality improvement and research.

Full detail at Royal Pharmaceutical Society

See also: Pharmacists must be integrated into diabetes care | RPS press release

Insulin Safety Week: National campaign promotes insulin safety

Diabetes Times | May 2019 | National campaign promotes insulin safety

This week to mark Insulin Safety Week (20-26 May 2019) over 500 diabetes teams predominantly in hospitals from the UK and Ireland  will promote the message of insulin safety. 

According to the results from the latest National Diabetes Inpatient Audit, extrapolated by the Diabetes Times, two in five people with diabetes on insulin (40 per cent) experience an error related to the administration of the drug while in hospital.

In response, the seven-day awareness campaign in an attempt to reduce incidents of insulin errors as part of Insulin Safety Week.

A total of 343 sites, mainly hospitals and GP surgeries, took part in the first-ever national Insulin Safety Week in May 2019, building on interest generated by successful local campaigns across the country in 2017, including in Leicester, Hastings, Eastbourne and Southampton.

Full, unabridged story from Diabetes Times

National diabetes audits

The Healthcare Quality Improvement Partnership has published the results of the following audits relating to diabetes:

NPDA
Image source: http://www.hqip.org.uk
  • National Paediatric Diabetes Audit: annual report 2017-18: care processes and outcomes – provides an analysis of data for children and young people with diabetes including information on prevalence of diabetes, diabetes-related outcomes and complications, compliance with health care checks and recommendations for improvements in care
  • National Diabetes Inpatient Audit – measures the quality of diabetes care provided to people with diabetes while they are admitted to hospital.  The results are presented in two reports covering the hospital characteristics survey and serious inpatient harms

Additional links: NHS Digital – National Diabetes Inpatient Audit (NaDIA) – 2018 | NHS Digital National Diabetes Inpatient Audit – Harms, 2018

Additional link: NHS Digital – National Diabetes Foot Care Audit, 2014-2018

Patients on NHS type 2 diabetes prevention programme lose almost 60,000kg between them

NHS England | April 2019 | Patients on NHS type 2 diabetes prevention programme lose almost 60,000kg between them

New figures released by NHS England show that the 17 000 participants of the diabetes prevention programme (DPP), lost on average 3.4 kg. This is more than 1 kg than they were predicted to lose.

The programme  provides advice on dieting, exercise and healthy lifestyle, is being doubled in size over the next few years to treat around 200,000 people annually as part of the NHS Long Term Plan’s renewed focus on prevention.

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The diabetes prevention programme is set to expand further in July this year as wearables and apps will enable patients who cannot attend DPP sessions due to work and family commitments, to participate online.

DPP is designed to stop or delay onset of Type 2 diabetes through a range of personalised lifestyle interventions, including:

  • education on lifestyle choices
  • advice on how to reduce weight through healthier eating
  • bespoke physical activity programmes (Source: NHS England)

Professor Jonathan Valabhji, NHS England national clinical director of diabetes and obesitysaid: “Around two thirds of adults and one third of children are now overweight or obese, driving higher and higher rates of Type 2 diabetes that we are now focusing huge efforts to address, as outlined in the NHS Long Term Plan.

“I’m delighted that our work so far in this area has been producing really positive results. This weight loss is promising – and we hope to help many more of those who are at risk of Type 2 diabetes to not get it in the first place.”

Full story from NHS England 

In the news:

OnMedica Weight loss targets exceeded on NHS type 2 diabetes prevention programme