Category: Treatment of diabetes

A dissemination event about the role of Skype consultations in a Diabetes service – Upton Park 9:30-13:30

From a email sent to colleagues, I know nothing more about this than what’s below… Jo

Via the Barts Health NHS Trust

DREAMS

Diabetes Review, Engagement and Management via Skype

Are web-based consultations a useful tool for supporting patient self-management in diabetes?

 

18 March 2015
9:30-13:30
FREE

Venue:
West Ham United Football Club, Boleyn Ground
Green Street, Upton Park, London E13 9AZ

Focus & Aims
The DREAMS study, led by Barts Health NHS Trust, explored the role of remote (‘Skype’) consultations in patients who find it difficult to engage with and attend diabetes services. The research, which ran between January 2012 and December 2014, aimed to provide a better understanding of how the introduction of remote consultations alter patterns of service use, the experience of remote consultations from the perspective of patients and service staff, and the challenges of introducing remote consultations in a clinical setting.

The purpose of the workshop is to share and discuss key findings from the DREAMS study. The event will focus on the personal experience of patients and service staff using Skype consultations, quantitative and qualitative outcomes that informed its implementation, and the key lessons and recommendations for other services.

The workshop is organised by the research team involved in the DREAMS study, which was funded by the Health Foundation.

Format
Presentations will be by clinical and research staff, and patients involved in the DREAMS study. Lunch will be provided after presentation and discussion sessions

Presentation topics will include:

  • Background and aims of the DREAMS study
  • How the introduction of Skype altered service use
  • Patient and service staff views and experience of Skype consultations
  • Guidance and recommendations on implementation and use of Skype in clinic settings

 

Registration Information
The event is free but places are limited, so to book a place email Joe Wherton at j.wherton@qmul.ac.uk , before March 6th. For more information about the event please contact Joe Wherton on 020 7882 2512 or Desiree Campbell-Richards on 020 7363 8569.

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ISO 15197:2013 & #diabetes – will new stds for blood glucose meter accuracy affect what’s on the market?

Is the new ISO 15197:2013 for blood glucose meter accuracy likely to bump a few BG meters off the market? 

ISO 15197:2013: In vitro diagnostic test systems — Requirements for blood-glucose monitoring systems for self-testing in managing diabetes mellitus”

The new (I say new, they came out last year but I’ve been out of the ‘diabetosphere’ for a while) guidelines can be found here but they cost CHF 154,000 which is a wee bit more than I want to cough up to read them. You can preview some of the document here.

The ISO’s own blog has written about this “More accurate self-testing results for diabetes patients with new ISO standard“.

Blood glucose meter and testing strips

See also

“The reliability of self-monitored glucose values is a prerequisite for an efficient and safe approach to treat patients to their target. Accuracy of SMBG, therefore, is a key aspect in this regard.9 Recently, accuracy requirements have been tightened. According to the revised ISO standard 15197:2013, 95% of the blood glucose (BG) results shall fall within ±15 mg/dl of the reference method at BG concentrations < 100 mg/dl and within ±15% at BG concentrations ≥ 100 mg/dl.10 The less restrictive ISO standard 15197:2003 loses its validity after a transitional period of 3 years.11

Source: Schnell and Erbach (2014) Impact of a Reduced Error Range of SMBG in Insulin-treated Patients in GermanyJournal of Diabetes Science and Technology February 5, 2014, doi: 10.1177/1932296813516206

There’s also been some discussion on the children-with-diabetes forum: Accuracy of blood glucose meters draws scrutiny childrenwithdiabetes (21 May 2013).

See also FDA to ISO 15197: Not good enough The Westgard Rules blog (15 January 2014)

“FDA believes that the criteria set forth in the ISO 15197 standard do not adequately protect patients using BGMS devices in professional settings, and does not recommend using these criteria for BGMS devices.” – quote excerpted from recent FDA draft guideline on blood glucose meters (line 277).

 

 

 

 

#Diabetes Manager – a free iPhone app for people w diabetes, from Patient.co.uk

This is a sort of but not quite press release about a new diabetes app for people with smartphones. Not investigated it myself, this comes from the wonderful CHAIN (Contact, Help, Advice & Information Network) which I have recommended many times on this blog before and continue to do so. It’s free to sign up.

‘I would like to let people with an interest in Diabetes know about a brand new free application Patient.co.uk have launched ahead of next week’s Diabetes Week, which helps people with either type 1 or type 2 diabetes to easily record and monitor their condition.

