Tuesday 11 December 2012

Naivety of Diabetics and the Medical Profession

In response to a comment on the post:

You must be rather naïve if you expect read in any publication associated with the medical profession, the connection between carbohydrate intake and diabetes complications. That would be tantamount to admitting years of failure of public policy based on a belief in medication alone – oral for Type 2, insulin for Type 1. Previous posts on this blog have referenced the ineffectiveness of the medication and the educational courses DESMOND and DAFNE. Until the medical profession (and the diabetics themselves) realise it is extremely unlikely (if not impossible) for the majority of diabetics to eat a ‘normal’ meal and achieve ‘normal’ blood glucose levels. Individuals may protest that they can do so, but the majority?

with the following results:

In response to the attitude of the medical profession: in any other aspect of public policy, years of failure would have led to a  fundamental review of the policy. And yet, new oral medications continue to be developed offering marginal improvement in HbA1c, courses are offered for advice on the use of insulin for ‘NORMAL’ meals and the appalling statistics for HbA1c and complications continue. Does anybody at NICE or even your GP review these statistics and ponder why?

How many more years are thousand s of diabetics to be condemned to a lifetime of pain and suffering or even an early death? Are those spuds worth it?


Tuesday 27 November 2012

Dr Phillip Lee MP/GP Make people with lifestyle-related illnesses pay for their drugs, says Tory MP

Phillip Lee MP, a practising GP and member of the right wing Tory Free Enterprise Group,  "said patients must live healthier lives or help meet the cost of their care from their own pockets. “If you want to have doughnuts for breakfast, fine, but there is a cost implication down the line,” he said."

This so called caring Doctor who is a disgrace to his profession is suggesting the patients with Diabetes and other so called life style health illnesses should pay for their medications and I don't just mean the prescription charge, he implies we should be paying the full cost price that is charged to the NHS.

What this well heeled idiot fails to grasp is the high prevalence of Type 2 in Deprived areas who are living below or on the poverty line, they can barely afford the basic necessities  let alone fund their own medications. Who's going to pick up the pieces when they can't afford the medications and they get complications that need urgent hospital treatment, that's of course if they can get free NHS care in the future.

Another quote from the Dr.

 "Dr Philip Lee, a GP in Slough, called for a Danish-style system where patients are given a “modest” personal drugs budget and have to pay for extra prescriptions themselves.

They could take out supplementary insurance for very expensive treatments such as for cancer."

I expect he and his family will be adequately covered by health insurance, with his earnings as a GP and MP it would be small change to him, and he's always got his nice little earner in the private sector as a freelance doctor for Medical Solutions Ltd

Is your MP on the list:

Over 60 MPs Connected to Companies Involved in Private Healthcare

Finally you can watch a video of his presentation:


The health foods doctors say don't work:


Dr Aseem Malhotra, lead cardiologist of the National Obesity Forum, says:

I don’t go near Benecol or any other margarine-type products that claim to lower cholesterol and I advise my patients to stay clear of them, too. 

First, they are expensive; second, these products are artificial, packed with unnatural products that really can’t do you any good; and third, I don’t believe there is any demonstrable health benefit.

They may have a very marginal effect on cholesterol, but — and this is critical — this hasn’t been established as having any clinical benefit in reducing the risk of a heart attack. In short, the whole saturated fat argument has been ridiculously overhyped. 

A review of studies in the American  Journal of Clinical Nutrition in 2010, which analysed almost 350,000 people for up to 23 years, revealed no consistent evidence  linking saturated fat and cardiovascular disease.

In fact, I’ve started advising my patients to have butter, though clearly in moderation. 

Really strong data is increasingly showing that the saturated fat from natural dairy products may even be beneficial in reducing heart attacks. It’s thought this is because it contains essential vitamins, such as A and D, as well as essential nutrients such as calcium and phosphorus, which studies  suggest can reduce the risk of heart disease and stroke.

Other research, by Dr Dariush Mozaffarian from the Harvard School of Public Health in Boston, found that people with higher levels of the trans-palmitoleic fatty acid (found mainly in dairy products) in their blood were about 60 per cent less likely to develop  type 2 diabetes over the next 20 years than those with the lowest levels. 

Again, this runs counter to long-standing recommendations to trade in whole milk and cheese for the skimmed varieties.

