Tag: Diabetes

The Role of Virtual Consultations in People with Type 2 Diabetes

Living with Type 2 Diabetes (T2D) can feel like a full-time job. Regular check-ups, monitoring blood sugar levels, adjusting medications, and managing lifestyle changes all demand time and effort. For the 460 million people worldwide dealing with diabetes (a number projected to climb to 700 million by 2045), finding convenient and effective healthcare solutions is more critical than ever. Enter virtual consultations (VC); a modern approach to healthcare delivery that is transforming how people with T2D manage their condition. Our recent systematic review and meta-analysis published in the Journal of Diabetes Science and Technology sheds light on just how powerful this tool can be. Let’s examine the benefits of virtual consultations for people with T2D and why they’re becoming more important in the care of people with long-term conditions like T2D.

Convenience Without Compromise: Effectiveness Matches In-Person Care

One of the key findings from the review is that virtual consultations are just as effective as traditional face-to-face visits when it comes to managing T2D. The meta-analysis, which included 15 studies and over 821,000 participants, showed no significant difference in HbA1c reduction (a key marker of blood sugar control in people with T2D) between virtual and in-person care. Whether it’s monitoring blood pressure, lipid profiles, or glycaemic levels, VCs hold their own. This means you can get appropriate care from the comfort of your home without sacrificing results. For busy people juggling work, family, or mobility challenges, this is very positive news – good quality care no longer always requires a trip to the clinic.

Saving Time and Money: Efficiency at Its Best

Time is money, and virtual consultations save both. The review highlighted how VCs cut down on the need for frequent in-person visits, reducing travel time and costs. One study found that treatment costs dropped by an average of $135 per patient with VCs—a significant saving for both individuals and healthcare systems. Another showed that while face-to-face care often required visits every one to two weeks, virtual care patients needed only one or two appointments over four months. VCs make diabetes management more efficient, freeing up time for what matters most.

Care When You Need It: Timeliness That Counts

When it comes to long-term conditions like T2D, timely adjustments to treatment can make all the difference. Virtual consultations have a role here as well. The review noted that the average time to an initial visit dropped from 106 days to just 46 days after implementing VCs. Faster access to healthcare providers means quicker feedback, medication adjustments, and support, helping keep your condition in check. Patients also reported shorter wait times and more flexible scheduling, making it easier to fit care into busy lives.

A Personal Touch: Boosting Patient Satisfaction

You might think remote care feels impersonal, but the data says otherwise. The review found high levels of patient satisfaction with VCs, with 83% of participants in one study rating them as helpful and convenient. Another 76% felt that tools like FaceTime made their care more interactive and engaging. Patients especially appreciated the flexibility of VCs during the Covid-19 pandemic, and many expressed a desire to stick with virtual care long-term. It’s not just about convenience. It is also about feeling heard and supported in a way that fits your lifestyle.

Bridging Gaps: Improved Access for Some

For people in rural areas or those with mobility issues, getting to a clinic can be a hurdle. Virtual consultations break down those barriers. The review pointed out that VCs can increase access to care, particularly for rural patients or those who struggle with transportation. One study even noted higher rates of preventive measures – like statin prescriptions – with VCs, suggesting that remote care can enhance certain aspects of diabetes management. While there is still work to be done to ensure everyone benefits equally (more on that later), VCs are a step toward making healthcare more accessible.

A Few Caveats: Safety and Equity Challenges

No solution is perfect, and the review flagged some areas to watch. Safety-wise, VCs can not fully replace physical examinations – such as checking for foot ulcers or neuropathy – which could miss some issues if VCs are not paired with in-person visits. On the equity front, younger, patients tend to thrive with VCs, showing greater HbA1c improvements and higher satisfaction. Older adults or those with lower digital literacy, however, faced challenges like technical difficulties or lower comfort with the technology, leading to less impressive outcomes. The digital divide is real, but it’s not insurmountable. But policies to boost digital literacy and access are essential.