Called ‘Diabetes Manager’ the application tracks various key indicators such as the number and severity of hypos, blood glucose levels and food and drink intake and is completely customisable.

Commenting on the application, Dr Hayley Willacy, who peer-reviewed Diabetes Manager said: “One of the most useful and practical aspects to this app is the ability for patients to see their records easily in a graph and save their most notable records as talking points to discuss with their GP. What’s more they can export and share their results with their doctor.”

David Cragg, a patient with diabetes who provided user insight to our team during the development of the app said: “It’s great that an organisation such as Patient.co.uk has engaged people with diabetes to help shape their iPhone application. The resulting application has some truly unique features, such as marking notable entries to help locate results when discussing concerns with health care professionals.”

To find out more and download the app you can visit: http://www.patient.co.uk/press-releases/launch-of-free-clinically-backed-diabetes-manager-app

See also: Diabetes UK Tracker app for people with diabetes (available for iPhone and Android) – this app won the Third Sector Excellence Award for use of digital media, in September 2012.

Medical device alert: Medtronic insulin pumps – #diabetes

I recently signed up to the MHRA’s alerts emails and this one has me a little bit confused. It was ‘issued’ on Friday 17 May but references a document (Field Safety Notice) from March 2013, so perhaps it’s more of an update than a new thing. Anyway…

Medtronic pumps affected:
Paradigm ambulatory insulin infusion pumps.
Models: MMT – 511, 512, 712, 712E, 515, 715, 522, 722, 722K, 523, 723, 723K, 554 (VEO) and 754 (VEO).

Medical Device Alert: Paradigm ambulatory insulin infusion pumps manufactured by Medtronic (MDA/2013/035)
Note that there are tabs with different bits of information about the Device | Problem | Action | Distribution | Contacts and Feedback

The Distribution tag intrigued me – it’s a list of NHS and related departments / divisions / organisations to which this alert is communicated. The audience is primarily healthcare professionals but I am a little bit surprised that these things aren’t communicated to patient support groups as from the picture of the pump it seems like something a person with diabetes would use at home (perhaps I am wrong, perhaps these are only ever used in a hospital setting?) so why not use other means to tell them? Obviously healthcare professionals can contact their patients and distribute the info as needed, but I don’t see why a bit of redundancy can’t be built in here. Belts and braces 🙂

 

Stem cells and Type 2 diabetes

Tuesday 1 December 2009

I wrote this, as part of my work, in response to someone enquiring about paying for stem cell treatments for Type 2 diabetes. I think there is an awful lot of work to be done in this area before that’s doable, but am aware that there is research into bone marrow stem cells and Type 2 diabetes (ie it’s a bit early, but it’s not actually a crazy idea).

This should not be taken as gospel (I might be wrong) nor as medical advice (I’m not medically trained) but I hope will be useful nonetheless 🙂

I’ve tweaked my response for this blog.

All views expressed are mine alone and do not necessarily reflect the views of my employer.

Dear ________

The research into stem cells and diabetes is not yet at the stage where it would be appropriate to start putting such cells into people with the intention of using this as a therapy (ie in the hope of improving symptoms).

There have been some small trials where people have received stem cell transplants, under very particular conditions, to ‘see what happens’ and to get an idea of the safety (or not) of doing this.

Companies offering stem cell transplants are, to the best of my knowledge, not involved in clinical trials but are instead claiming this as a therapy, and charging for it. Without sufficient evidence from clinical trials that show that stem cells can actually help people with Type 2 diabetes and that the transplants are safe in the long run then this sort of intervention is rather speculative.

There is nothing wrong with a clinical trial to see if transplanting stem cells can help but prospective patients are not usually asked to pay. Also there are very strict regulations for clinical trials in place to protect participants. People travelling abroad for stem cell transplants do not have this protection if anything goes wrong. The science journal Nature has an interesting blog post on charging people for unproven stem cell treatments http://blogs.nature.com/reports/theniche/2008/03/patients_paying_for_stem_cells.html

At this stage it is not exactly clear how a stem cell transplant would help someone with Type 2 diabetes. As insulin resistance is generally the major problem (that is, insulin can still be produced by the cells of the pancreas but the body becomes less able to respond to it) then adding in more insulin-producing cells would not necessarily be an appropriate way to treat that problem.

It is certainly true that Type 2 diabetes is a progressive condition (which effectively means that the way in which the condition is treated changes over time) and the insulin-producing cells may well begin to fail after a while, meaning that less insulin can be produced. Of course it makes sense, theoretically, that someone in this situation could benefit from replacement insulin-producing cells – however we do not yet have the evidence that stem cell transplants can help.

