In Focus
Conference Round-up Diabetes UK Professional Meeting concluded: “Working in partnership with mental health services can improve engagement with physical health services, including routine annual health checks. However, those with severe mental illness and diabetes remain a challenge and it appears that successful insulin therapy in this group is particularly challenging.”
Steve Allen/Science Photo Library
This year’s Diabetes UK Professional Meeting in Manchester, UK, saw more than 500 symposia and oral and poster presentations. The programme covered traditional subjects such as complications of diabetes and risk of mortality in type 1 diabetes, as well as the less well known fields of gestational diabetes, and the rapidly developing research exploring the relationship between diabetes and mental health.
Gestational diabetes Mental health and diabetes Lynda Cochrane (University of Dundee, UK) and colleagues presented some surprising data about diabetes and schizophrenia. This case–control study investigated all patients attending a schizophrenia Clozapine Clinic in Edinburgh, UK (n=63). Controls were matched by bodymass index, age, sex, and diabetes type (three controls per case). Eight (12·7%) patients had diabetes (one type 1 diabetes, seven type 2 diabetes). Mean HbA1c levels were 8·28% in those with schizophrenia versus 8·43% in controls. Total cholesterol levels were also lower in clinic attendees than in controls (5·00 mmol/L vs 5·36 mmol/L). Diabetic complications and attendance rates for diabetes care or screening did not differ. Perera concluded: “Patients with schizophrenia in this small study have better glycaemic control and lower cholesterol than matched diabetes controls, with no evidence of increased complication rates or poorer quality of care ... this raises intriguing questions about the pathophysiology underlying diabetes development in schizophrenia, which may differ from those developing diabetes de novo”. Another mental health abstract examining the caseload of patients with diabetes and severe mental health disorders in an inner city region was presented by David Gable and colleagues from Imperial College Healthcare NHS Trust, London, UK. The team identified 36 patients, most of whom had type 2 diabetes (94%) and were male (61%). Ethnic origin was 28% white, 17% Arab, 30% African-Caribbean, and 25% south Asian. Referral to the service was from general practitioners (GP; 61%) and mental health services (28%), and 11% were inpatients from mental health clinics. The mental health diagnosis was schizophrenia (58%), severe depression (19%), or other (21%). Case management supported 22 (77%) patients to attend two or more appointments. In this cohort, mean HbA1c level was 69 mmol/mol and was higher in those prescribed insulin alone or in combination (n=18) compared with those prescribed oral agents alone (n=10; mean 80·6 mmol/mol vs 52·3 mmol/mol; p=0·004). Mean cholesterol level was 4·70 mmol/L with 61% prescribed statin therapy. Mean systolic blood pressure was 130/80 mm Hg with 39% prescribed treatment. Gable www.thelancet.com/diabetes-endocrinology August 2013
Andrew McGovern and colleagues (University of Surrey, UK) presented data showing more than eight in ten women with gestational diabetes are missing out on crucial postnatal care. Just 13% of women who have had gestational diabetes received the right care after giving birth, leaving them at risk of developing type 2 diabetes. The study used data on nearly 800 women with gestational diabetes from GP practices across England. Only 102 (13%) of these women were recorded as having received one or more blood glucose test after the delivery, as recommended by national guidelines. For women whose blood glucose levels were tested, 8% were outside of normal levels, 2% had developed type 2 diabetes, and 6% showed signs of prediabetes. McGovern said: “The short-term follow-up of women with gestational diabetes appears to be haphazard with no set date of recall, which goes against national guidance. This study shows the power of using electronic records to identify gaps in quality, especially in primary care. These same records could be used to create recalls and reminders to close this quality gap and make sure that women receive the care they need.”
Published Online April 2013 The Diabetes UK Professional Meeting took place in Manchester, UK, on March 13–15, 2013
Risk of diabetes-related amputations Naomi Holman (Yorkshire and Humber Public Health Observatory, UK) and colleagues presented data on 1·75 million people from the National Diabetes Audit. Of these 3390 (0·19%) had at least one amputation. Being male (odds ratio [OR] 2·38) and older (1% increased risk per additional year of age) increased risk. People from black (OR 0·61) and south Asian (OR 0·23) ethnic groups were less likely to have had a major amputation than people from white ethnic groups. Deprivation increased the risk of major amputation, with those in the poorest 20% of the population 72% more likely to have an amputation than the richest 20%. Holman said: “It is important that everyone with diabetes takes good care of their feet. While we do not fully understand why white men living in poorer areas have a higher risk of diabetes-related amputation, our findings suggest that efforts to reduce amputations should focus particularly on this group.”