Conclusions

Virtual consultations aren’t just a stopgap. They are a viable, long-term option for managing people with Type 2 Diabetes. They match in-person care in effectiveness, save time and money, deliver timely support, and keep patients happy. While there is room to improve safety and ensure everyone can benefit, the potential is clear. As the review suggests, integrating VCs into routine care, paired with efforts to bridge the digital divide, could improve how we support people with T2D to manage their condition.

Using Mobile Apps for Diabetes Self-Management: A Review of Patient Perspectives

Diabetes is a chronic disease that affects hundreds of millions of people worldwide. Self-management is crucial for people with diabetes to maintain their health and prevent complications.  Mobile applications have emerged as promising tools to help people with diabetes self-manage their condition. Our recent article in the journal BMJ Open – What are the perceptions and experiences of adults using mobile applications for self-management in diabetes? A systematic review – reviewed some of the the research literature in this area to obtain patient perspectives on these apps.

What are the benefits of using mobile apps for diabetes self-management?

Our systematic review explored the perceptions and experiences of adults with types 1, 2, and gestational diabetes using mobile applications for self-management.  The review included 24 qualitative studies that interviewed or surveyed people with diabetes who used mobile apps for self-management.

We found that people with diabetes generally have a positive view of mobile apps for self-management.  App features that were particularly valued included:

  • Monitoring blood glucose, diet, and exercise
  • Receiving reminders about blood glucose checks, medication, and mealtimes
  • Learning about the interrelationship between blood glucose, diet, and exercise

What are the challenges of using mobile apps for diabetes self-management?

We also identified several challenges that people with diabetes face when using mobile apps for self-management. These challenges include:

  • Uploading excessive information
  • Monitoring device incompatibility
  • Episodic app crashes
  • Telephone handling issues

What are the implications of this research?

We concluded that mobile applications are promising tools to help people with diabetes self-manage their condition.  However, it is important to address the challenges that people with diabetes face when using these apps. We also recommended that future research should:

 

  • Include healthcare professionals (HCPs) to get their views on the apps
  • Explore the long-term usage of mobile apps
  • Evaluate the role of AI in providing interactive support for self-management

Conclusion

Mobile apps have the potential to improve diabetes self-management. By addressing the challenges and incorporating the recommendations of this research, we can develop apps that are truly beneficial for people with diabetes.

High quality primary care and achievement of key quality targets lowers the risk of amputations in people with type 2 diabetes

Amputations are an important and largely preventable complication of type 2 diabetes mellitus that impact considerably on the life expectancy and quality of life of those affected. In England, more than 9000 diabetes-related amputations are performed each year, with decreasing rates but higher absolute numbers of major amputations, and the annual direct healthcare costs of diabetic foot ulceration and amputation are approximately £1 billion.

In an article published in BMJ Open Diabetes Research & Care, we investigated the associations between attainment of primary care quality clinical indicators, completion of National Diabetes Audit care processes, and non-traumatic lower limb amputations among people with type 2 diabetes. We observed that minor or major, as well as major-only, amputation rates were 26%–51% and 3%–51%, respectively, lower among those who met the HbA1c indicator and 14%–47% lower among those who met the cholesterol indicator for our primary outcome.

Comprehensive primary care-based secondary prevention may offer considerable protection against diabetes-related amputation. This has important implications for diabetes management and medical decision-making for patients, as well as type 2 diabetes quality improvement programs.

DOI: http://dx.doi.org/10.1136/bmjdrc-2020-002069

Association between attainment of primary care quality indicators and diabetic retinopathy

Nearly three million people in England have type 2 diabetes. Diabetic retinopathy is a common complication, affecting nearly a third of patients with type 2 diabetes with considerable impacts on visual acuity and quality of life. In a paper published in the journal BMC Medicine, we examined the associations between attainment of primary care indicators and incident diabetic retinopathy among people with type 2 diabetes in England.

We found that that attainment of primary care HbA1c and BP indicators is associated with lower incidence of diabetic retinopathy in patients with type 2 diabetes. There is scope to enhance coverage of HbA1c and BP indicator attainment, and thus to potentially limit the incidence of diabetic retinopathy in England, through appropriate community-based measures. Further research is required to examine whether tighter glycaemic and/or BP control could achieve greater reductions in diabetic retinopathy.

