̽��ֱ�� of Cambridge - Hajira Dambha-Miller

Type 2 diabetes remission possible with ‘achievable’ weight loss, say researchers

cjb250 — Mon, 30 Sep 2019 06:55:51 +0000

̽��ֱ��findings suggest that it is possible to recover from the disease without intensive lifestyle interventions or extreme calorie restrictions.

Type 2 diabetes affects 400 million people worldwide and increases the risk of heart disease, stroke, blindness and amputations. While the disease can be managed through a combination of positive lifestyle changes and medication, it is also possible for the high blood glucose levels that define diabetes to return to normal – through significant calorie restriction and weight loss. An intensive low-calorie diet involving a total daily intake of 700 calories (less than one cheeseburger) for 8 weeks has been associated with remission in almost nine out of ten people with recently diagnosed diabetes and in a half of people with longstanding disease.

However, there is little evidence to show whether the same effect can be achieved by people undergoing less intensive interventions, which are more feasible and potentially scalable to the wider population. To answer this question, a team led by researchers at the ̽��ֱ�� of Cambridge studied data from the ADDITION-Cambridge trial, a prospective cohort study of 867 people with newly diagnosed diabetes aged 40 and 69 years recruited from general practices in the eastern region.

̽��ֱ��research was funded by Wellcome, the Medical Research Council and the National Institute for Health Research.

̽��ֱ��researchers found that 257 participants (30%) participants were in remission at five-year follow-up. People who achieved weight loss of 10% or more within the first five years after diagnosis were more than twice as likely to go into remission compared to people who maintained the same weight.

“We’ve known for some time now that it’s possible to send diabetes into remission using fairly drastic measures such as intensive weight loss programmes and extreme calorie restriction,” says Dr Hajira Dambha-Miller from the Department of Public Health and Primary Care.

“These interventions can be very challenging to individuals and difficult to achieve. But, our results suggest that it may be possible to get rid of diabetes, for at least five years, with a more modest weight loss of 10%. This will be more motivating and hence more achievable for many people.”

Senior author Professor Simon Griffin of the MRC Epidemiology Unit added: “This reinforces the importance of managing one’s weight, which can be achieved through changes in diet and increasing physical activity. Type 2 diabetes, while a chronic disease, can lead to significant complications, but as our study shows, can be controlled and even reversed.”

In order to clarify the best way to help patients with type 2 diabetes achieve sustained weight loss, the team is currently undertaking a study called GLoW (Glucose Lowering through Weight management). ̽��ֱ��study compares the current education programme offered by the NHS to people after they have been diagnosed, with a programme delivered by WW (formerly Weight Watchers®). ̽��ֱ��team is looking to recruit individuals who have been diagnosed with type 2 diabetes within the last three years, have not attended a structured education programme and are able to visit one of our testing centres in Wisbech, Ely or Addenbrooke’s Hospital. Further details can be found at the GLOW Study website.

Reference
Dambha-Miller, H et al. Behaviour change, weight loss and remission of type 2 diabetes: a community based prospective cohort study. Diabetic Medicine; DOI: 10.1111/dme.14122

People who achieve weight loss of 10% or more in the first five years following diagnosis with type 2 diabetes have the greatest chance of seeing their disease go into remission, according to a study led by the ̽��ֱ�� of Cambridge.

This [study] reinforces the importance of managing one’s weight, which can be achieved through changes in diet and increasing physical activity

Simon Griffin

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Fitness

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Patients with an ‘empathic’ GP at reduced risk of early death

cjb250 — Mon, 08 Jul 2019 21:00:58 +0000

Empathy is an important concept within healthcare and as such is emphasised in policy, codes of practice, national clinical guidance and medical training. It is also a high priority for patients. In a healthcare context, empathy refers to care that incorporates understanding of the patient perspective, shared decision making between patient and practitioner, and consideration of the broader context in which illness is experienced.

Optimising management of diabetes is a public health priority given the growing prevalence of the disease. Type 2 diabetes affects around 4 million people in the UK, and is associated with significant risk of death from heart disease and stroke and with early death. Type 2 diabetes is estimated to cost the UK over £9billion annually, 10% of the UK NHS budget.

Researchers at Cambridge followed up 867 individuals across 49 general practices in the UK as part of the ADDITION-Cambridge study to examine the association between primary care practitioner (GP and nurse) empathy and incidence of cardiovascular disease events (such as heart attack and stroke) or death.

Twelve months after diagnosis, patients assessed their GP’s empathy and their experiences of diabetes care over the preceding year using the consultation and relational empathy (CARE) questionnaire. ̽��ֱ��researchers then divided their CARE scores into three groups.

̽��ֱ��results of the study are published today in the Annals of Family Medicine.

Of the 628 participants who completed the questionnaire, just under one in five (19%) experienced a cardiovascular disease event and a similar number (21%) died during follow up from causes including cancer and heart attack.

Those patients reporting better experiences of empathy in the first 12 months after diagnosis had a significantly lower risk (40-50%) of death over the subsequent 10 years compared to those who experienced low practitioner empathy. Participants experiencing better empathy also tended to have a lower risk of cardiovascular disease events, although this was not statistically significant.

“In trying to manage the growing burden of chronic preventable disease, we’re increasingly moving towards precision healthcare, target-driven care and technology-based assessment, while at the same time focusing less on the human, interpersonal empathic aspects of care,” says Dr Hajira Dambha-Miller, a GP and researcher at the Department of Public Health and Primary Care, ̽��ֱ�� of Cambridge.

“Our findings suggest that these more human elements of healthcare early in the course of diabetes, may be important in their long-term health outcomes. ̽��ֱ��potential impact is considerable and is comparable to prescribing medicines but without the associated problems of side effects or non-adherence.”

̽��ֱ��researchers say there are several possible explanations for the association between greater empathy and better health outcomes. Previous studies have suggested that patients with lower levels of anxiety or those with an optimistic outlook (and who are more likely to report better perceptions of care), are also likely to live for longer.

They say it is also possible that GPs with empathic, patient-centred skills may be more likely to succeed in promoting positive behavioural change such as medication adherence or physical activity. Previous studies have also reported that greater practitioner empathy is associated with higher patient motivation towards activation, enablement and self-management of disease. Practitioner empathy may also reflect the doctor’s listening ability and the trust of the patient in disclosing what is really wrong so that it can be addressed.

̽��ֱ��research was largely funded by the National Institute for Health Research (NIHR), the Medical Research Council and Wellcome.

Reference
Dambha-Miller, H et al. Association between primary care practitioner empathy, and risk of cardiovascular events and all-cause mortality amongst patients with type 2 diabetes: a population based prospective cohort study. Annals of Family Medicine; 8 July 2019

Patients who have been diagnosed with diabetes are at a lower risk of early death if they have a doctor who they describe as showing empathy towards them, a new study from the ̽��ֱ�� of Cambridge has found.

We’re increasingly moving towards precision healthcare, target-driven care and technology-based assessment, while at the same time focusing less on the human, interpersonal empathic aspects of care

Hajira Dambha-Miller

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