93 postmenopausal women with type 2 diabetes took part in the trial. The age of participants ranged from 51 to 74 years. Half were given two small bars of flavonoid-enriched chocolate each day and half were given placebo chocolate bars. Those receiving the extra flavonoids reduced their risk of suffering a heart attack in the next decade by 3.4% – an important effect for a dietary intervention. Their insulin resistance and cholesterol levels were significantly reduced by the flavonoids.

“These results are significant from a public health perspective because they provide further concrete evidence that diet has a beneficial clinical effect over and above conventional drug treatment,” said lead researcher Professor Aedin Cassidy of the Department of Nutrition, Norwich Medical School at UEA.

Prof Cassidy said she was not advocating eating more commercially available chocolate because many commercial chocolates do not contain high levels of the beneficial flavonoids.

Previous studies have shown that dietary flavonoids reduce the risk factors for heart disease in healthy people. However, this is the first long-term study to examine their effect on a medicated, high risk group.

Funded by Diabetes UK, the study was led by UEA in collaboration with colleagues at the Elsie Bertram Diabetes Centre, Norfolk and Norwich University Hospital (NNUH) and the Institute of Food Research (IFR).

Dr Ketan Dhatariya, one of the researchers and a consultant in diabetes at the Norfolk and Norwich University Hospital, said: “This is an important result. We are not saying that people with diabetes should be eating lots of chocolate, but that foods that are rich in flavonoids can potentially reduce the risk of heart attacks and strokes, which sadly remain the leading causes of premature death in this group of women”.

Dr Iain Frame, director of research at Diabetes UK, said: “This trial assessed the effects of flavonoids on the risk of heart disease in post-menopausal women with type 2 diabetes over a period of one year. Although it involved quite a small number of women already at high risk of heart disease, these compounds appeared to offer them better protection against heart problems than conventional drugs when administered under very carefully controlled circumstances.

“Flavonoids are found in tea, red wine and other foods, but this study only looked at the effects of specially prepared chocolate with much higher amounts of flavonoids than in chocolate available commercially. We would be very concerned if the results of this research were reported as encouraging people with type 2 diabetes to increase their consumption of chocolate and red wine. Both of these can cause weight gain that would eliminate the health benefits described here and should only be consumed as part of a healthy balanced diet. It will be interesting to see whether larger studies of different flavonoids in more diverse populations over longer periods demonstrate similar effects.”

References

1 Curtis P, Sampson M, Potter J, Dhatariya K, Kroon P, Cassidy A. Chronic ingestion of flavon-3-ols and isoflavones improves insulin sensitivity and lipoprotein status and attenuates estimated 10-year CVD risk in medicated postmenopausal women with type 2 diabetes: a one year double-blind randomized controlled trial. Diabetes Care online 2012.

“We know that healthcare professionals are committed to delivering the 15 healthcare essentials and recognise it is crucial for people with diabetes to get the treatment they deserve. In 2012 we will be launching a major campaign to get a better deal for children with diabetes and we will focus on ensuring everyone gets good foot care to reduce the risk of devastating amputation.”

Providing the right education

In 2012 Diabetes UK will continue to encourage people to check they are receiving the 15 healthcare essentials, a list of the checks and services that all people living with diabetes should be receiving annually, the charity says. In the New Year they will be encouraging people to look through this list and ensure that in 2012 they will receive all of their annual checks. If people are concerned that they have not been receiving the right level of care, Diabetes UK will encourage them to voice their concerns to their healthcare teams.

Aims for 2012

In spring the charity will be focusing on a campaign to ensure everyone gets good foot care to reduce the risk of amputation. A recent survey by Diabetes UK showed that one in four people with diabetes in the UK could be at risk of amputation because they have not received a foot check in the last year. There are currently 100 amputations carried out per week because of diabetes and people with diabetes are up to 15 times more likely to have a major amputation than people without the condition.

During the NHS restructure Diabetes UK remains committed to ensuring that diabetes is at the top of the agenda for clinical commissioning groups. They will continue to highlight the importance for regional and national teams to engage with service providers to ensure that this happens.

To learn more about these and other Diabetes UK initiatives, visit www.diabetes.org.uk.