Attainment of primary care quality of care indicators and emergency hospital admissions in people with type 2 diabetes

England has invested considerably in diabetes care over recent years through programmes such as the Quality and Outcomes Framework and National Diabetes Audit. However, associations between specific programme indicators and key clinical endpoints, such as emergency hospital admissions, remain unclear. In a study published in the Journal of the Royal Society of Medicine, we aimed to examine whether attainment of Quality and Outcomes Framework and National Diabetes Audit primary care diabetes indicators is associated with diabetes-related, cardiovascular, and all-cause emergency hospital admissions.

Diabetes, cardiovascular and all-cause unplanned hospital admission rates were 7%–12% lower among those who met the Quality and Outcomes Framework HbA1c indicator, and 8%–14% lower among those who met the cholesterol indicator. By contrast, univariate analyses demonstrated that blood pressure indicator attainment was associated with higher rates of all types of unplanned admission. However, this association only persisted for diabetes-related admissions in multivariate analyses, and blood pressure attainment was associated with a significantly lower rate of cardiovascular-related unplanned admissions after adjustment for confounders.

Longer latency to diabetes, cardiovascular and all-cause unplanned admissions was also observed among those who met the HbA1c or cholesterol indicators, and again an association was not observed for the blood pressure indicator. Completing 7–9 National Diabetes Audit processes was associated with lower rates of all types of unplanned admissions, and meeting all nine National Diabetes Audit care processes was linked to 22%–26% lower rates for all types of unplanned admissions.

DOI: https://doi.org/10.1177/01410768211005109

Associations between attainment of incentivized primary care indicators and incident sight‐threatening diabetic retinopathy

Our new study published in the journal Diabetes, Obesity and Metabolism shows a lower incidence of sight‐threatening diabetic retinopathy in people with type 2 diabetes who meet QOF targets for HBA1c, blood pressure and lipid control.

We aimed to examine the impact of attainment of primary care diabetes clinical indicators on progression to sight‐threatening diabetic retinopathy (STDR) among those with mild non‐proliferative diabetic retinopathy (NPDR).

We carried out a historical cohort study of 18,978 adults (43.63% female) diagnosed with type 2 diabetes before 1 April 2010 and mild NPDR before 1 April 2011 was conducted. The data were obtained from the UK Clinical Practice Research Datalink during 2010‐2017, provided by 330 primary care practices in England. Exposures included attainment of the Quality and Outcomes Framework HbA1c (≤59 mmol/mol [≤7.5%]), blood pressure (≤140/80 mmHg) and cholesterol (≤5 mmol/L) indicators in the financial year 2010‐2011, as well as the number of National Diabetes Audit processes completed in 2010‐2011. The outcome was time to incident STDR. Nearest neighbour propensity score matching was undertaken, and univariable and multivariable Cox proportional hazards models were then fitted using the matched samples. Concordance statistics were calculated for each model.

A total of 1037 (5.5%) STDR diagnoses were observed over a mean follow‐up of 3.6 (SD 2.0) years. HbA1c, blood pressure and cholesterol indicator attainment were associated with lower rates of STDR (adjusted hazard ratios [95% CI] 0.64 [0.55‐0.74; p < .001], 0.83 [0.72‐0.94; p = .005] and 0.80 [0.66‐0.96; p = .015], respectively).

Our findings provide support for meeting appropriate indicators for the management of type 2 diabetes in primary care to bring a range of benefits, including improved health outcomes—such as a reduction in the risk of STDR—for people with type 2 diabetes.

DOI: https://doi.org/10.1111/dom.14344

Type 2 Diabetes in Children and Young Adults

Newly published statistics show that nearly 7,000 children and adults aged under 25 in the UK have been diagnosed with type 2 diabetes. The onset of Type 2 Diabetes is strongly associated with lifestyle factors such as obesity, lack of exercise and high calorie (high sugar) diets. In recent decades, countries such as USA and UK have seen large increases in the number of people with type 2 diabetes. Most of these cases have been among older people but we are now also seeing an increasing number of cases of Type 2 Diabetes among younger people.

