Diabetes Glastonbury

Read Rob’s post from day one and two

If you don’t know, Glastonbury is a gigantic music festival in the UK. Over 5 days it deatures 2,000 different acts on 90 different stages. A town with the population of Buffalo NY is built in the Somerset countryside and lasts for just a couple of weeks before the fields are handed back to the dairy cows. You can’t make a plan because things distract you as you try to carry it out, you always want to be in two places at once, there’s mega-walking to do (I racked up 50,000 steps over 3 days) and the very best things (Jennifer Mahammadi’s talk on day 2 for me) are a complete surprise.

Glastonbury tickets 2020: Deadlines, sale dates and everything you need ...

Okay, so maybe it’s not exactly like Glastonbury

Happily, like the Sunday of Glastonbury, Day 3 of the Diabetes UK Professional conference are a bit more relaxed. The opening session was about early onset Type 2 diabetes. Not really my thing, but Professor Helen Murphy spoke of the importance of preparing women with diabetes for pregnancy. A lot of us worry about that for ourselves and our daughters and it surprised me that I hadn’t come across this idea. Here’s the message: If you’re planning to get pregnant (i) take 5mg of foli acid daily (ii) get your HbA1c down as low as you can, ideally below 43 (6.1%) (iii) check with your primary care doctor about medications that aren’t great during pregnancy such as blood pressure control tablets or statins. These things massively improve the odds of a successful pregnancy, to roughly the same level as the general population.

HbA1c<43 = Best chance of healthy baby. And get some folic acid.

Later on we heard about the future of CGM use in diabetes care. Personally, I found it a bit frustrating in several ways. The medics still aren’t getting just how revolutionary Dexcom and Libre have been for us. The HbA1c U shaped mortality study was referenced a lot. In a nutshell this massive 10 year study in China found that mortality increased when HbA1c fell below 5.7% and it also increased when HbA1c was over 6.7%. The study impresses because of it’s 10 year duration and the 35,000+ patients who were part of it.

But in referring to it the medics are overlooking a pretty gigantic factor: In 2012 Dexcom released the G4. In 2015 Abbott release Libre. These devices had had an utterly dramatic impact on the lives of those of us with Type 1. They make the Chinese study unhelpful at best and actively misleading at worst. Despite at least 2 people with Type 1 setting out to the conference just how much difference these things can make, the message still isn’t getting through. In terms of mortality below HbA1c <5.7, it’s akin to relying on a study performed before insulin was discovered in 1922.

It’s scary that the sexiness of big science seems far more important to some doctors than the value of providing treatment to individual patients. Hey ho. Rant over.

Median HbA1c down from 73 to 61 in 13 years – Well done HCPs! (And patients? Maybe?)

The final session of the day was presented by Professor May Ng, Dr Tom Crabtree and Dr Clare Hambling.  Tom spoke on the success of the NHS England pilot to see the effect of closed loops on HbA1c in practice, May of the reduction in HbA1c among children using these systems and Clare on how they might be rolled out in practice. An idea she trailed was that of a national (international) helpline expert in all the different systems. Doctors sign up to practice medicine rather than IT but my own experience of AID is that it’s the techy side that’s the bigger problem, not the medicine. Comfortingly May also identified that whilst the UK is doing really well on diabetes care Sweden is doing even better. She didn’t mention the U shaped mortality study…

Complications: HbA1c really, really matters

So, that’s it from me at this year’s Glastonbury Diabetes Professionals Conference. It was an incredible privilege to be amongst these impressive HCPs. Their brilliance and commitment to the cause was beyond question. There’s going to be a lot of patients getting better care next week as the connections and ideas exchanged this week feed back into front line practice.

BOB

Rob (Bob Dee) Darbyshire