The cells used in these transplants are generally the patient’s own bone marrow stem cells. These cells have the capacity to form a limited number of blood cells (including cells of the immune system) and they do not naturally form insulin-producing cells. While it is possible to modify cells in a laboratory to persuade them to secrete insulin the modified cells may not be very safe for transplantation.

I do want to stress that scientists are not discounting the possibility that transplanting bone marrow stem cells into people with Type 2 diabetes could help – it is possible that the presence of these blood-type cells could help to ‘rescue’ in some way the pancreatic cells from further damage and so improve blood glucose levels. It’s less likely that the cells would spontaneously form insulin-producing cells, but it’s not impossible.

A report of a recent trial (with 25 patients) suggested that this might be a possibility (http://www.physorg.com/news157534107.html) – but this research is at an early stage and it would be unlikely for patients to have to pay for this.

We do not know what the long-term effects of giving stem cell transplants are and one particular case study has caused concern among researchers and doctors http://news.bbc.co.uk/1/hi/health/7894486.stm

Interestingly several case studies have suggested that bone marrow transplants (given to children suffering from leukaemia) may actually be linked with a subsequent worsening of glucose metabolism and insulin resistance http://www.ncbi.nlm.nih.gov/pubmed/11041401

I would recommend this brief (eight pages) patients’ guide to stem cell treatments http://www.isscr.org/clinical_trans/pdfs/ISSCRPatientHandbook.pdf and seek advice from your own doctor before committing any money to unproven treatments.

Stem cells and diabetes (i)

Lots to say on this topic, so will have to break it up into manageable pieces using multiple posts!

Something I’ve been getting an increasing number of enquiries about is stem cell transplants for diabetes as there are a number of companies making the claim that they can cure the condition. I’m not aware of any evidence for this (beyond the company’s own claims, based on patient testimony – which is no guarantee of truth or accuracy) so am inclined to be very wary.

It seems that bone marrow cells are removed from the patient and purified (or otherwise modified in some way) before being returned to the patient in the hope of improving their blood glucose levels.

Bone marrow stem cells are able to form a fairly limited number of blood type cells – I’m not convinced how easy it is for them to transdifferentiate into insulin-producing cells once replaced in the body. If they’re modified before transplantation then I’d want to know a bit more about the safety of the modification procedure. The sort of laboratory tweaking that can be done to cells is generally performed only for research purposes and could preclude the cells from being suitable for transplantation.

It’s often claimed that because the stem cells are the person’s own cells there will be no issue of tissue rejection. This may not be true.

Type 1 diabetes is caused by an underlying autoimmune disorder which seeks out, and destroys, the insulin-producing beta cells in the pancreas and de. If new insulin-producing cells are transplanted then there’s every reason to suspect that the autoimmune attack will recur and these will be destroyed too. I don’t think the immune system cares too much where insulin-producing cells come from, if they’re producing insulin then it seems that this is sufficient for them to be destroyed.

Sometimes it’s claimed that the transplanted cells ‘support’ the pancreas in some way, to help it to regenerate its own insulin-producing cells. Maybe, but this would surely just mean that that the cells the pancreas generates itself will be destroyed (which is exactly what happened during the development of Type 1 diabetes in the first place).

Companies are also claiming that transplanted cells can help people with Type 2 diabetes – but for these people it’s more likely that insulin resistance is the problem driving their diabetes rather than a lack of insulin. It’s not clear how adding in more insulin-producing cells would help.

It’s something I expect to come back to in this blog as the pace of research is pretty speedy – but just because research in an area is fast-moving it doesn’t mean that it’s appropriate to bend the research too quickly into a treatment.

Monya Baker of nature.com’s stem cell blog “The Niche” has written a post highlighting that “Patients paying for stem cells are probably getting bad science
http://blogs.nature.com/reports/theniche/2008/03/patients_paying_for_stem_cells.html

Good places to find out about the status of research is to see what clinical trials are being done at ClinicalTrials.gov and Current Controlled Trials.

Clinical Trialsdiabetes and stem cells results page.
Current Controlled Trialshttp://www.controlled-trials.com/mrct/ – type in diabetes and stem cells into the ‘search for’ box and put a tick by ‘all registers’ to search all of them or choose individual registers.

Note that the results may contain trials that are not specifically about the use of stem cells in the treatment OF diabetes, merely that diabetes might be mentioned somewhere as a keyword.

Jo

Disclaimer – all posts are my opinion and not necessarily those of my employer.