Reversing the increase in Type 2 Diabetes is not easy. It requires action by individuals, and also by governments and societies. For individuals, it is important that people eat a healthy, balanced diet that is not too high in calories, and not high in refined carbohydrates and sugars. Dietary changes need to be combined with regular exercise to keep weight down to healthy levels, thereby reducing the risk of developing type 2 diabetes.

A number of people with established type 2 diabetes have reversed their condition through measures such as dieting and exercise. This shows even if an individual has Type 2 Diabetes, they can resolve this through appropriate lifestyle measures.

Measures taken by individuals need to be backed by measures targeting the entire population. This can include for example, ‘sugar taxes’ on high-calorie drinks to encourage individuals to consume them less and to encourage manufacturers to produce lower calorie version of these drinks. Calorie labelling of food can also help people make suitable choices about their diets. We also need measures to encourage physical activity, for example, making it easier and safer for people to cycle and walk rather than using cars.

It’s important that regular exercise and healthy diets are introduced at a young age. Hence, nurseries, schools, colleges and universities also have an important role to play in addressing the causes of Type 2 Diabetes.

The costs to the NHS of prescribing for diabetes

Drugs used to treat diabetes are now responsible for 11.4% of total primary care prescribing costs in England, £1,012 million annually. The very high costs to the NHS of treating diabetes are an inevitable consequence of the increase in the prevalence of type 2 diabetes in recent decades. This increase in the prevalence of type 2 diabetes is in turn a consequence of lifestyle factors such as high-calorie diets (particularly diets high in sugars and refined carbohydrates), physical inactivity and obesity. We need effective strategies at both population and individual level, and changes in the obesogenic environment we live in, to reverse these adverse lifestyle- associated factors and bring down the prevalence of type 2 diabetes.

Source: NHS Digital

Bariatric surgery – Should we prioritise patients with type 2 diabetes?

The results of recent research studies illustrate the importance of prioritizing obese people with type 2 diabetes mellitus when it comes to selecting patients for bariatric surgery. For example, the number of people eligible for bariatric surgery in England far exceeds the bariatric surgery capacity of its National Health Service. If the aim of bariatric surgery is to reduce mortality and morbidity among obese patients, then the focus should be on selecting patients for surgery based on the presence of the conditions that have the greatest detrimental effect on health status. It may therefore be appropriate to reconsider the importance of body mass index alone as a predictor of mortality and put more emphasis on the presence of comorbidities when assessing eligibility for bariatric surgery. Given the significant benefits for people with type 2 diabetes that bariatric surgery offers and the resulting major improvements in their health status, there is a strong case that type 2 diabetes should be considered as the preferred comorbidity when selecting patients for surgery.

The full letter can be read in JAMA Surgery.

Clinical impact of lifestyle interventions for the prevention of type 2 diabetes

In a study published in the journal BMJ Open, we reviewed the clinical outcomes of combined diet and physical activity interventions for people at high risk of type 2 diabetes. We looked at combined diet and physical activity interventions including ≥2 interactions with a healthcare professional, and ≥12 months follow-up. Our primary outcome measures included glycaemia, diabetes incidence. Secondary outcomes included behaviour change, measures of adiposity, vascular disease and mortality.

We identified 19 recent reviews for inclusion in our study. Most reviews reported that interventions were associated with net reductions in diabetes incidence, measures of glycaemia and adiposity. Small effect sizes and potentially transient effect were reported in some studies, and some reviewers noted that durability of intervention impact was potentially sensitive to duration of intervention and adherence to behaviour change. Behaviour change, vascular disease and mortality outcome data were infrequently reported, and evidence of the impact of intervention on these outcomes was minimal. Evidence for age effect was mixed, and sex and ethnicity effect were little considered.

We concluded that relatively long-duration lifestyle interventions can limit or delay progression to diabetes under trial conditions. However, outcomes from more time-limited interventions, and those applied in routine clinical settings, are more variable, in keeping with the findings of recent pragmatic trials. There is little evidence of intervention impact on vascular outcomes or mortality end points in any context. Hence, ‘real-world’ implementation of lifestyle interventions for diabetes prevention may be expected to lead to modest outcomes.