Read more: http://www.dailymail.co.uk/health/article-2238928/The-health-foods-doctors-say-dont-work-From-blueberries-cod-liver-oil-margarine-cuts-cholesterol.html#ixzz2DQY7QbHj
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Sunday 25 November 2012

Fat lot of good !

For years we've been told saturated fat is bad for us. Now experts suggest that it is actually healthy to eat.

I was hovering over the nuts display in the supermarket, wondering which to buy. I had just interviewed Oliver Selway, a radical diet-and-fitness coach and proponent of a food regimen that does not fear fats. He had told me macadamias were by far the most nutritious nuts to eat, a nut that any dieter will know is forbidden as it is astonishingly calorific. “They’re the fattiest nuts, you know,” a woman next to me said. “They are so bad.” Cheerily, I repeated Selway’s nutritional proposition: that animal and other natural saturated fats from whole foods are good for us. They are what human bodies have known for millions of years, and we can successfully lose weight not just on a high-fat diet, but on a diet that is high in saturated fat. She was beyond incredulous, and her hysterical reaction illustrated how emotional and deeply entrenched our belief is that fats — and saturated fats in particular — are unhealthy and make us obese. I bought some walnuts, made my excuses and left.

Selway’s Instinctive Fitness plan modifies the largely meat-based paleolithic diet, and includes potatoes, wild rice, parsnips, quinoa and buckwheat. “What’s not up for negotiation is avoiding sugar and wheat,” he says, “and the total rejection of processed foods.”

The strict paleo diet belongs to the health-freak category, the sort who doesn’t drink and, like Matthew McConnaughey, a vocal paleo, exercises with rocks, in bare feet. What is interesting about it, as with Atkins previously, is its acceptance of something that has been demonised for a generation. Saturated fat has for years been presumed and, it is claimed, scientifically proven to cause high cholesterol, heart disease, cancer, strokes and big bottoms. Opinion is changing, though, and not just among diet kooks. For every paper that says eating fats causes all these modern diseases, there are as many that say they are not and might even protect us.

Dr Alison Law, a GP, is an exponent of the sat-fat diet, even though she is supposed to advise patients differently. When she was looking for “a quick fix to lose post-pregnancy flab”, she went on a high-fat diet. “We are taught that a diet low in saturated fat and high in carbs is good for patients. Low-carb, high-fat diets are viewed sceptically by the medical community,” she says. “But after reading the physiology behind the sat-fat diets, it made sense.” Law has stuck with this “semi-paleo” diet. A typical meal for her is roast butternut squash with parma ham and rocket, or steak with roast veg. She has the occasional pigout on cakes and pudding, but mostly confines sweetness in her diet to 85%-cocoa chocolate.

I spoke to others who claim to be “sort of paleo”, including neolithic wine, butter and cheese in their menus; their rejection of starchy and processed carbs, however, is total. There’s no doubt about it, these people are shrugging off department of health guidelines and braving the dangers of eating saturated fat in far greater quantities than the government says is good for them. And while sat-fat makes its way back onto the menu, the processed-food manufacturers are under increasing attack. The heavyweight lawyers in America who won hundreds of millions of dollars for their clients from the big tobacco companies have filed lawsuits against some of the biggest players. Their argument is not about excessive fat content in processed food, but the misleading labelling.

Professor Tom Sanders, head of diabetes and nutritional sciences at King’s College, London, sees a logic to people who let their gut decide their diet rather than government guidelines. “Fat intake has fallen in Britain,” he says. “There’s been a 50% reduction in the past 10 years, and yet obesity and diabetes are rising. If you like a marbled steak, fine — saturated fat from the source is not evil — but trim the fat off your meat and give it to the cat.” Not because it will harm you, he says, but because it will make you fat. “It’s not meat that is harmful — it’s the rubbish in processed meat products.”

All natural fats have functions for health; they are not inherently bad. They carry many vitamins that cannot be absorbed in any other way, as well as flavour. Sanders calls margarine “the devil’s semen” and is glad butter has overtaken it in popularity again. Man-made trans fats in margarines and processed foods such as cakes, biscuits and pastries are made from artificially hardened, partially hydrogenated fats, and have been banned in Denmark, Switzerland, Austria and parts of the United States, notably California and New York.

Emma Cannon, a respected traditional Chinese medicine (TCM) practitioner and fertility expert, says we have been reducing our fat intake for more than health reasons. “There are many people who would benefit from more fat in their diet,” she says. “I see a lot of women who say they are committed to having babies, yet I often find they are more committed to being thin. We’ve got some really crossed wires on healthy eating. In TCM, pork fat is used as a tonic.”

