Diabetes

Diabetes Footcare and Complications

New diabetes footcare statistics data published, obtained by Roisin Shortall TD, shows that 608 people with diabetes underwent a lower limb amputation in 2020, accounting for 69% of the total procedures carried out in the year. There was a further 2,536 people with diabetes hospitalised requiring foot ulceration treatment spending on average 14 days in hospital for treatment in 2020.

Despite limited access to diabetes review appointments during the past 2 years, it seems from this data that diabetes related amputations and diabetes foot ulceration in patient numbers remain high year on year.

Diabetes Ireland is encouraging adults of all ages who have diabetes to ensure they have a full and proper foot assessment by a podiatrist or other appropriate healthcare professional. People with diabetes have special reason to take good care of their feet. Long term high blood glucose levels may make feet susceptible to injury and infection. This is because the protective sensation in the toes or feet, the “pain alarm system” may slowly disappear due to long term exposure to high blood glucose levels.

The latest data provides a county-by-county breakdown of both diabetes related lower limb amputations and diabetes foot ulceration in patient numbers over the period 2016-2020.

With such high numbers, Diabetes Ireland is asking people with diabetes to be proactive by booking a foot assessment which will identify any problems and allow treatment to be undertaken early thus preventing more serious problems from occurring. It recommends that people should examine their feet daily and be on the lookout for small cuts, changes in skin colour and temperature, red areas and swelling. They also must check they have continuing sensation in their feet and be alert

to signs such as prickly pain in the feet, numbness and peculiar sensations such as a feeling of walking on cotton or of wearing tight socks. This is important as without a pain alarm system, injuries and poor fitting shoes may go unnoticed.

Diabetes Ireland now has over 5,000 clients attending their preventative footcare services in Dublin & Cork. These services were set up to provide people with access to a high-quality and unique podiatry appointment service.

100 Years of Insulin

On January 23 1922, 14-year-old Leonard Thompson received the first successful insulin injection, which resulted in a drop in his blood glucose levels without any side effects. This day now marks a celebration of this major scientific breakthrough and the millions of lives that have been saved ever since.

One hundred years later, as well as ever more performing insulins, many new medicines and technologies have been developed, making a hugely positive impact on the lives of people living with diabetes (PwD).

We also know a lot more about the complexity of this disease, which, according to the World Health Organization (WHO), actually covers 14 distinct types, of which the most common are Type 1 and Type 2 Diabetes.

Extensive research and studies have demonstrated how both the risk of developing Type 2 diabetes and diabetes related complications and people’s ability to manage their diabetes optimally are influenced by a multitude of often interlinked factors. In addition to non-modifiable genetic factors, these include modifiable risk factors such as a person’s socio, economic and environmental circumstances as well as external elements such as the structural organisation of care and the use of data, innovative tools, technologies and approaches by national health systems and people living with diabetes.

The socio-economic determinants of health themselves include factors that today represent some of the most pressing challenges in our societies, such as food insecurity, working life conditions, access to education, income, housing, and social inclusion.

It is evident that these determinants generate huge inequalities which have a negative impact on PwD’s lives. In Europe, such inequalities exist between and within countries and regions and represent an obstacle to the fulfilment of PwD’s fundamental right to the highest attainable standard of health as stated by the WHO Constitution.

In this context, new technologies, tools and innovative approaches have the potential to revolutionise diabetes prevention, care and management and improve both the quality of life and the health outcomes of PwD.

The inherent complexity of diabetes prevention and management means, however, that the deployment of these new innovations and technologies must make inclusivity a priority and address the systemic issues of access that might affect their adoption. Alongside the increased use of novel tools and approaches, a holistic approach to diabetes prevention, care and management must also be implemented, taking into the account the need for improved integration of care; the provision of adequate support for PwD including focusing on mental health and emotional well-being; and the deployment of effective training, education and other support mechanisms for improved self-management, including for example peer support and patient empowerment programmes.

