Diabetes UK Professional Conference 2014

Last week I took a day away from my PR and marketing activities to attend the Diabetes UK Professional Conference on Albert Dock in lovely Liverpool. The conference was HUGE. Around 3000 people, all of whom have a deep interest in finding prevention, cure or providing the best outcomes for people living with diabetes.  The programme addressed a whole range of issues from basic science, to clinical care and psychosocial aspects of diabetes. 

There was a strong focus on technologies and their application. I attended some brilliant, inspirational, extremely interesting and insightful talks from the top people in the field of diabetes management and research.  

Barbara Young's, Chief Exec of Diabetes UK, opening speech gave us some interesting facts and figures. One focus for Diabetes UK in the coming year will be to encourage the government to devise a Diabetes Plan.  Scotland, Wales and Ireland have them, but England does not.  Another aim will be to find ways of identifying the estimated 7 million people in the UK who are at risk of type 2 diabetes.  Diabetes UK will launch Type 1 Essentials for Children and Young People. Advice about food choices and about healthy eating will be central to this.  A very useful online type 2 education programme will also be launched.  A recent survey revealed that when people are diagnosed with diabetes, the most common questions are around finding out what they can eat.  This shows that tools like Cook & Count app are central to diabetes support and management. 

Then onto a talk about diabetes care. Bernie Stribling, Leicester, and Su Down, Somerset, told us about the fantastic work being done in providing enhanced service and improving diabetes care despite funding challenges and decreasing secondary care capacity. Key themes in diabetes management were education and self-care. Common feedback from patients was that they wanted health care professionals to be able to provide more consistent information and to be greater equipped to enable patients to self-manage. Again, this is where apps that help with education and self-management can play a key role.

After coffee (a good flat white, yumm) I listened to a very interesting and convincing talk from Roy Taylor, Newcastle-upon-Tyne on "Food, health & diabetes".  Type 2 diabetes patients frequently ask why their blood glucose rises overnight even though they haven't eaten or drunk anything. In type 2 diabetes there is a problem with insulin sensitivity of the liver. But this can be fixed. Several studies have shown that liver insulin resistance can be normalised by moderate calorie restriction which decreases liver fat.  And an acute negative energy balance will cause a fall in fat in the pancreas which in turn leads to increased insulin production. An 8 week weight loss experiment showed a rapid change in plasma glucose which was maintained over the duration of the study, with a baseline average liver fat of 36% reducing to 2% after 8 weeks!  Of specific interest to the carbohydrates debate: they found that excess carbohydrate leads to liver triglycerides (fat) whereas eating excess saturated fat did not have the same effect.

Prof Taylor then introduced an ongoing long-term study that he was leading. Significantly, they had found that type 2 diabetes only occurs with a positive calorie balance.  So with someone who has an inherited insulin resistance and is overweight, then the likelihood of developing type 2 diabetes becomes much greater.  He introduced the concept of the ‘personal fat threshold’ which explains why even normal weight people can get type 2 diabetes. The theory suggests that those people are carrying more weight than they need to be. This can be as little as 2 or 3 kg.

Next was the Dietitians meeting which took place at lunchtime of course – my tummy was rumbling! Candice Ward, Principal Diabetes Dietitian at the Cambridge Diabetes Education Programme, spoke about the need to standardise education programmes in order to increase trustworthiness which would reassure patients that they are getting up to date, reliable and evidence based information. 

And then after a very rushed and not particularly nutritious sarnie I returned to the debate about whether it was time for dietitians to stop promoting carbohdyrates.  In a very packed room Trudi Deakin, Chief Executive of X-PERT Education, very convincingly gave her side of the argument which was to stop  the blanket recommendation that carbs should form the greatest part of the diet.  This was because there was no evidence about the ideal percentage of calories to come from carbohydrate, nor from anything else for that matter.  Instead, more effort was needed to educate people about what carbs are and how they work as awareness of these was very low. She concluded that dietary advice should be given according to individualised plans.

Carla Gianfrancesco, Sheffield, who has designed several carbs awareness tools, equally convincingly gave the pro carbs side of the argument.  She warned against reducing carbs too heavily as this might result in a reduced intake of fruit and wholegrains, all of which have protective benefits.  She did point out, for people with type 1 diabetes, that the higher the carbs intake, the greater the chance of inaccuracy. Having said that, accuracy was more important than the actual amount of carbs eaten. Professor Lee added entertainingly to the argument by telling us about the evidence for vitamin deficiency in low-carb diets and the large literature on the benefits of carbs.  In the end it was a close call, but the vote swayed slightly in the favour of Carla Gianfrancesco.

Last lecture of the day – Dr Partha Kar.  Brilliant! Such an enjoyable and thought provoking talk. It was with his team at Portsmouth Hospital that I did my first Cook & Count Carbs demo. They are a lovely group of diabetes specialist nurses and dietitians, with a great attitude towards thinking about things from the patients’ point of view and towards learning new technologies etc. So back to Partha Kar … He encouraged diabetes teams to make things happen, to be open to learning and to communicating.  He suggested that they should look at what other diabetes teams were doing, and not be afraid to emulate if they thought it made sense: there was no point in spending weeks, months, years, devising and developing new strategies and services when others had already gone through the process.  He is a keen social media user (see @Parthsakar on Twitter) and encouraged health professionals to use social media more, particularly using it understand patients better by finding out what they are saying and which issues are important to them.  And then he made a point which was very close to my heart.  He stated emphatically that we should be treating type 1 diabetes as a different disease from type 2 diabetes.  They have different causes and different treatments.  In Partha Kar’s words:

Type 1 diabetes is not:

- Cured by insulin

- Contagious

- Just for kids

- Caused by an unhealthy lifestyle or eating too much sugar

- Something you outgrow

- Preventable

I agree with Partha entirely. One thing I found slightly disappointing about the conference, although not surprising, was that in many debates and lectures type 1 diabetes was not treated any differently from type 2. It needs to be. For example, for those with type 1 diabetes, particularly children and young people, weight loss is not the aim and carbohydrates are an important source of energy in the diet. Thank you Partha Kar for such an inspirational talk. 

In between the lectures, I managed to meet with the DMEG (Diabetes Management and Education Group) team. What fun - they had a diabetes dietetics quiz and competition on their stand. Phew ... luckily I got my quiz question about carbohydrates correct – mmm that would have been a bit awkward. I also met with the DAFNE team on their stand and gave them a quick demo of Cook & Count Carbs app, which they loved the look of.

After a quick look around the poster exhibition, where there was a good spattering of studies about the increase of use and interest in apps and technology, I made the long journey back home from Liverpool, arriving at home in Bath late that night.  

It sounds like there were some great talks the following day. I wish I'd been there for Prof Stephen Greene's lecture entitled 'Diabetes in the young: technology, engagement and context.' He talked about the 'lost tribe' of young people with type 1 and how diabetes health professionals needed to move with the times and listen and understand young people's needs. They needed to keep up to date with technology, including with the use of apps for self-management.  I also wish I'd been there for Laura Cleverly's (@ninjabetic1) great talk about the Our Diabetes platform and the online diabetes community. Next year ...

All in all, a really good conference. I was reassured by the strong focus on diet, education, self-management and social media use. And I have a whole note pad full of new ideas and contacts.