Diabetes News

DIABETES NEWS Amanda Veall / Claire Holme DSN Team Cornwall

Low CHO DVLA Remission Information Prescribing Digital Libre what do we know? Hot off the press What's coming ? Low CHO

DVLA August 2018 clarification of sleep/awake hypos Group 1 drivers do not need to report nocturnal hypos unless concern regarding hypo awareness Group 2 driver Do need to report all episodes of severe hypos requiring the assistance of another including nocturnal hypos Feb 2019 Interstitial Glucose Monitors (Flash and CGM) Group 1 May use these systems at times relevant to driving but must confirm with a finger prick test when the glucose level is 4.0 mmol/L or below when symptoms of hypoglycaemia are being experienced when the glucose monitoring system gives a reading that is not

consistent with the symptoms being experienced Group 2 interstitial fluid glucose monitoring systems are not permitted for the purposes of Group 2 driving and licensing DIABETES REMISSION March 2019 ABCD and PCDS position statement on diabetes remission Groups called for consistent coding and to use remission not diabetes resolved Person with diagnosed Type 2 diabetes needs to meet the 3 following criteria: 1. Weight loss

2. Fasting plasma glucose , < 7 mmol/l or HbA1C <48 on 2 occasions separated by at least 6 months 3. Achieve 1 & 2 following the complete cessation of all glucose lowering therapies Where type 2 diabetes is associated with weight gain or obesity, remission in type 2 diabetes can be achieved through several means and all require a sustainable weight loss. This is particularly true in the early stages of type 2 diabetes when irreversible damage to the beta cell has not happened. Once achieved, remission must be sustained to gain the full health benefits. Of the various strategies shown to be effective, weight loss through bariatric surgery or low calorie diet, remain the most successful methods. Both require ongoing sustained

modest restriction of energy intake and increase in daily physical activity. The groups acknowledge that weight loss achieved by any means, including unintentional weight loss, may contribute to remission of type 2 diabetes. Implicit in defining remission is that biochemical parameters must have been achieved and maintained following the discontinuation of all glucose-lowering therapies. It is important, that in those individuals who achieve and sustain remission, robust systems are in place to call and recall these individuals for annual review and that primary care is adequately resourced to facilitate this Information Prescribing Providing patients with their own information Diabetes UK information prescriptions: Emis,

Vision, Systm One BP Cholesterol HbA1C Emotions Improving your diabetes knowledge Keeping your kidneys healthy Kidney Disease Contraception and pregnancy Feet (low, moderate/high risk) Remission https://

www.diabetes.org.uk/professionals/resources/resources-to-improve-y our-clinical-practice/information-prescriptions-qa What does the future look like ? Medication that didnt exist 10 years ago Companies that didnt exit 20 years ago Technology that didnt exist 10 years ago Generation that access

information very differently Facebook Netflix .. Fasted growing TV network Apps Genomic medicine Workforce issues Some specialities moving from computer review to computer diagnosis

Digital Road Map Digital diabetes NHS Type 1 Diabetes Resource on line - includes videos for injecting / monitoring / driving / hypos https://www.nhs.uk/conditions/type-1-diabetes/ NHS TYPE 2 Diabetes Resource on line https://www.nhs.uk/conditions/type-2-diabetes/ Torbay / Kernow CCG suite of Diabetes Health and Care Videos https://www.kernowccg.nhs.uk/your-health/long-term-conditions/ NHS APPS LIBRARY 80 assured apps, 117 under review currently 13 apps diabetes

https://www.nhs.uk/apps-library/category/diabetes/ Libre NHS England National Guidance April 2019 For a 6 month trial Patients with: 1. Type 1 Diabetes Any form of diabetes on haemodialysis taking insulin Diabetes associate with cystic fibrosis AND

who as a clinical need have to monitor 8 times a day as demonstrated on a blood glucose meter download/review over the past 3 months Libre Criteria 2. People with Type 1 diabetes who are incapable of self-management of their diabetes due to their physical or mental health needs, and therefore require third party assistance to carry out glucose monitoring. 3. Type 1 Diabetes previously self-funding And met the above when criteria they started using the

device AND shown an improvement in HbA1C 4. Patients discussed and agreed at the Specialist Diabetes MDT who have Type 1 diabetes and who have an occupational hazard (e.g. working in insufficiently hygienic to safely finger prick) or psychosocial circumstances that warrant a trial 5. Previous self-funders of Flash Glucose Monitors with Type 1 diabetes where those with clinical responsibility for their diabetes care are satisfied that their clinical history suggests that they would have satisfied one or more of these criteria prior to them commencing use of Flash Glucose Monitoring had these criteria been in place prior to April 2019 AND has shown improvement in HbA1c since self-funding.

Criteria for 12 month use (this will not routinely continue after 12 months) 1. Pregnant women with Type 1 diabetes for a 12 month period only (inclusive of post-delivery period). Additional Criteria For Trial Additional requirements for all criteria Agree to perform 8 or more scans a day and collecting 70% of daily data and share the data via download Education must have been provided and completed in person or online Agreement to regular reviews with the specialist

diabetes team and does not miss two consecutive specialist follow up appointments Previous attendance or due consideration given to future attendance at a Type 1 Diabetes structured education programme Continuation Criteria Performing 8 or more scans a day and collecting 70% of daily data and does not miss two consecutive specialists follow up appointment and Are improving individual self management e.g.

improvement in HbA1C, improvement in time in range, improvement in symptoms such as DKA / hypoglycaemia improvement in psycho-social welling Diabetes Specialist Team will advise if continuation criteria is not being met Libre and Devon /Cornwall Libre What do we know? ADA 2019 UK based audit results 4709 with diabetes, median age was 44 years, 99% had type 1 diabetes,

54% were female, duration of diabetes was an average of 20 years, baseline HbA1c was 8.2%, median body mass index (BMI) was 26 kg/m2, and median follow up was 6 months Median HbA1C 7.6% reduction of 0.6% Hypos measured using gold score 79% reported reduction in proportion time in hypo, 31% reduced rate of hypos, 39% reduced rate of nocturnal hypos Hospital Admissions DKA reduced from 7.3 % to 1.9 % Hypos reduced from 2.71 % to 0.5% Hot off the Press

NICE guideline [NG19], Diabetic foot problems: prevention and management Where Next ? GCM for Type 1 diabetes and pregnancy ? Link with Apple iphone and iwatch with closed loop administration / monitoring system ? Libre where next ? ? Medication to delay Type 1 diabetes ? Smart insulin pumps ? Smart insulin

? New Generation GCM ? More Flash monitors ? New Glucagon formulation Questions ?