About one in 3,300 women in England will die between the ages of 15 to 34; but this risk increases nine-fold among women with type 1 diabetes to one in 360, and six-fold among women with type 2 diabetes to one in 520.  A similar picture is true for young men with diabetes; men aged 15 to 34 in the English population are much more likely to die than women, at one in every 1,530; but this risk rises four-fold for men with type 1 diabetes to one in 360, and by just under four-fold among those with type 2 diabetes to one in 430.

The findings echo conclusions made earlier this year by the National Diabetes Audit, which found nearly 450,000 children and younger adults (aged up to 54) with diabetes have high risk blood sugar levels that could lead to severe complications. The audit, which is managed by the NHS Information Centre and commissioned by the Healthcare Quality Improvement Partnership (HQIP), also found this age group was the least likely to receive all the basic care checks required to monitor their condition.

The report also found:

• There is a strong link between deprivation and increased mortality rates. Among under-65s with diabetes the number of deaths among people from the most deprived backgrounds is double that of those from the least deprived backgrounds.

• Death rates among people with diabetes vary according to where they live. London has the lowest rates for both type 1 and type 2 diabetes, at 1.8% and 1.2% respectively, while the highest rate for both type 1 and type 2 diabetes was in the North East, at 2.4% and 1.7% respectively.

Audit lead clinician Dr Bob Young, consultant diabetologist and clinical lead for the National Diabetes Information Service, said: “For the first time we have a reliable measure of the huge impact of diabetes on early death. Many of these early deaths could be prevented. The rate of new diabetes is increasing every year. So, if there are no changes, the impact of diabetes on national mortality will increase. Doctors, nurses and the NHS working in partnership with people who have diabetes should be able to improve these grim statistics”.

References

1 NHS The Information Centre. National Diabetes Audit 2007/8 Mortality Analysis.  The Health and Social Care Information Centre, 2011.

“The idea was born out of my own frustration as a Type 1 diabetic of over 25 years,” said co-founder John Sjölund. “I manage my insulin injections with insulin pens and know all too well that a missed shot leads to raised blood sugar levels and causes drowsiness and body aches. At the same time, an accidental double dose has the opposite effect: blood sugar levels plummet, bringing on sweats and it can even cause a severe long & short term health complications. But mostly, it causes daily anxiety. I hate that. People with diabetes need a simpler way of knowing if they took their insulin, and when.”

“This is a very common problem: most insulin-dependent patients have at some point missed a dose or taken a double dose, specifically because they weren’t sure when they took their last shot,” said John Grumitt, Vice Chair of the Diabetes UK Board of Trustees.  “A simple solution, like the one Timesulin offers, should ease the daily anxiety for many people living with diabetes.”

The cap carries the CE mark, works with all major insulin pens, requires no change in habit and works straight out of the package without any programming required. Retailing at £25 for a pack of two replacement caps, Timesulin will be available to customers throughout the EU, including in the UK, from mid-November 2011.

McCormick said: “Omacor has already proved to be extremely successful in the treatment of high triglycerides in the blood, but if this trial is successful it will provide evidence that treatment with these purified long chain fatty acids can also serve to improve small nerve and blood vessel function that is very relevant to people at risk of Type 2 diabetes. It is hoped this knowledge could then help to improve the lives of people with diabetes who are at risk of nerve and blood vessel damage.”

McCormick’s is one of eight projects receiving ongoing funding from Diabetes UK, which last year dedicated £828,000 to support new research into the causes of Type 1 and Type 2 diabetes, and protection against their complications. The National Institute for Health Research (NIHR) is also supporting his research through core funding for the Biomedical Research Unit in Nutrition, Lifestyle and Obesity at Southampton University Hospitals Trust. Diabetes UK has stated its aim to spend over £6 million on diabetes research in 2011.

Professor Christopher Byrne is Principle Investigator responsible for the trial, which is also being undertaken with Professor Geraldine Clough and colleagues from the Southampton University Hospitals Trust and additional hospitals across the South Coast. McCormick’s research is being supervised by both Professor Byrne and Professor Clough.

The European Society of Cardiology (ESC) has recently emphasised the increased risk of cardiovascular disease amongst diabetics. Speaking for the ESC Professor Joep Perk, Board Member of the European Association of Cardiovascular Prevention and Rehabilitation (EACPR), said: “The impact of growing obesity levels is pushing Type 2 diabetes into an epidemic. It is a very serious problem for healthcare providers due to the cost of treatment, but also for cardiologists who now see diabetes prevention as one of the main health challenges”. Perk insists that, while actively maintaining cardiovascular health is advisable to all, “for diabetics it is literally a matter of life or death”.

