Tag: technology

New diabetes calculator helps determine if you are type one or type two

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New calculator improves diagnosis of diabetes
Lynam A & al. BMJ Open 26 Sep 2019
curated by Pavankumar Kamat UK Medical News 30 Sep 2019

Scientists have developed a new calculator tool to help clinicians determine whether a patient has type 1 or type 2 diabetes, ensuring appropriate treatment and fewer complications. The beta version of the calculator is available here.

https://www.diabetesgenes.org/t1dt2d-prediction-model/
Determining the type of diabetes remains a challenge for clinicians, and current blood and genetic tests are not robust enough to provide a definitive diagnosis. The tool utilises a model that incorporates patient data (age of diagnosis and body mass index) and blood test results to provide a personalised approach.

It is useful in determining the likelihood of type 1 diabetes in patients, thereby reducing misdiagnosis.

Researchers at the Universities of Exeter, Oxford and Dundee analysed data on 1352 individuals with diabetes and tested the calculator in an additional 582 individuals.
The new tool follows the footsteps of another calculator previously developed at the University of Exeter which helps clinicians determine the presence of diabetes sub-type MODY. The tool has been successfully used by more than 100,000 people.
Dr Angus Jones, the lead researcher, said: “The right diagnosis in diabetes is absolutely crucial to getting the best outcomes for patients, as treatment is very different in different types of diabetes. Our new calculator can help clinicians by combining different features to give them the probability a person will have type 1 diabetes, and assess whether additional tests are likely to be helpful.”
References
Lynam A, McDonald T, Hill A, Dennis J, Oram R, Pearson E, Weedon M, Hattersley A, Owen K, Shields B, Jones A. Development and validation of multivariable clinical diagnostic models to identify type 1 diabetes requiring rapid insulin therapy in adults aged 18-50 years. BMJ Open. 2019;9(9):e031586. doi: 10.1136/bmjopen-2019-031586. PMID: 31558459

 

BMJ: Children with type one diabetes do just as well with jags as pumps

kaitiscotland3 Comments

 BMJ 13 April 19

Pumps versus Multiple Daily Injections

Across various centres in England and Wales, 294 new onset type one diabetes patients were randomised to receive either pumps or MDI from the very start after diagnosis. The age range was just 7 months to 15 years. There were 144 in the pump group and 147 in the MDI group.

At one year the average HbA1c was around 60 (7.6%) for both groups. There were 14 serious events such as diabetic ketoacidosis or severe hypoglycaemia in the pump group and 8 such events in the MDI group.

It cost £1,863 more to treat the pump group but they had no better outcomes or improvement in quality of life compared to the MDI group. Indeed adverse events were a bit more common in the pump group even though there were fewer of them.

My comment: Looks like they were not advised about low carb diets given the relatively high HbA1Cs at a time that the honeymoon phase can be protective.

BMJ 16 Feb 19

Type one children performed just as well as their schoolmates in exams

Although both high and low blood sugar can affect concentration and memory and cognitive function, Danish researchers found that in national exams, type one children performed just as well as other children.

Enterovirus may act as a trigger for Coeliac Disease

Norwegian researchers looked at infection with adenoviruses and enteroviruses in childhood and later diagnosis of coeliac disease.

They tested children who were already at risk due to a particular genotype. They were recruited between 2001 and 2007 and were followed up till 2016.

They found that infection with enteroviruses but not adenoviruses were associated with higher onset of coeliac later on.

My comment: Enterovirus infection has been associated with the onset of type one diabetes too. People with type one are also more likely to develop coeliac. There could be common genetic susceptibility and environmental triggers.

 

 

Before you fly print out your Medical Devices awareness card

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The Civil Aviation Authority are asking that all passengers who have medical devices such as Insulin Pumps and Continuous Glucose Monitoring  systems carry a card to remind themselves and the security officer about what precautions both sides must take to travel safely and securely.

For passengers the card can be printed by clicking on the link below or simply googling Medical Devices awareness card.

You should also have a letter from your GP or hospital doctor saying that you are wearing the device.