While people have been told for decades to cut saturated fat from their diet, they have replaced it with what some studies suggest is more harmful: refined carbohydrates. One Australian study found that a high-fat, low-carb diet was no more likely to cause heart disease than a high-carb, low-fat one. However, it was a more effective means of weight loss and less likely to cause diabetes.

The largest ever controlled study of diet, conducted by the University of Copenhagen in 2010, concluded that “current dietary recommendations are not good enough to prevent overweight persons from gaining weight. You should cut down on finely refined starch calories such as white bread and white rice”.

Zoë Harcombe, an obesity researcher and author of The Obesity Epidemic, says forgetting about calories and eating a diet of real food is the best route to healthy weight and good nutrition. Natural foods and grass-fed meats have a beneficial mix of all the different types of fats, and to isolate saturated fat is irrational because nowhere in nature does it exist alone. Even lard is only 39% saturated fat (compared to butter, which is 63%), the rest being mostly monounsaturated fat. Cheese is especially high in saturated fat. However, it is what Sanders calls “micronutrient dense”. “You get a lot of nutrients per calorie.” “Similarly, oily fish such as smoked mackerel is high in saturated fat and salt, but you won’t go on eating it long after you’ve had enough, unlike Pringles.”

It is this nutrient density that makes Harcombe believe “real” food cannot harm us. She’s not anti oats, as a paleo would be, but, “an egg for breakfast, cooked in butter, spanks porridge nutritionally”. The University of Wales at Newport has banned any mention of her in its nutrition class because she won’t stick to official guidelines. “It astounds me that I am seen as radical,” she says, “because all I’m saying is eat real food. Meanwhile, the fake food, like sugary cereals, has an army of dieticians to recommend it.”

Sanders offers a word of caution on fatty binges, particularly at this time of year. He describes an unusually high number of heart attacks in middle-aged men after the Christmas blowout. “Then again,” he chuckles, “that could be about exposure to family.”

The sat-fat revival


Large skinny latte with sweetener
Tuna niçoise with low-fat dressing
Sliced turkey breast
Reduced-fat hummus
Müller Light
Skinny popcorn
Snack a Jacks
Steamed cod
Processed low-fat ham
Lean steak, grilled
Diet hot chocolate


Omelette and herbs
Peanut butter
Americano with cream and cinnamon
Avocado, chilli, lemon and olive oil
Roast pork and crackling
Unpasteurised cheese
Greek yoghurt, mixed berries
Toasted sunflower seeds
Cashew nuts
Pan-fried salmon
Organic, unsalted bacon
Sirloin sautéed in butter
Piece of dark chocolate with hot, full-fat milk 

Friday 23 November 2012

Prevalence of Diabetes in U.S. Youth Set to Rise Considerably

(HealthDay News) – Projected estimates suggest considerable increases in the prevalence of Type 1 and 2 diabetes among youth by 2050, according to research published in the December issue of Diabetes Care.
Giuseppina Imperatore, MD, PhD, from the U.S. Centers for Disease Control and Prevention in Atlanta, and colleagues used a Markov modeling framework to generate yearly forecasts of the number of individuals <20 years with and without diabetes through 2050. Based on the 2001 prevalence and 2002 incidence, two scenarios were considered for Type 1 and 2 diabetes incidence: a constant incidence over time and an increased incidence (varying increase with age for Type 1 diabetes and a constant 2.3% increase across all ages for Type 2 diabetes).
Under Scenario 1, the researchers projected that the number of youth with Type 1 diabetes would increase from 166,018 in 2010 to 203,382 in 2050. For Type 2 diabetes, the increase would be from 20,203 to 30,111. Under Scenario 2, there would be an increase in the number of youth with Type 1 diabetes, from 179,388 in 2010 to 587,488 in 2050 (prevalence of 2.13 and 5.2 per 1,000 respectively). The largest increases would be in youth of minority racial and ethnic groups. For Type 2 diabetes there would be an increase from 22,820 in 2010 to 84,131 in 2050, an increase in prevalence from 0.27 to 0.75 per 1,000.
"Our projections indicate a serious picture of the future national diabetes burden in youth," the authors write. "Even if the incidence remains at 2002 levels, because of the population growth projected by the U.S. Census the future numbers of youth with diabetes is projected to increase."

