Monday 18 August 2008

Shocking new Figures - So what!


The extract below reproduced from Diabetes UK newsletter once again highlights the cost of diabetes to our friends and families. One in eight of us will die as a result of diabetes and its complications by 2010.

Statistics no longer shock us. The stock market has seen to that. Statistics and numbers no longer shock us. The price of fuel has seen to that. Statistics no longer shock us. Insane measurements of SATs and examination progress have seen to that.

How best can we address the cause of the epidemic of diabetes? Individual responsibility or Government intervention. Both even?


Here is a statistic- Don't eat processed food, do some light exercise every day, smile a little more and you will be 100% more likely to live a long and healthy life.

Is it really that simple? How do I start to exercise when I have never exercised? I can't afford organic food. I have no time to cook food, ready made food is easier. It's not easy for me to cook.


Australians seem to have worked the message of sunshine and cancer into the psyche - how can we do a similar thing with food, exercise and diabetes? There in lies the challenge.




"Shocking new statistics

11 August 2008

New figures by the Yorkshire and Humber Public Health Observatory reveal that more than one in ten (11.6 per cent) deaths among 20 to 79-year-olds in England can be attributed to diabetes. If current trends continue, one in eight (12.2 per cent) deaths among 20 to 79-year-olds will be attributable to the condition by 2010. This work is based on data that shows adults under 80 with diabetes are around twice as likely to die as those without the condition and women with diabetes have a greater increased risk of death compared to their male counterparts. Biggest health challenge“These new figures are truly alarming and confirm that diabetes is one of the biggest health challenges facing the UK today," Douglas Smallwood, Chief Executive of Diabetes UK. "There are currently 2.3 million people diagnosed with diabetes and more than half a million people are unaware they have the condition.“Good self-management, awareness, and improved access to specialist diabetes care services are crucial if we are to curb this growing health crisis and see a reduction in the number of people dying from diabetes and complications attributed to the condition.”Primary Care Trusts (PCTs) with the highest percentage of diabetes-attributable deaths are areas with a higher than average proportion of the population over 40 and where there are large numbers of over 40s of Asian and Black origin, who are at greater risk of developing Type 2 diabetes. These areas also have high levels of deprivation compared to PCTs with the lowest proportion of deaths.The percentage of diabetes-attributable deaths varied at PCT level from 9 per cent in Buckinghamshire to 17 per cent in Newham, East London.Data methodBy using a method that combines data from previous research studies and estimates of diabetes prevalence with population and mortality data, the work is able to provide a more accurate picture of the number of deaths attributable to diabetes than from routine sources which often fail to identify diabetes or diabetes-related complications as the principal cause of death.Whilst still around twice as likely to die as their peers without the condition, the number of deaths in the younger age groups is small compared to the older age groups."

Friday 1 August 2008

Diabetes the cause of 100 amputations each week

Diabetes UK today released some research showing that 100 people each week are undergoing amputations as a result of complications caused by their diabetes. mydiabetes.com will soon be available for patients with diabetes to learn more about their disease and to share their stories

Monday 28 July 2008

Stress, Men and Diabetes

This article posted by the BBC today discussed some scandinacian research into the increased risk of developing diabetes.
Stress, Sleepless Nights and anxiety in men all play their part in increasing the risk acording to the atricle. Good news for women is that there is no similar link for them!

Friday 25 July 2008

Fruit or Fruit Juice?

Interesting article in todays telegraph about the risk of fruit juice drinking and type II Daibetes.

Wednesday 23 July 2008

MRSA - Killer Superbug - Economics

There was a very interesting interview on Radio 5 live earlier today. I did not catch the name of the Professor being interviewed however I did catch the essence of his presentation and also a little gem he threw in at the end of the piece.
The conversation was about the use of antibiotics, their misuse and historic prescribing of antibiotics for viral infections. As patients we have adopted a we need a pill culture and the guests thrust was that as patients we need to accept that from time to time we must trust our bodies and let them heal themselves. Viral infections cannot be treated with antibiotics. The Professor believes that a simple diagnostic test that could be performed in the GP surgery identifying a bacterial or viral infection would be of immense benefit to patients and doctors.

The interview moved on to the problems of MRSA and the facts that the super bugs are getting stronger.

When questioned about the research on new drugs to beat MRSA the response was this, its probably not economical for the drug corporations to work on a remedy for MRSA. What they want to do is invent a blockbuster drug that great numbers of the population will need to take every day for the rest of their lives.

So the question for me is how do we as a people, or as a country, or indeed as mankind encourage our drug companies to solve some of the worlds health problems even though some diseases may not be as profitable as others, economically speaking of course.
I'll do some research tomorrow and find out the name of the interviewee.

Update

Professor Richard James - University of Nottingham

Sunday 20 July 2008

Restrictions for patients self testing blood glucose levels


Diabetes UK have the following position statement on patient self testing of blood glucose levels.

mydiabetes supports this stance and will in the near future be offering a sensible way forward to help both local health authority managers, budget holders, PCT's, practitioners and patients to achieve their joint goals.


