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DUKPC research highlights: Days 3 and 4

Over the last couple of days, research shared at our professional conference (DUKPC) has given us new insights into links between type 1 diabetes and musculoskeletal problems and has brought us up to speed on technologies that are radically changing the treatment and management of diabetes. 

Type 1 diabetes can cause musculoskeletal problems  

Dr Harry Green at the University of Exeter presented his important new research revealing that type 1 diabetes is likely to directly cause certain musculoskeletal conditions (conditions that affect the bones and muscles), including frozen shoulder. By looking at genetic and health data, the researchers identified four conditions that should now be considered as complications of type 1 diabetes.

We already know that some musculoskeletal conditions are more common in people with type 1 diabetes. But until now, it hasn’t been clear whether type 1 diabetes is a direct cause, or whether there are other factors in play.

The team of researchers analysed data from UK Biobank – one of the largest health studies in the world – and FinnGen, a similar database in Finland. They used genetic and health information to investigate whether people with type 1 diabetes were more likely to develop a range of common conditions. When a link between type 1 diabetes and a musculoskeletal condition was found, the team used a statistical technique called Mendelian randomisation to understand whether type 1 diabetes was a direct cause.

Their analysis revealed that type 1 diabetes directly increased the risk of developing frozen shoulder, trigger finger, carpal tunnel syndrome and Dupuytren’s contracture – musculoskeletal conditions that are all characterised by pain and reduced mobility in the shoulder, hand, wrist, or fingers. However, type 1 diabetes was not found to be play a direct role in the development of osteoarthrosis (degeneration of joints).

Similarly to other diabetes-related complications, like heart or kidney disease, musculoskeletal damage is likely to be caused by having high blood sugar levels over a long period of time. Dr Green hopes that understanding more about the role that type 1 diabetes plays in the development of musculoskeletal conditions will help raise awareness among healthcare professionals and pave the way for these conditions to be recognised and treated earlier. Dr Elizabeth Robertson, our Director of Research, said:

“Dr Green’s research has shown, for the first time, that several musculoskeletal conditions are a direct complication of type 1 diabetes. People with type 1 diabetes should now be made aware of these conditions, alongside established complications such as heart and kidney disease. 

“These results are a reminder of the importance of supporting people with type 1 diabetes to manage their blood sugar levels so that they can live well with the condition and avoid future complications. 

“It is crucial that healthcare professionals are aware of these complications, so they are armed with the knowledge to facilitate early diagnosis and treatment, ensuring the best possible care for people with type 1 diabetes.”

Updates on the artificial pancreas  

In a session all about diabetes technology Professor Roman Hovorka, from the University of Cambridge, gave us an update on the lates artificial pancreas research and what the future could hold.

The artificial pancreas, or closed-loop system,lets your insulin pump ‘talk’ to your continuous glucose monitor(CGM). Based on your blood sugar levels, and the direction they’re heading, the device will automatically adjust the amount of insulin your pump is delivering.

The four artificial pancreas systems that are licensed for use in the UK at the moment. They are:  

Earlier versions of artificial pancreas systems worked to control basal(background) insulin. But scientists have been developing better algorithms that mean newer devices are hitting the market, which can also correct for high blood sugars by delivering a dose of quick-acting insulin. However, you still need to manually tell your pump the amount of carbohydrate you’re eating to get a delivery of quick-acting insulin at mealtimes.

Trials have shown the artificial pancreas helps people to spend more time with their blood sugars in a healthy range, reduces hypos and reduces HbA1c. It also helps people spend less time managing their diabetes (down to 10-20 minutes a day) and those using it report a better quality of life.

There are huge benefits for parents and carers of people with diabetes too. One study testing the system in children with type 1 diabetes found:

  • 85% of parents spent less time managing their child’s diabetes
  • 90% less time worrying about their child’s blood sugar levels
  • 90% had less trouble sleeping. 

Professor Horvorka revealed that the four artificial pancreas systems that are currently licenced for use in the UK are now being assessed by NICE - the body that makes recommendations on medical treatments and devices. If they are approved, it’s the first step to making this life-changing technology more widely available on the NHS.

Professor Horvoka also touched on the future of the artificial pancreas. There’s early research into systems that use both insulin and another hormone called glucagon, which raises blood sugar levels, to help more tightly control blood sugar levels. But this would increase the cost and complexity the artificial pancreas. As the technology improves, it’s hoped these more advanced systems will become a more feasible option.

Barriers to Freestyle Libre access  

Another revolutionary piece of type 1 diabetes tech is the Freestyle Libre. It has been shown to help improve blood sugar levels, reduce hospital admissions and diabetes distress.

Thanks to our campaigning, the Freestyle Libre’s available on the NHS for some people with type 1 diabetes who meet a specific criteria. But research led by Dr Emma Wilmot, at the Royal Derby Hospital, highlights that this tech isn't always equally accessible to everyone.

The research team looked at 5,407 people with type 1 diabetes prescribed the Freestyle Libre to see how their age, ethnicity and gender compared with the wider type 1 population of over 230,000 people in England and Wales, using data from the National Diabetes Audit (NDA).

They found that men and older people were less represented in the Libre group.They also saw the Libre group had a lower proportion of Black and Asian people than the NDA. This suggests that there could be barriers to accessing the Freestyle Libre in people with diabetes who are male, from ethnic minority backgrounds or of older age.

Research like this will help us to better support people who are not yet benefiting from diabetes technologies, and make sure that all people with diabetes have equal access to care that can improve their health and lives.

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