Thursday 22 November 2012


If you show the appalling NHS results (highlighted in the 2 following posts):

to a GP or a HCP they will often reply that the results are due to the patient’s non-compliance or ignorance.

It is then of some interest to examine the results for patients who have received the NHS diabetic education course for Type 1 and Type 2 diabetes.

The structured education programme DAFNE (Dose Adjustment For Normal Eating) is for Type 1 diabetes. A recent publication:

assessed HbA1c over a 7-year period following such a course. Over the7 year period a reduction in HbA1c from an average of 8.6% to an average of 8.3% was achieved.

The DESMOND Programme (Diabetes Education Self-Management On-going and Newly Diagnosed) is for Type 2 diabetes. A recent publication:

concluded: “a single programme for people with newly diagnosed type 2 diabetes mellitus showed no difference in biomedical or lifestyle outcomes at three years although there were sustained improvements in some illness beliefs.”

                Appalling diabetes statistics
                Educational programmes bring no significant improvement
                The consequences for the future are well known
A recent publication:

Used information from national databases representing over 20 000 patients from 2005 to 2008, Scottish researchers led by Helen Colhoun from the University of Dundee, found that people with type 1 diabetes have 2 to 3 times the risk of heart attacks, strokes, or premature death than the general population and that this increased risk is higher in women than in men. The authors found that in those with type 1 diabetes, the risk (chance) of having a cardiovascular event (heart attack or stroke) for the first time was 2.5 higher in men and 3.2 higher in women, than in the general Scottish population. Furthermore, in those with type 1 diabetes, death rates from any cause were 2.6 higher in men and 2.7 higher in women than in the general Scottish population.

Worryingly, the authors also found that the majority of patients in this Scottish dataset had poorly controlled blood glucose levels, with only 13% having HbA1c levels (a test that measures the blood sugar control over the previous 3 months) in the target range.

They continue: "A striking feature of the data is the very low rate of achievement of glycaemic control targets." The authors add: "Risk factor management should be improved to further reduce risk but better treatment approaches for achieving good glycaemic control are badly needed.”

What better treatment approach for achieving good glycaemic control would you suggest?


Link Between Vitamin D Deficiency And Type 1 Diabetes !

A study led by researchers from the University of California, San Diego School of Medicine has found a correlation betweenvitamin D3 serum levels and subsequent incidence of Type 1 diabetes. The six-year study of blood levels of nearly 2,000 individuals suggests a preventive role for vitamin D3 in this disease. The research appears the December issue of Diabetologia, a publication of the European Association for the Study of Diabetes (EASD). 

"Previous studies proposed the existence of an association between vitamin D deficiency and risk of and Type 1 diabetes, but this is the first time that the theory has been tested in a way that provides the dose-response relationship," said Cedric Garland, DrPH, FACE, professor in UCSD's Department of Family and Preventive Medicine. 

This study used samples from millions of blood serum specimens frozen by the Department of Defense Serum Registry for disease surveillance. The researchers thawed and analyzed 1000 samples of serum from healthy people who later developed type 1 diabetes and 1000 healthy controls whose blood was drawn on or near the same date but who did not develop type 1 diabetes. By comparing the serum concentrations of the predominant circulating form of vitamin D - 25-hydroxyvitamin D (25(OH)D) - investigators were able to determine the optimal serum level needed to lower an individual's risk of developing type 1 diabetes. 

Based mainly on results of this study, Garland estimates that the level of 25(OH)D needed to prevent half the cases of type 1 diabetes is 50 ng/ml. A consensus of all available data indicates no known risk associated with this dosage. 

"While there are a few conditions that influence vitamin D metabolism, for most people, 4000 IU per day of vitamin D3 will be needed to achieve the effective levels," Garland suggested. He urges interested patients to ask their health care provider to measure their serum 25(OH)D before increasing vitamin D3 intake. 

"This beneficial effect is present at these intakes only for vitamin D3," cautioned Garland. "Reliance should not be placed on different forms of vitamin D and mega doses should be avoided, as most of the benefits for prevention of disease are for doses less than 10,000 IU/day." 


Wednesday 21 November 2012

Conference skirmishes with cholesterol, statins and statistics !

Saudi Gazette report

HOFUF — The subjects of cholesterol, statins and statistics, the hot topics of debate in an increasingly sceptical medical world, came under attack at the King of Organs heart conference in Hofuf Tuesday.

