What I learned at Preventing Illness 2016

Firstly thanks to all the good folks that shared their thoughts with me before the Preventing Illness conference.

Here’s my feedback from the event.

The event was attended by about 200 people from the world of science, medicine and public health. Most of them were mid-level such as local directors of Public Health England or Clinical Commissioning Groups and a few movers and shakers.

About 50% of the speeches and workshops were about diabetes – these were mostly looking at the scale of problem, the failings in prevention and treatment and some of new technology ideas to support diabetics. The failure rates on Type 1 diabetes are particularly worrying.

LCHF diet etc. You might be aware of the Eatwell Plate. It is the NHS recommended balanced diet for normal healthy people: http://www.nhs.uk/Livewell/Goodfood/Pages/the-eatwell-guide.aspx. Many of the delegates made the point that they understand that the Eatwell Plate is not necessarily the right diet for many diabetics and that there should be a greater focus on low carb.

But…..firstly, any change in the official recommended diet by the NHS takes time to implement. It needs to be thoroughly supported by research, have wide considering of the options, consult with numerous organisations and individuals. It also needs to be supported by a training, implementation and communication program. All of which takes time, public policy moves painfully slowly.

Secondly, there is great concern about how you educate on LCHF. A good long-term LCHF diet is actually very complex to get right and very easy to get wrong, and if you get it wrong the consequences can be quite serious. A LCHF long-term diet means very little of the wrong carbs, sufficient of the right carbs to give you enough fibre, good fat but not so you exceed your calorie requirements and very little of the bad fats + you need protein + minerals etc. They need to figure out how you effectively communicate this to an audience that may not be that engaged or educated.

Thirdly....there is very little resources due to government cuts

If you have followed my other rants on this blog then you’ll know that I was recently presenting at the Childhood Obesity Summit and a big conference for the hospitality industry. This week I have been meeting with Jamie Oliver to discuss how we can lobby the BBC to improve the presentation of food on children’s TV and what we want from London Mayor, Sadiq Khan, who is very supportive of our work. One theme comes through in everything I do – we diabetics need to be making more noise if we want to be heard.

catapillar said:

Could you expand on what you mean by this please? When you say the failure rate on type 1 diabetes I'm struggling to see you mean failure in preventing, given that no one knows what causes type 1. Do you mean failure in treatment? If so, how is success/failure of t1d treatment assessed?

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i mean in management.
they big concern is the failure of all diabetics, but particularly type 1 to meet their blood score targets,
about 70% of type 1 and 34% of type 2 are failing to get inside 58mmol on HbA1c
if you look across all three blood test targets (HbA1c, pressure and blood fats) only 19% of type 1 and 41% of type 2 are making all three targets.

catapillar said:

Thank you. I think the hba1c target is 48. Although this is adjusted for individuals too take into account lifestyle and hypo awareness. Did anyone give any plans to help people with type 1 manage their diabetes to meet the targets and improve the success rates? Bearing in mind it is exceptional to get funding for a continuous glucose monitor.

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48 is considered good, only 9% make 48, 58 is considered OK, anything above 86 is considered critical, 15% of T1s are above 86.
pretty much nothing of note on improving this, personally i think we need to improve the quality of educational information for type 1, particularly for kids.

Freema said:

well that is very worrying, it looks like an indirect kind of suicide, and those numbers should just by themselves make politicians aware that the treatment regimen is not at all good enought in helping especially type 1 but altså type 2 patients on their very often very lonely jurney

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i think you re exactly right, there is a total lack of emotional support and inspiration

serenity648 said:

Was there any awareness by those who attended that the Eatwell plate recommendation is harming successful outcomes in diabetes management and contributing to the high figures?

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quietly and not quite so directly, these are public health types. they say things like "the case for modifying the eatwell plate for type 2 diabetics warrants further investigation"

tim2000s said:

Having had a very similar conversation about this yesterday with someone who is a leading light in the UK pumping world, when you discover that a significant portion of people using pumps don't test the four times a day just to keep them safe on the pump, the issue is very clearly that there are huge psychological issues with type 1 that need to be addressed.

Telling people to do things doesn't help. DAFNE clearly helps some, but not all, and the key is still to get people to accept that they have T1 and they need to do something about it rather than pushing it away and ignoring it. Part of the trick is to try and get people talking to one another face to face, so they know that "Just another T1D looks like me". Even getting people to do that is hard.

It comes back to the same things. The HCPs aren't all that bothered about those of us engaging in social media, whatever form it is. It means we are engaged and caring, and while we might not have the numbers we want, we at least are trying. It's the 95% of the population that isn't that drives the concerns. And now amount of shouting or threatening is helping that. COnferences that say "71% (If you look at the National diabetes audit data) of T1s have an Hba1C greater than 7.5% (which is an improvement on previous years, by the way!!!), how terrible", misses the point. Just about every specialist involved in Diabetes knows this. What they are struggling with is how to change it. Some of us are trying to help, but the critically difficult aspect to it is the individuals themselves and their involvements in their diabetes. Until you can find a compelling reason for them to get involved themselves, then nothing is likely to change. And identifying that trigger is proving very difficult.

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exactly right.
the system relies too much on fear to motivate
we need to see greater emphasis on hope and inspiration

Daibell said:

Hi. I don't agree at all that LCHF is difficult to teach or convey. What do you mean by '... the consequences can be quite serious'? I can't think of any reason at all why LCHF can have serious consequences. This is just negative thinking and is the reason the NHS is moving at snails pace whilst great harm is done to many thru the Eatwell Guide.

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their concerns are about people not getting enough fiber and people consuming the wrong fats, both of which have serious consequences. They need to find a way to educate this message to the least engaged, least knowledgeable and, frankly, least bright members of society as anything they produce must work for everybody. As a community if we want to work with the medical and public health professionals we need to understand their concerns and help address these challenges. Please remember the general level of ignorance and massive tide of misinformation around food. We live in a world where people still think that eggs are bad, nuts are bad, chocolate is good for you and chips count as one of five a day.