On this day, the International Diabetes Federation Europe called on policy-makers and other stakeholders to come together to make diabetes a priority and improve the lives of PwD through:

• The promotion of a person-centred, and outcomes-based approach

• Further digitalisation of health services, and the provision of innovative tools and technologies

• The adoption of an integrated care system, including strengthening primary care

• The reduction of inequalities and improved access to the required diabetes medicines, supplies, technologies and care

• Greater PwD empowerment and engagement in their care, and

• Increased focus on prevention, health promotion and early action

Higher Risks of Diabetes for Children?

Children who have recovered from Covid-19 appear to be at an increased risk of developing Type 1 or Type 2 diabetes, researchers at the Centers for Disease Control and Prevention (CDC) have said.

A heightened risk of diabetes has already been seen among adults who recovered from Covid-19, according to some studies. Researchers in Europe have reported an increase in the number of children being diagnosed with Type 1 diabetes since the pandemic started, the New York Times reported.

But the CDC study is among the first to examine large insurance claim databases in the US to estimate the prevalence of new diabetes diagnoses in children aged under 18 who had Covid-19 or were known to be infected with the coronavirus.

The study used two claim databases from the US health plans to look at diabetes diagnoses made in youngsters under 18 over a year or more, starting March 1, 2020, comparing those who had Covid to those who didn't.

The researchers said, “New diabetes diagnoses were 166% (IQVIA) and 31% (HealthVerity) more likely to occur among patients with Covid-19 than among those without Covid-19 during the pandemic and 116% more likely to occur among those with Covid-19 than among those with ARI during the prepandemic period. Non–SARS- CoV-2 respiratory infection was not associated with diabetes. These findings are consistent with previous research demonstrating an association between SARS-CoV-2 infection and diabetes in adults.

“The inclusion of only patients aged <18 years with a health care encounter possibly related to Covid-19 in the non–Covid-19 HealthVerity group could account for the lower magnitude of increased diabetes risk in this group compared with risk in the IQVIA group. In addition, patients without Covid-19 in HealthVerity had higher hospitalization rates than did those in IQVIA, suggesting more severe disease at the index encounter in the HealthVerity comparison group.

“The observed association between diabetes and Covid-19 might be attributed to the effects of SARS- CoV-2 infection on organ systems involved in diabetes risk. Covid-19 might lead to diabetes through direct attack of pancreatic cells expressing angiotensin converting enzyme 2 receptors, through stress hyperglycemia resulting from the cytokine storm and alterations in glucose metabolism caused by infection, or through precipitation of prediabetes to diabetes.

“Alternatively, Covid-19 might have indirectly increased diabetes risk through pandemic-associated increases in body mass index, a risk factor for both serious Covid-19 illness and diabetes. Future studies addressing the role of comorbidities and increases in body mass index in post– Covid-19 diabetes are warranted. Although this study can provide information on the risk for diabetes following SARS-CoV-2 infection, additional data are needed to understand underlying pathogenic mechanisms, either those caused by SARS-CoV-2 infection itself or resulting from treatments, and whether a Covid-19–associated diabetes diagnosis is transient or leads to a chronic condition.

“Among persons aged <18 years with Covid-19 and new diabetes diagnoses in this study, nearly one half had DKA at or around the time of diagnosis. This number was higher than that in comparison groups, and higher than previous reports of DKA among incident type 1 diabetes cases before the pandemic (28%). Increased frequency of DKA at time of diagnosis of type 1 diabetes during the pandemic has previously been reported and was thought to be due to delayed care-seeking for diabetes. However, the observed association of increased risk for diabetes diagnosis following SARS-CoV-2 infection would not be explained solely by delayed care.

“Health care providers should screen for diabetes symptoms in persons aged < 18 years with a history of SARS-CoV-2 infection. These symptoms can include frequent urination, increased thirst, increased hunger, weight loss, tiredness or fatigue, stomach pain, and nausea or vomiting.”