These devices should not be put through  X ray scanners whether on your body or not. You shouldn’t be required to remove them from your body either.  You may need to check what security alternatives exist in foreign airports but the UK has other ways of determining your safety to fly.

https://www.caa.co.uk/uploadedFiles/CAA/Content/Standard_Chttps://www.caa.co.uk/uploadedFiles/CAA/Content/Standard_Content/Passengers/Before_you_fly/Health/CAA_AOA_MedicalDeviceAwarenessCard.pdfontent/Passengers/Before_you_fly/Health/CAA_AOA_MedicalDeviceAwarenessCard.pdf

Freestyle libre on NHS prescription at last!

kaitiscotland7 Comments

My son has at last been given an NHS prescription for the Freestyle Libre sensors.

These make a big difference in the ease and frequency with which you can test your blood sugars. If you know how to adjust your insulin to meals, activity and sort out your basals, the added readings that you get help you stay in your target zone much more easily.

I bought the device and the sensors   for my son very soon after they launched and have been funding them at £100 every four weeks since. Ouch!

This was worth it for the added peace of mind. The worry of a child never ends and is more so if that child uses insulin, lives alone, is a driver, and is 5 hours drive away.

My son was actually expecting to wait another four months as he was told there was an eighteen month waiting list for the diabetic clinic. He got a short notice cancellation some four months earlier. I know from Emma and other people with type one that getting the device and sensors is a post-code lottery and that although Theresa May thinks everyone who would benefit from them should get them, this is far from practice at present.

I can only hope that there is an increase in funding to help those of  you who need them and that the scripts continue to be NHS funded, particularly when I retire.

Update: The Freestyle Libre System can now be used for drivers say the DVLA.

 

Diabetes Digital Media launch low carb app endorsed by NHS

kaitiscotland5 Comments

Adapted from The Times  January 6 2019 by Peter Evans

The better late than never NHS has finally endorsed a phone app that helps diabetics stick to a low carb diet.

Diabetes Digital Media based in Warwick have had their app, The Low Carb Program, accepted by the NHS apps library.  DDM has partnered with Ascensia Diabetes Care to allow patients free use of the app when recommended by GPs.

DDM was founded by Arjun Panesar and Charlotte Summers. Their company is on track to make sales of 1.7 m this year.

 

Exercise games can aid weight loss in overweight children

kaitiscotland5 Comments

USA researchers have proven that video games such as Kinect Sports and Just Dance can help overweight children lose weight and improve their cardiovascular risk factors.

Adherence to the programme of one hour three times a week was very high with 94.4 % sticking to the games. 46 families were involved with 23 families in the intervention and control groups.

BMI , blood pressure, total cholesterol and LDL cholesterol all improved in the intervention group.

The study was funded by the AHA.

Why I bought my son a Freestyle Libre

kaitiscotland3 Comments

The Freestyle Libre blood sugar monitoring system has been out for about a year now. It consists of a sensor that you put in your upper arm and a reader, a bit like a mobile phone, that tells you the blood sugar, whether the trend is rising or falling, and what your blood sugar pattern has been like over the last eight hours.

I haven’t met anyone who has tried it who didn’t prefer it to finger pricks. About the only situation that it is no good for is driving. You need to have proof of your blood sugar on a regular meter should your ability to drive while under the influence of injected insulin comes under scrutiny.

The NHS is a big organisation and no doubt funding for this will vary from area to area, but in Scotland at least, there is no prospect of my son getting one on the NHS.

The main people who will be able to get the device are pregnant women and those women who are planning a pregnancy. Since these women ideally have to get their Hbaic down to 6% or under to ensure a healthy baby, then you can see why they have the greatest need. You are looking at two patients in one and complications that can affect a child lifelong.

The other groups that are eligible are those with very frequent admissions for diabetic ketoacidosis or severe hypoglycaemia. By this is meant three times in a single year. Both these complications of diabetes can result in sudden death or brain damage and often in young people.