The overall impression that evolved from the presentations was summed up in the words of Dr. Malcom Kendrik, “The whole cholesterol thing is bunk”.

A phalanx of speakers and researchers qualified to present such a controversial stance against the mainstream medical establishment what was, in the esoteric world of cardiovascular specialists, a declaration of turf war. “The war against manipulation of data starts here, and about time too,” were the un-attributable words of one professor of cardiovascular medicine.

Prof. Paul Rosch, Clinical Professor of Medicine and Psychiatry, launched the opening salvo of the Hofuf campaign.

In a systematic analysis of the published figures and claims supporting statins, he highlighted the flaws and contradictions in the claims by manufacturers of the drug and reviewed the semantic confusion he found in works about statins. “There is a confusion between association and causation,” he said and identified it as an underlying factor in what he saw as the current misinformation about statins.

As a coup de grace in his presentation he stated: “All statins are carcinogenic in laboratory animals when used in clinical doses.”

Dr. Malcom Kendrick, Executive Member of the International Network of Cholesterol Sceptics, opened a second campaign, this one aimed at myths about high fat diets and the dangers of cholesterol.

“We are told that if we eat a high fat diet and have high cholesterol we will have a heart attack.”

He presented a powerful case, from wide ranging statistical evidence and constructed an argument that countered the contention. He detailed the impossibility of cholesterol lining arteries in the way fat lines a pipe and demonstrated that in fact the nature of the epithelium, the layer of cells that forms the lining of arteries, “lets nothing past it does not want to. To say that it lets stuff through is as stupid as my saying I can walk through walls.”

He showed that in reality the epithelium has to be damaged to allow the formation of fat behind it and then the “skin” grows back. He noted that despite the evidence, the popular image of “fat in pipes” was the one that sold and stuck.

That, he said, was important as campaigns had been mounted with equally specious “facts” to support them and gave the example of an anti-smoking campaign in the UK that linked smoking to the buildup of fat in arteries, “but offered no explanation to support it”. Even more importantly although cholesterol, fat and strokes have been inextricably linked by campaigns and in the public mind, “no one has ever found a link between cholesterol and stroke death.”

To illustrate that “the whole cholesterol thing is bunk,” he pointed to the case of Japan, among other nations as proof. In 50 years, fat consumption has risen by 200 percent, cholesterol by 60 percent but cases of heart disease have dropped by 40 percent.

Kendrick went on to make a case for the part that stress played in heart disease and showed positive links between lifestyle and both chronic and acute points of stress in life. Causes varied from combat trauma through bullying to child abuse – all were factors in stress and were all important factors.

Using his own dietary challenge as an example, Prof. David Diamond looked critically at the relationship between bad science, politics and commercial profit as he traced the history of diets from the 19th century onward. He came to the conclusion that fat, far from having a deleterious effect has in most cases the opposite. The idea of the meat, fat and vegetables diet he thought was neither new nor incorrect. It had been recycled several times in history. Indeed, an all animal-product diet was standard for several cultures – Inuit in Alaska, Sami in Finland and Masai in Kenya – where heart disease and cancer were almost unheard of.

The idea that fat food was linked to arteriosclerosis he contended was propagated originally by Ancel Keys, who became the national food guru during the McCarthy era in the 1950s. One essential factor left out of Keys’ research into the cause of heart conditions was sugar. It was carbohydrates that were the real enemy, said Diamond, in the form of sugars and starches.

The idea of fat and heart disease stuck with the public and a whole industry developed promoting fat-free foods; the net effect is that because the majority contain high quantities of sugar and carbohydrates in other forms, that obesity in the US, for example, has risen, not declined.

With this, Diamond opined, arose a whole industry to control the effects of a diet that caused the problems. He concluded that there was a choice between statins or low to zero carbohydrate diet – leaving out bread, potatoes rice and sugar. “Dark chocolate is a far better drug to take than statins,” he said.

Kendrick concluded his campaigning day by asking the conference to consider the methods of and reasons behind data manipulation. It was, he said, outrageous and largely unchallenged and should be stopped. His presentation drew loud applause after he detailed the extent of the habit in commerce, the publication of papers and research.

Kendrick showed published statistical samples were manipulated to prove a case, unsupportive data hidden, accurate research that was not acceptable to mainstream thought published in low circulation minor publications, threats of funding withdrawal from research projects that seemed to be producing the “wrong” results and outright peer pressure – bullying by another name.