Contact

Katie Power
tel: 020 7424 1164
email: pressteam@diabetes.org.uk

Diabetes leaves the heart more vulnerable to stress as less oxygen and nutrients are delivered to the heart and other organs. Heart damage can be caused by high levels of glucose entering cardiovascular cells, which forms toxins that accelerate the ageing of the cell.

Around 50 per cent of people with diabetes die from cardiovascular disease, and this complication is the leading cause of death among people with diabetes. Researchers warn that with increasing prevalence of diabetes, with around one in twenty people in the UK now diagnosed with the condition (1), diabetes will result in a new epidemic of heart failure unless new treatments are developed.

A team of researchers at the University of Bristol gave a synthetic derivative of vitamin B1 called benfotiamine to mice with and without diabetes. They found that treating mice with Type 1 or Type 2 diabetes with benfotiamine from the early stages of diabetes can delay progression to heart failure (2). They also found that the vitamin B1 derivative improved survival and healing after heart attacks in Type 1 mice, and even those without diabetes (3). Foods rich in vitamin B1 include Marmite, yeast and Quorn, but it is not yet known whether changes to diet alone would provide enough of the vitamin to see the same effects as supplements achieved in mice.

Previous Diabetes UK-funded research at the University of Warwick was the first to show that people with Type 1 and Type 2 diabetes have around 75 per cent lower levels of vitamin B1 than people without diabetes (4). It is thought that this may not be due to diet, but due to the rate at which the vitamin is cleared from the body. Small scale clinical trials of people with Type 2 diabetes have also discovered a link between taking vitamin B1 supplements and a reduction in the signs of kidney disease.

The latest Diabetes UK-funded research has been published in the Journal of Molecular and Cellular Cardiology (3). Professor Paolo Madeddu who led this research at the University of Bristol said “Supplementation with benfotiamine from early stages of diabetes improved the survival and healing of the hearts of diabetic mice that have had heart attacks, and helped prevent cardiovascular disease in mice with both Type 1 and Type 2 diabetes. We conclude that benfotiamine could be a novel treatment for people with diabetes, and the next step in this research will be testing whether similar effects are seen in humans.”

Dr Victoria King, Head of Research at Diabetes UK said “Diabetes UK is pleased to have supported this research and is encouraged by these promising results which now need to be tested and confirmed in human trials. We would like to note that it’s still too early to draw any firm conclusions about the role of vitamin B1 in the prevention of complications and we would not advise that people look to vitamin supplements to reduce their risk of cardiovascular complications at this stage. Taking your prescribed medication, eating a healthy balanced diet and taking regular physical activity are key to good diabetes management and therefore reducing your risk of diabetes associated complications.”

References

1. Quality and Outcomes Framework, NHS (2010). UK average prevalence of diabetes in the adult population is 4.26 per cent. There are 2.8 million people diagnosed with diabetes in the UK.
2. Katare, R. et al. (2010). Vitamin B1 analog benfotiamine prevents diabetes-induced diastolic dysfunction and heart failure through Akt/Pim-1-mediated survival pathway. Circulation: Heart Failure. 2010 March: 3 (2): 294-305.
3. Katare, R., Caporali, A., Emanueli, C and Madeddu, P. (2010). Benfotiamine improves functional recovery of the infracted heart via activation of pro-survival G6PD/Akt signalling pathway and modulation of nerohormonal response. Journal of Molecular and Cellular Cardiology.2010 Oct: 49 (4): 625-38.
4. Thornalley, P.J. et al. (2007). High prevalence of low plasma thiamine concentration in diabetes linked to a marker of vascular disease. Diabetologia.Volume 50, Number 10, 2164-2170.

“Diabetes can affect anyone, at anytime,” notes Sir Michael Hirst, the President-Elect of the IDF. “Raising awareness of diabetes, the risk factors and warning signs and encouraging people to seek help if they have concerns is therefore vital. It is also important for us to help people with diabetes better understand the condition to promote effective management and prevention of complications such as cardiovascular disease.”

WDD was created by the IDF and the World Health Organization (WHO) and its member associations in 1991, and is held every year on November 14. The campaign slogan for 2010 is ‘Let’s take control of diabetes. Now.’ with a focus on raising awareness of diabetes, prevention and effective management of the disease.

