Diabetes UK 2018 - snippets
If you didn’t manage to attend the 2018 Diabetes UK APC go to the App store and download the meeting App (DUKPC). It will give you a flavour of the meeting and access to the Abstracts. Below are summaries of the presentations which are most likely to appear in the popular press.
Diabetes UK launched its new nutrition guidelines in the 1st parallel session (6-8 parellel tracks throughout this year’s meeting) at this year’s meeting. There were three presentations detailing new aspects of the guidance, notably dietary advice for ethnic populations, foods for prevention of type 2 diabetes, foods for glycaemic control and prevention of cardiovascular disease. Individualisation is a key feature of the new guidelines. A summary has been published in Diabetic Medicine HERE and the full guidelines are available on the Diabetes UK website HERE
Data from the 2017 National Diabetes Inpatient Audit HERE were presented. Data collection occurred 25-29 September 2017 at 208 hospital sites in England and Wales and showed about 1 in 6 (18%) inpatients had diabetes. Headline figures include: 31% of diabetes inpatients experienced a medication error, 18% had a hypo; 4% had hospital-acquired DKA; 28% of hospitals don’t have a dedicated inpatient diabetes specialist nurse and 20% of hospitals still lack a multi-disciplinary footcare team. Key numbers can be found in a summary of the audit (produced in association with Diabetes UK) HERE
Abstract A19 (P515): It is well established that early-onset (<40 years) type 2 diabetes has a more rapid and aggressive pathophysiology compared to that seen in people diagnosed later in life. Analysis of 7 years of data from the National Diabetes Audits in over 2.7 million people diagnosed with type 2 diabetes after 2008 has confirmed that early-onset type 2 diabetes is associated with higher mortality – even after adjusting for poorer initial risk profiles. Indeed those who develop type 2 diabetes before 40 years of age have a 2.5 fold increased risk of dying compared with people diagnosed > 60 years old. The analysis also showed that people with early onset type 2 diabetes were 5 times more likely to be of South Asian ethnicity, have a higher BMI and higher HbA1c compared to those diagnosed over the age of 60.
Abstract A25 (P193): In a case series of age, sex and BMI-matched adults with new-onset of type 1 diabetes those who were physically active (n=17) had a mean ‘honeymoon’ period of 28.1 months, compared with 7.5 months in the sedentary control group. The benefits of exercise included improved HbA1c, reduced hyperglycaemia and fewer microvascular and macrovascular complications. This study highlights the benefits of exercise in delaying the progression of type 1 diabetes.
Abstract A29 (P446). It is now recognised that diabetes and depression are independent and interacting risk factors for the development of dementia. Adults > 50- years old (n= 4,338) without diabetes or dementia who were registered in the English Longitudinal Study for Ageing were followed-up for 10 years and assessed for pre-diabetes (FPG >5.6 mmol/L), depression (CES-D 8 score >4) and dementia (self-reported or short-IQCODE >3.5). The study showed that pre-diabetes and depression were risk factors for dementia, but people with both pre-diabetes and depression had an almost 3-fold risk of developing dementia than those with neither condition.
Abstract A38. A study of 546 women with gestational diabetes who gave birth in the UK between 2014 and 2017 compared outcomes in women who gained weight with those whose weight remained stable. Women who gained excessive weight later in their pregnancy (between weeks 28 and 36) needed higher doses of insulin, were at increased risk of delivering a large-for-gestational-age baby, requiring instrumental delivery and more often needed a caesarean. They also had higher blood glucose levels after giving birth. Women who maintained a stable weight following diagnosis of gestational diabetes were more likely to have better short and long-term health outcomes.
Abstract A59 (P87). The link between obesity and type 2 diabetes is well established, but not all obese people develop the condition. Data from subjects (n=451,000) from the UK Biobank were studied to find genetic variants associated with adiposity. ‘Favourable’ adiposity alleles were defined as those associated with a ‘favourable’ metabolic profile (higher HDLc, adiponectin, sex hormone binding globulin and lower TGs, fasting insulin and ALT). Of the 14 ‘favourable’ adiposity gene variants 7 had been previously identified. Abdominal MRI of 5000 of the subjects in the Biobank showed that those carrying more ‘favourable’ adiposity alleles had less liver fat and a lower visceral : subcutaneous fat ratio – largely associated with greater subcutaneous deposits. Thus these ‘favourable’ alleles may be protecting against type 2 diabetes by promoting adipose storage in ‘safer’ subcutaneous depots.