The solution he thought includes independent review bodies with statutory powers to impose effective sanctions, a common statistical method so that results could be compared accurately and great personal skepticism.

On its final day (Wednesday) the conference moves into more esoteric areas of debate on the outer fringes of research into the electromagnetic aspects of the heart and body taking center stage.


Nutrition: from negative to nourishment !

After a period of joyless nutritional advice, let's remember the old concept of nourishment.

Bee wilson nutrition notebook

I'll always remember the day my then four-year-old daughter's class were sent home with a diet sheet from the local authority. It advised that if your child became hungry between meals, you could try giving them a sugar-free jelly. Sure! That'll fill them up – a mix of gelatin, sweeteners, colouring and water.
For a long time official nutritional theory was largely negative. A food was 'good' if it had zero fat, zero sugar or zero cholesterol. This was a joyless way of looking at the process of eating. And it didn't work. While governments and doctors exhorted us to cut our pleasures out, obesity levels soared.
We are now in the midst of a nutritional sea change. The old enemies of fat and protein are being welcomed back, while refined carbohydrates are the new devil. But the change is far bigger than this. There's a new sense that food is not just about calories in, calories out. We are starting to realise that 400 calories of salmon and lentils might keep us going for longer than 400 calories of low-fat white sliced bread. What we are seeing – and about time, too – is a return to the old concept of nourishment.
The wartime generation, living with scarcity, judged foods largely in terms of how they nourished you. Fish was brain food. Meat and milk would build you up. Butter and eggs were husbanded, as golden treasure. Blackcurrant and oranges were valuable vitamin C. Children needed to be fed, not fobbed off with sugar-free jellies.
We came to reject the idea of nourishment as old-fashioned. Looking at our increasingly chubby youth, we felt that 'nourishing' was the last thing they needed. We were wrong. A gathering body of scientific evidence suggests that the obesity of the West and the malnutrition of the developing world are not as far apart as they seem.
'Eat less and exercise more – it's not rocket science, is it?' is a view often expressed when the subject of obesity comes up. But this takes no account of the complexity of the problem – nor the fact that it has never been seen on this scale before. A 2009 paper in Nutrition Reviews by Garcia, Long and Rosado found that obesity worldwide was linked with a lack of vitamins and minerals. Obese children are far more likely to be deficient in vitamin D. Deficiency in vitamins C, E, A and zinc has also been associated with higher body fat. You can be overstuffed and undernourished at the same time.
Meanwhile, Robert Lustig, a children's doctor, has electrified public opinion in America by suggesting that one of the root causes of obesity is, bizarrely, hunger. His argument (watch his YouTube video, 'Sugar: the Bitter Truth') is that the excess sugar in our diets – much of it in 'low-fat' processed foods – messes with leptin, a hormone that tells us when we are full. If Lustig is right (some scientists dispute him), children who gorge on sugary foods are not just being greedy; they are often genuinely hungry, because their diet fails to satisfy.
The answer is not sugar-free jelly but a completely different approach to healthy eating, one that recognises the complex needs of the human body. The real mystery is how we ever forgot that the point of food is to feed.

NHS Diabetes: Treatment Targets

An earlier post summarised the NHS’s lack of success in ensuring that diabetics received all nine diabetes care processes specified in the NICE Clinical Guidelines: five risk factors - weight (BMI), blood pressure, smoking, glucose levels (HbA1c), and serum cholesterol and four tests for early complications - digital eye photography, laboratory urine microalbumin: creatinine ratio, serum creatinine and foot nerve and circulation examination.

The NICE guidelines also specify treatments target standards: HbA1c ≤ 7.5%, total cholesterol ≤ 5 mmol/l and a blood pressure target of < 140/80 for those patients without a recorded eye, kidney or vascular disease (EKV-) and < 130/80 for those patients with a recorded eye, kidney or vascular disease.

Given that the HbA1c upper limit is dangerously high and almost all diabetics are prescribed statins and blood pressure tablets it is of some interest to note what percentage of people registered with diabetes achieve all 3 target standards. From:

% of patients achieving all 3 target standards

Type 1
Type 2

Do we regard this as acceptable?