Diabetes UK Position statement on self monitoring of blood glucose is;



People with Type 1 and Type 2 diabetes should have access to self-monitoring of blood glucose (SMBG) based on individual clinical need, type of diabetes, personal circumstances and informed consent - not on ability to pay. 95 per cent of diabetes care is self-care. As such, self-monitoring supported by education, is essential to inform the day-to-day lifestyle and treatment choices of individuals, as part of an integrated management strategy. Decisions about the type and frequency of self-monitoring should be made on a case-by-case basis and not on blanket decisions and removal of strips from prescriptions.
Diabetes is a life-long condition, and can have a profound impact on lifestyle, relationships, work, income, health, wellbeing and life expectancy. Clinical trials have demonstrated the value of tight glycaemic control to reduce the risk of costly and life threatening complications (1-7). Prolonged raised blood glucose levels are extremely detrimental to health, as it is associated with increased risk of heart disease, strokes, blindness, amputations and kidney disease (8-10).
National guidelines and frameworks set the standards of care that people with diabetes should expect and prioritise information, education, training and support to enable people to manage their diabetes themselves (11-19). SMBG, by blood and/or urine testing, combined with education, provides information for people with Type 1 and Type 2 diabetes to make day-to-day decisions about food, physical activity and treatment to maintain optimum control of blood glucose.
The debate
It is generally recognised that routine SMBG is beneficial, when supported with education, for all people with Type 1 diabetes and those with Type 2 diabetes using insulin (12,18-21). The debate largely focuses on the clinical and cost effectiveness of SMBG for people with non-insulin treated diabetes (22,23,24 ).
The Health Technology Assessment Review (25) was not supportive of SMBG, owing to a lack of evidence for clinical or cost effectiveness, particularly in relation to those with Type 2 diabetes. National Institute for Health and Clinical Excellence (NICE) guidelines for Type 2 diabetes state that self-monitoring be used as part of an integrated package of care in conjunction with appropriate therapy and education (13,12). The guidelines focus on the use of HbA1c to give a picture of overall control and for that control to be stable. It is however difficult to make recommendations and take action on treatment and lifestyle adjustment, without at least some form of home monitoring. To use the guideline as a basis to restrict access is a misinterpretation and was not the intention of the Guideline Development Group.
Current evidence is either lacking or contradictory. It can be argued that this is due to the limitations of the trials undertaken to date and the lack of focus on patient preferences. Sound evidence is needed to review all the factors contributing to optimum blood glucose management and its relationship to and with self-monitoring over time. This needs to include effects of education, actions taken by those self-monitoring, motivation, behaviour change, and patient related outcomes such as quality of life, well-being and satisfaction (26). The current lack of evidence does not mean that SMBG is not effective for those not treated by insulin, it just means that there is no evidence. Research commissioned by Diabetes UK, and others, is in progress.
Costs and benefits
In 2001 the UK spent approximately £90 million on self-blood glucose monitoring (27). It has been cited that more is spent on testing strips than on oral glycaemic agents. The implication being that this is not a good use of resources. This does not consider that for some people with diabetes, being able to monitor blood glucose levels may be as beneficial to them as taking the medication. In order not to waste resources it is important that people with diabetes are able to utilise self-monitoring effectively through diabetes education. Without the education to know when and how to test, and what to do with the results, there is little point in self-monitoring. It is short-sighted to look to reducing costs through restrictive policies that prevent people from having the information they need to self-care. This is likely to result in increased prevalence of complications, costs to society and individuals themselves.
Considerable cost savings and improvements in quality of life are to be made from supporting people with diabetes to self care, in line with health policy, including improved health and well-being, prevention of unnecessary hospital admissions, and reduced frequency of support from the NHS (28). People with diabetes do generally take on board the issues of cost and should use blood glucose testing responsibly and appropriately. Evidence has shown that SMBG is beneficial to, and valued by, people with diabetes to:
enable better management of short and longer term metabolic control (12, 23,29-35) assisting in the prevention of short and long term complications (36)
monitor effectiveness of medication, eating and physical activity on blood glucose levels (35-38, 43)
help to maintain or improve motivation for managing diabetes (38,43)
provide reassurance and reducing anxiety and fear of hypoglycaemia (30,37)
improve feelings of confidence and control over their own diabetes (30,37).
Local restrictions
An increasing number of people with diabetes are reporting restrictions or denial of blood glucose testing equipment causing distress and anger among those who rely on these tools to self-manage their diabetes (39). 27 per cent of PCTs in England (40) report the existence of a policy restricting the provision of blood glucose test strips for people with diabetes.
Actions
Decisions about blood glucose monitoring should be made on a case-by-case basis and not by blanket removal of strips from prescriptions or local restrictive policies. Local guidelines should be in place to encourage healthcare professionals to work in partnership with individuals with diabetes to inform them of the role that SMBG plays in self-management.
Increased awareness is needed of the importance of people with diabetes being able to access appropriate tools and support to manage their own diabetes.
Diabetes care teams should discuss the advantages and disadvantages of monitoring either by blood or urine, at diagnosis to enable people with diabetes to make informed choices. Those choosing to monitor their blood glucose should do so as part of an integrated package of care as defined in national guidelines.
Training and education should be provided about testing methods, how to interpret results and how to use results to adapt diet, lifestyle and medication to achieve optimum control (41-43). Methods and frequency of testing should be jointly agreed between the person with diabetes and healthcare professional through care planning. Any changes or reviews must only be made through discussion with, and agreement of, the person with diabetes.
This position should be interpreted as the basis upon which discussions are initiated about whether a person with diabetes wishes to or should monitor their blood glucose levels. The decision should be jointly agreed between the person with diabetes and their own healthcare team.