Within the UK, it is currently estimated that 10% of the NHS budget is spent on diabetes. This works out at £9 billion a year or £1 million per hour. Around 7% of this is attributable to the cost of prescription medicines and a significant proportion is made up of the costs of treating serious long-term complications of the disease. Currently 40% of people in the UK with diabetes are at high risk of complications because their glucose control is not to target. As well as raising awareness among the general public, this year’s WDD campaign aims to improve the knowledge of people with diabetes to help facilitate effective management of the disease and prevent such complications.

Novo Nordisk and Bayer Diabetes Care are supporting WDD through the sponsorship of diabetes awareness imaging on London’s Shell Tower. Both companies are dedicated to advancing diabetes care for the benefit of the growing number of people living with diabetes.

“Novo Nordisk believes promoting greater awareness of diabetes and encouraging best-practice sharing throughout global diabetes communities, is key to fighting this disease,” said Viggo Birch, Managing Director of Novo Nordisk UK and Ireland. “World Diabetes Day is an important event for us and the rest of the diabetes community and we are pleased to support this campaign.”

Sarah Millington, Chief Executive, of Bayer Diabetes Care in the UK added, “Bayer is proud to be associated with IDF and to play its part in activities, such as the World Diabetes Day reception and the diabetes awareness imaging on Shell Tower, which aim to increase awareness, prevention and education in the field of diabetes.”

Simon O’Neill, Diabetes UK Director of Care, Information and Advocacy, said: “Once again we see a shocking rise in diabetes and obesity rates in the UK.  Many, but not all, people develop Type 2 diabetes because they are overweight or obese so we must keep up the mantra of ‘five fruit and veg a day’, encourage daily physical activity, and warn of the potentially devastating consequences of an unhealthy lifestyle.

“The obesity-fuelled Type 2 diabetes epidemic is a clear example of where the new coalition government’s rhetoric of tackling health problems through prevention must be turned into action. Failure to act now means a bleak future of spiralling NHS costs and worsening public health. Diabetes is serious”. Diabetes UK is encouraging people to go online and take its new Diabetes Risk Score test (www.diabetes.org.uk/riskscore) to find out about their risk of developing Type 2 diabetes. People at increased risk of Type 2 diabetes can often decrease or even reverse their risk by losing weight, increasing their physical activity levels and improving their diet.

Around 10 per cent of NHS spending goes on diabetes and its complications; this equates to £9 billion per year or £1 million an hour.

People with diabetes registered with GP practices (aged 17 years )

People registered with GP as obese (aged 16 years +)

Notes

1 (All data recorded April 2009 to March 2010)

England – 2009-2010 Quality and Outcomes Framework (QOF) for England by The NHS Information Centre for Health and Social Care – (www.ic.nhs.uk)

Northern Ireland – The Department of Health, Social Services Public Safety – (www.dhsspsni.gov.uk)

Scotland – The Information Services Division – (www.isdscotland.org)

Wales – Welsh Assembly Government, Stats Wales – (www.wales.gov.uk)

CVD has become more prevalent in India and China than in all of the economically-developed countries in the world combined.¹ The trend is particularly evident in the younger population; data shows a 15% increase in prescriptions of agents to manage cardiovascular risk factors in young adults.² One of the greatest concerns is the development of type 2 diabetes, with up to 50% of deaths in diabetes patients related to CVD.³ Estimates predict diabetes will rise in South East Asia by more than 33% by 2025 – the highest percentage increase around the globe.⁴

Furthermore, there is evidence to show that CV risk factors may have greater impact in Asian populations; for the same levels of systolic blood pressure Asian patients have a greater risk of developing coronary heart disease and stroke compared with Caucasians.⁵

The burden of CVD is predicted to severely impact healthcare systems – the WHO estimates that China is likely to lose US $558 in national income as a result of rising heart disease, stroke and diabetes.⁴

Following on from successful events organised last year, a second Joint Scientific Forum, organised by the ESC and the European Association for the Study of Diabetes (EASD), will be held on 27 November at three venues across China – Beijing, Shanghai and Guangzhou. The theme is the Optimal Management for Diabetes, with talks given for an audience of clinicians who treat diabetes and cardiology patients. Subjects to be covered include long-term efficacy for current treatment, early intervention and combination treatment for maximum benefit, Hyperglycemia and CVD, and Diabetic cardiopathy.