NHS Diabetes: Care Processes

The NHS diabetes care processes are specified in NICE Clinical Guidelines and include five risk factors  - weight (BMI), blood pressure, smoking, glucose levels (HbA1c), and serum cholesterol and four tests for early complications  - digital eye photography, laboratory urine microalbumin: creatinine ratio, serum creatinine and foot nerve and circulation examination.

It is of some interest to note what percentage of people registered with diabetes received all nine of the key processes of diabetes care. From:

% of patients receiving all care processes*

Type 1
Type 2

*For patients under 12 years of ages, ‘all care processes’ is defined as HbA1c only as the other care processes are not recommended in the NICE guidelines for this age group.

One as to ask why if they have the patient in the room they cannot complete all nine care processes.


Tuesday 20 November 2012

Diabetes: 1-in-3 inpatients suffer NHS error, report to claim !

Almost one-in-three diabetic inpatients in Wales has experienced at least one NHS medication error, a new report by Diabetes UK Cymru is to reveal.

The charity is concerned because the number of people with diabetes in Wales rose more than a quarter in five years.
Meanwhile figures obtained by BBC Wales show only one of the seven Welsh health boards has taken on more specialist diabetic nurses in the last four years.
One board has cut staffing while the other five have kept the same total.
The Diabetes UK Cymru report to be published on Wednesday reveals diabetes is growing rapidly with an increase of 35,000 people with the condition in Wales over the past five years to 160,000 - a rise of 28%.
By 2025, the number of people with diabetes is forecast to top 250,000 with 66,000 people currently undiagnosed.
Despite the concern, the charity says 70% of adults with type 1 diabetes and 43% with type 2 are not getting simple checks, such as blood glucose tests.
Diabetes UK Cymru director Dai Williams told the BBC Wales Week In Week Out programme: "The cost of diabetes is massive - the bottom line is - it's a ticking time bomb.
"We've got people wandering around with high blood sugars, not even realising it's going to cause a problem."
The report, called State of the Nation 2012, will also claim that 29.8% of inpatients with diabetes experienced at least one medication error while on a ward.
The programme features the family of David Joseph, from Aberaeron, Ceredigion, whose care before his death in 2009 was criticised in April this year by the Public Services Ombudsman for Wales, Peter Tyndall.
Madie JosephMadie Joseph said she 'foolishly' thought her husband would be safe in hospital
Mr Tyndall raised concerns over clinical record keeping by the Hywel Dda health board and made recommendations.
Mr Joseph's widow, Madie, a former nurse, tells the programme: "We thought, foolishly, that patients with diabetes in hospital would be safe and clearly he was not.
"I still don't understand how they [nurses] could have been so mistaken - so ignorant - and it mustn't happen again to another patient."
The family received an apology following the release of the ombudsman's report.
Week In Week Out has also learned about three more complaints about the treatment of diabetic inpatients at Hywel Dda health board hospitals.
Councillor Elizabeth Evans, a senior case worker for Mark Williams MP, tells the programme the complaints received over the past 18 months include concerns over fluid intake and patients not eating properly.
She says: "Every single case would go into hospital for a very different reason. So it was issues about fluid intake, about food, not eating, and obviously any diabetic specialist will tell you that a diabetic needs to eat."
In a statement Hywel Dda health board said it takes any allegation of a breach of professional standards seriously and an investigation was ongoing.
Hywel Dda was the only health board in Wales which has increased the number of specialist diabetes nurses, from seven in 2008/9 to the equivalent of 12.34 full-time staff in 2012/13.
Cwm Taf in the south Wales valleys was the only board to cut staffing, from the equivalent of 13.89 full-time nurses in 2008/9 to 11 in 2012/13.
Cwm Taf Health Board is pioneering a new scheme to cut diabetes-related medication errors in their hospitals.
It is a highly visible branding campaign called Think Glucose and involves raising awareness of diabetes with all staff throughout every ward.
Hypo Boxes on every medication trolley means treatment can be given to patients suffering a hypoglycemic attack quickly; pre-printed medication charts cut the risk of mis-reading doseage; and colour-coded blood sugar monitoring charts mean that dangerously low blood sugar levels go into a red zone - alerting staff of the need to treat the patient quickly.
The campaign has seen medication errors at one hospital, the Royal Glamorgan, decrease from 50% to 6%.
At the moment, Cwm Taf is the only health board running Think Glucose, but other health boards are showing interest - and Hywel Dda says it will be rolling out the programme in the New Year.