Tony Kirby s21
Conference Round-up Diabetes UK Professional Meeting concluded: “Working in partnership with mental health services can improve engagement with physical health services, including routine annual health checks. However, those with severe mental illness and diabetes remain a challenge and it appears that successful insulin therapy in this group is particularly challenging.”
Steve Allen/Science Photo Library
This year’s Diabetes UK Professional Meeting in Manchester, UK, saw more than 500 symposia and oral and poster presentations. The programme covered traditional subjects such as complications of diabetes and risk of mortality in type 1 diabetes, as well as the less well known fields of gestational diabetes, and the rapidly developing research exploring the relationship between diabetes and mental health.
Gestational diabetes Mental health and diabetes Lynda Cochrane (University of Dundee, UK) and colleagues presented some surprising data about diabetes and schizophrenia. This case–control study investigated all patients attending a schizophrenia Clozapine Clinic in Edinburgh, UK (n=63). Controls were matched by bodymass index, age, sex, and diabetes type (three controls per case). Eight (12·7%) patients had diabetes (one type 1 diabetes, seven type 2 diabetes). Mean HbA1c levels were 8·28% in those with schizophrenia versus 8·43% in controls. Total cholesterol levels were also lower in clinic attendees than in controls (5·00 mmol/L vs 5·36 mmol/L). Diabetic complications and attendance rates for diabetes care or screening did not differ. Perera concluded: “Patients with schizophrenia in this small study have better glycaemic control and lower cholesterol than matched diabetes controls, with no evidence of increased complication rates or poorer quality of care ... this raises intriguing questions about the pathophysiology underlying diabetes development in schizophrenia, which may differ from those developing diabetes de novo”. Another mental health abstract examining the caseload of patients with diabetes and severe mental health disorders in an inner city region was presented by David Gable and colleagues from Imperial College Healthcare NHS Trust, London, UK. The team identified 36 patients, most of whom had type 2 diabetes (94%) and were male (61%). Ethnic origin was 28% white, 17% Arab, 30% African-Caribbean, and 25% south Asian. Referral to the service was from general practitioners (GP; 61%) and mental health services (28%), and 11% were inpatients from mental health clinics. The mental health diagnosis was schizophrenia (58%), severe depression (19%), or other (21%). Case management supported 22 (77%) patients to attend two or more appointments. In this cohort, mean HbA1c level was 69 mmol/mol and was higher in those prescribed insulin alone or in combination (n=18) compared with those prescribed oral agents alone (n=10; mean 80·6 mmol/mol vs 52·3 mmol/mol; p=0·004). Mean cholesterol level was 4·70 mmol/L with 61% prescribed statin therapy. Mean systolic blood pressure was 130/80 mm Hg with 39% prescribed treatment. Gable www.thelancet.com/diabetes-endocrinology August 2013
Andrew McGovern and colleagues (University of Surrey, UK) presented data showing more than eight in ten women with gestational diabetes are missing out on crucial postnatal care. Just 13% of women who have had gestational diabetes received the right care after giving birth, leaving them at risk of developing type 2 diabetes. The study used data on nearly 800 women with gestational diabetes from GP practices across England. Only 102 (13%) of these women were recorded as having received one or more blood glucose test after the delivery, as recommended by national guidelines. For women whose blood glucose levels were tested, 8% were outside of normal levels, 2% had developed type 2 diabetes, and 6% showed signs of prediabetes. McGovern said: “The short-term follow-up of women with gestational diabetes appears to be haphazard with no set date of recall, which goes against national guidance. This study shows the power of using electronic records to identify gaps in quality, especially in primary care. These same records could be used to create recalls and reminders to close this quality gap and make sure that women receive the care they need.”
Published Online April 2013 The Diabetes UK Professional Meeting took place in Manchester, UK, on March 13–15, 2013
Risk of diabetes-related amputations Naomi Holman (Yorkshire and Humber Public Health Observatory, UK) and colleagues presented data on 1·75 million people from the National Diabetes Audit. Of these 3390 (0·19%) had at least one amputation. Being male (odds ratio [OR] 2·38) and older (1% increased risk per additional year of age) increased risk. People from black (OR 0·61) and south Asian (OR 0·23) ethnic groups were less likely to have had a major amputation than people from white ethnic groups. Deprivation increased the risk of major amputation, with those in the poorest 20% of the population 72% more likely to have an amputation than the richest 20%. Holman said: “It is important that everyone with diabetes takes good care of their feet. While we do not fully understand why white men living in poorer areas have a higher risk of diabetes-related amputation, our findings suggest that efforts to reduce amputations should focus particularly on this group.”
Tony Kirby s21