Those people whose HbA1cs are over 8.5% or who test their blood sugars more than six times a day will also be considered. Since most people attending hospital diabetic clinics will have blood sugars over this threshold it is a big group.  Perhaps diabetic athletes will also be considered.

The group that won’t be given the device and sensors on the NHS are the ones who are already making great efforts to reduce complications by eating low carb diets, exercising consistently and monitoring frequently.  Using the Freestyle libre should help this group adjust their insulin and food more finely, in particular avoiding hypos, since their blood sugars are wiggling around normal much of the time anyway.  As they are already at much lower risk for complications they are saving the NHS a great deal of money just by being so committed to their task, yet something that would make the job easier is denied them because they are not “bad enough”.

So, I’ve just bought my son one. So far he is thrilled with it. The sensors are £45 (VAT exempt) a fortnight and the initial outlay is £137 (VAT exempt) including two sensors.

There are two great advantages as far as I’m concerned. Peace of mind. And Christmas and Birthday presents for the foreseeable future are sorted.

 

 

 

 

 

Virtual reality has changed my attitude to computer games

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virtual-reality-

I was never into computer games. My sons certainly are and since X box first made an appearance they have drove numerous vehicles, shot armies of opponents, and have died a thousand times.
This year, Steven brought his new super powerful computer, the headset and hand controls to match, back home for ten days over the winter holidays so that the rest of us could marvel at the worlds you can explore from your living room or bedroom.
I am now hooked.
Although I am as clumsy as a two year old with the hand controls there are plenty of games where you can get involved without needing to use your hands much. So far I’ve been on roller coasters, flown various aircraft around futuristic towns badly, and entered Mexican fiestas. I’ve been killed a great many times over the last week but have also dished it out. When it comes to dexterity and the ability to figure out what button or fingers I should be pressing I’m even less good. I’ve broken nearly all my toys, set fire to my office, and fallen off a few mountains. I now understand why two year olds should never handle small animals no matter how well intentioned they may be. I’m a two year old again.
I can see why kids don’t come out their bedrooms for days now.
As if this wasn’t enough to blow my mind, Steven gave me an Amazon Echo dot for Christmas. Surprisingly it was easy to programme since we have home wi fi set up already. Very soon we were asking Alexa all sorts of questions. She comes in handy for playing music, telling stories, telling you the news and weather and setting timers and alarms. This backfired a bit. I had told Alexa to get me up at 8am. I was already up getting my breakfast by this time. She woke up my husband on the dot, but for some reason he couldn’t remember her name to get her to shut up! He had to open his tablet and find the amazon site to get her name. Of course, he could have come down stairs and asked me….same issue as the directions!
So how will this help the people with diabetes who read our posts? A little bit perhaps. There are apps that can tell you the nutrient content of various foods including the carb count per 100g. There are some exercise apps. There are meditation and relaxation apps. Have you found out any apps for Alexa that you have found helpful?

 

BMJ: Continuous glucose monitoring in pregnant women halves adverse birth effects

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Freestyle libre

Adapted from the BMJ article by Susan Mayor 23 Sept 17

A study has shown beneficial effects in type one pregnant patients. One in two babies born to such women have complications such as prematurity, stillbirth, congenital anomalies, and being too big. These are due to high blood sugar levels in the womb and there has been no reduction in these in the last 40 years.
Denise Feig, the author of the study, based at the University of Toronto, says, “Keeping blood sugar levels in the normal range during pregnancy for women with type one diabetes is crucial to reduce risks for the mother and child. As insulin sensitivity varies through the pregnancy adjusting insulin accurately is complex. Since our results have come through we think that continuous blood sugar monitoring should be available to all type one women.”
In the international study 325 women who were planning a pregnancy or pregnant took part. Two thirds were randomised to get the monitors and the rest had standard treatment. Large newborns were halved and so was neonatal intensive care admissions and hypoglycaemia. Women had a small but significant reduction in HbA1c. They had more time in the normal blood sugar range and hypoglycaemia was not increased.
The extra cost of the monitors could be offset to some extent by the reduced cost of medical care after the birth.