Following last year’s inaugural event, a second ESC Asia Cardiovascular Symposium was held in Beijing on 12 September. The one-day programme provided an opportunity for leading physicians from Asian countries to examine CVD risk factors and discuss management of an increasing precedence of the disease – attributed to westernisation of diet and lifestyle. The first ESC Asia Cardiovascular Symposium in Shanghai in September 2008 aimed to raise awareness of the growing burden of CVD in the AP region, and the need for screening and risk assessment tools for early detection and intervention.

The second symposium set out to take the next step by:

• defining effective pharmacological management of hypertension, diabetes and the risk of thrombosis in the AP region.
• translating clinical practice guidelines into reality in local practice.
• underlining the importance of informing primary care physicians of current guidelines and to practise accordingly.
• considering similarities and differences between East and West in the prevention and treatment of CVD.
• providing an opportunity to exchange information and experience.

Atrial fibrillation a priority

The September symposium was co-chaired by three experts in the fields of cardiovascular medicine: Professor Lars Rydén (Sweden) representing the ESC, Professor Lim Yean Teng (Singapore) and Professor Yong Huo (China). For the attending delegates, who came from all over AP and represented a number of specialties, the programme provided an opportunity to look at a multifactorial approach to CVD risk management. Using patient case studies, speakers demonstrated how lifestyle modification often has to be supplemented by pharmacotherapy.

Panel discussions raised important issues such as the need to proactively manage patients with atrial fibrillation, who are at increased risk of stroke. There was agreement among the disciplines that intervention per se should be based on total cardiovascular risk, but that each of the contributing risk factors needs to be managed with appropriate, evidence based agents. However, putting this into practice remains a challenge for physicians across the globe, highlighting the need for greater awareness and education regarding the benefits of timely implementation, and for surveys on actual practice.

References

1. WHO Global Report, WHO 2005.
2. Liberman JN, et al. Archives of Pediatric and Adolescent Medicine 2009:163;357-64
3. Diabetes Fact Sheet No. 312. WHO Geneva 2008. www.who.int/mediacentre/factsheets/fs312/en/index.html
4. IDF 2008. www.idf.org
5. Perkovic V, et al. Hypertension 2007;50;991–7

Contact

Education Department, European Society of Cardiology

Tel: +33 (0) 4 92 94 86 37
Fax: +33 (0) 4 89 872012
Email: education@escardio.org

Ms. Lisa Cheng, Project Manager for the 2^nd ESC Asia Cardiovascular Symposium

EMD Asia Scientific Communication Ltd.
Unit 4002B, 40^th Floor , Metroplaza Tower 2
223 Hing Fong Road, Kwai Fong, Hong Kong
Tel: +852 3690 1213
Fax: +852 3690 1219
Email: lisa.cheng@emd-asia.com

In total, 847 patients (7.6%) had AF at baseline. Compared to the overall population, they tended to be older and heavier, with higher blood pressure and urinary albumin to creatinine ration (UCR), and a history of macrovascular disease, treated hypertension, left ventricular hypertrophy or pathological Q waves.

Patients were followed up for a mean duration of 4.3 years: 879 patients died during this period. Fifty-three percent of deaths were due to cardiovascular causes, and 15% of deaths took place in patients with AF. AF was associated with greater risks of death due to any cause (hazard ratio [HR] 1.61, p<0.0001), cardiovascular death (HR 1.77, p<0.0001) and heart failure (HR 1.68, p=0.0002). Patients with AF also had a higher risk of major cerebrovascular events (HR 1.68, p=0.0008) but the association with major coronary events was of borderline significance (HR 1.27, p=0.09).

Active treatment to lower blood pressure produced similar relative risk reductions in all-cause death, cardiovascular death and major coronary events in participants with and without AF but, since patients with AF were at higher baseline risk, the absolute benefit of active treatment was greater for this group. Thus, it can be estimated that five years of active treatment would prevent one cardiovascular death among every 42 patients with both DM and AF, compared with one among every 120 patients with diabetes but without AF.

In conclusion, if AF is detected in a patient with diabetes, then more aggressive treatment of all cardiovascular risk factors is indicated.

Reference

1. Du X, Ninomiya T, de Galan B et al. Risks of cardiovascular events and effects of routine blood pressure lowering among patients with type 2 diabetes and atrial fibrillation : results of the ADVANCE study. Eur Heart J doi:10.1093/eurheartj/ehp055