Medicine Matters diabetes

PARTH NARENDRAN: So bear in mind, this is a consensus report, rather than guidelines. So a consensus report is one that's derived from the opinion of experts. Whereas guidelines, as we classically think of them, are put-- more systematically reviewed evidence. And they've called it the consensus report, which I think is-- which I think is an appropriate description for this.

I think it's useful. Our last set of guidelines in the UK are, most of us would use are from nice 2015. And a lot has happened since then in the last six years in the type 1 field. So it's a welcome addition. It's a long piece of work, it's over 15 sections and over 40 pages, but it's worth a read for a number of reasons.

It brings people up to speed with developments in the area. It's fairly comprehensive, it starts from education at the time of diagnosis all the way through to beat cell replacement and hybrid closed loops and all of that. It's fairly comprehensive and it's worth a read. It'll give ideas for service and, furthermore, we can use it to lobby for service development and service expansion. So it's a useful document to refer to if we're doing these.

The highlights for me and the things-- the sections which I think people will find interesting are the sections relating to diagnosis. So the greater use of islet autoantibodies and c-peptide for accurate diagnosis of type 1 diabetes. We know that we're pretty-- we're not very good at diagnosing people, particularly in the older age group.

So the use of islet antibodies earlier on, soon after diagnosis and c-peptide later on, I think is worth looking at and worth considering. Niacin, as you know, currently don't recommend antibody testing at diagnosis, but I think more and more people are doing that.

The other sections are use of technology in remote clinics. So the COVID pandemic has sort of shown how useful remote reviews can be for some patients some of the time. It's worth thinking about how we can incorporate that into our service. Certainly it saves time for patients in terms of travel and parking. It may not save us much time, but I think for some patients who need frequent review, the use of remotely review and Diacin and all of these things do make-- do facilitate that.

There's a hefty section, as you can imagine, on glucose sensing and hybrid closed loops. And this is moving really fast, particularly in the UK with hybrid closed loop trial that's currently ongoing. So it brings that to the fore and if you look at some of the authors they're quite involved in the technology field. So I'd be surprised if this wasn't highlighted in the consensus report.

And I guess the other section that's worth highlighting is the section around psychosocial support. So again, here, we and many others are aware that we're not providing-- it's difficult to provide a service in this area even though it's very important for some of our patients. So it highlights the need, it doesn't tell us how to go about it. I guess these are discussions we need to take out with our commissioners, but those would be the areas that I think would be of interest. But I think as a general read it's worth looking at.