The study potentially paves the way for genetically determined predictors of disease complications to allow earlier interventions.

Published in , the study co-led by Professor Andrew Morris from The University of Manchester is a collaboration of more than 350 authors from 130 studies around the world and the largest type 2 diabetes genome-wide association study to date.

The researchers scanned complete sets of DNA (genomes) from 2.5 million people – a sample size almost three times larger than in previous studies – to identify variations in the genetic sequence associated with the development and progression of type 2 diabetes.

More than 400 million people worldwide are living with type 2 diabetes, a condition which occurs when the body is not able to make enough of the hormone insulin, causing the level of sugar in the blood to become too high.

Left untreated, high blood sugar levels can cause serious health problems and complications that affect  the eyes, kidney and nerves. People with type 2 diabetes are also more likely to suffer from heart disease and stroke.

As well as factors such as weight and exercise, the risk of developing type 2 diabetes, which is the most common type of diabetes, is also linked to genetics. Variations of the genetic code can increase the risk of developing type 2 diabetes and its complications, which can be passed down through families.

The research team revealed over 600 places in the genome -  a biological blueprint needed for life to exist - which increase the risk of type 2 diabetes, of which 145 had previously been unidentified.

The DNA of more than 2.5 million people were analysed, including 428,452 people who have type 2 diabetes from six different ancestry groups: African American, East Asian, European, Hispanic, South African and South Asian.

91ֱ��ing a range of ancestry groups ensures that the findings of the research are relevant to diverse populations across the globe, where type 2 diabetes is a major health concern.

For the first time across multiple ancestry groups, the team were also able to generate genetic risk scores associated with developing harmful type 2 diabetes complications such as coronary artery disease and diabetic kidney disease.

Senior co-corresponding author Professor Andrew Morris, Professor of Statistical Genetics at The University of Manchester and the (NIHR) (BRC), said:

“Our work has improved our knowledge of the biological processes that lead to the development of type 2 diabetes and progression to its complications in diverse population groups across the world.

“Better understanding of the genetic causes of the disease has the potential to allow us to predict these complications before they occur and may help put in place early interventions to delay or even prevent these debilitating medical conditions."

The analysis, carried out by University of Manchester researchers shows that when controlling for the characteristics of participants, the risk of Diabetes progression was 20% lower in people with pre-diabetes referred to the NHS Diabetes Prevention Programme (NDPP) when compared to similar patients not referred to NDPP.

, funded by the National Institute for Health and Care Research (NIHR), and hosted by Northern Care Alliance NHS Foundation Trust, is published today in the journal PLoS Medicine.

The NHS Healthier You Diabetes Prevention Programme in England is offered to non-diabetic adults with raised blood sugars – or pre-diabetes - providing exercise and dietary advice to help reduce people’s risk of developing the disease.

Across the 2,209 GP practices for which the researchers had data, over 700,000 people were identified with pre-diabetes and around 100,000 had a code in their health records indicating they were referred to the programme.

18,470 patients referred to NDPP were matched to 51,331 similar patients not referred to NDPP.

The probability of converting to Type 2 Diabetes at 36 months after referral was 12.7% for those referred to the NDPP and 15.4% for those not referred to the NDPP.

Using a figure of 1,000 people referred to NDPP and 1,000 not referred to NDPP, by 36 months after referral, the team calculate they would expect 127 conversions to Type 2 diabetes in the group referred to the programme and 154 in the group not referred.

The mechanism for the difference is likely to be through weight reduction, with previous work showing that people who attended the NHS DPP were associated with a significant reduction in weight - the key factor in reducing risk - of 2.3 kg on average.

In addition, prior work also showed levels of HbA1c - the average blood sugar levels for the previous two to three months - reduced by a significant 1.26 mmol/mol.

Most of the previous trial results have shown that weight loss is the key factor in reducing risk of the disease; increased BMI was also a key factor.

Dr Rathi Ravindrarajah from The University of Manchester said: “Our findings show that the NDPP appears to be successful in reducing the progression from non-diabetic hyperglycaemia to Type 2 Diabetes.

“Even though we were only able to examine referral to the programme, rather than attendance or completion, it still showed a significant reduction in risk of 20%.

“That suggests the decision to implement programme quickly and at scale in England was the right one.

“And as the results are reproducible, it also supports the continuation of similar programmes to Northern Ireland, Scotland and Wales.”

Professor Evangelos Kontopantelis from The University 91ֱ�� said: “Type 2 diabetes is a major public health concern which has been rising globally, with over 3 million people in the UK currently diagnosed with it.

“Previous studies have shown that both lifestyle modifications through diet and physical activity and medication can prevent progression to this condition.

”This study is good news for the Healthier You Diabetes Prevention Programme which we show beyond doubt is a powerful way to protect your health.”

Health and Social Care Secretary Steve Barclay said: “The NHS Diabetes Prevention Programme has seen promising results with a 20% reduction of risk to those taking part developing Type 2 Diabetes, empowering people suffering with pre-diabetes to take control of their own health. 

“Diabetes costs the NHS around £10 billion a year, but this evidence-based programme is an example of how we can help people make lifestyle changes to prevent the disease progressing, whilst ensuring value for the taxpayer.”

NHS national clinical director for diabetes and obesity, Professor Jonathan Valabhji, said: “This important study is further evidence that the NHS is preventing type 2 diabetes and helping hundreds of thousands of people across England to lead healthier lives.

“We completed roll out of the NHS Diabetes Prevention Programme in 2018, and now over 1.2m people have been offered support with lifestyle changes including better quality nutrition, weight loss, and increased physical activity, which this study shows is preventing development of this life-changing condition.

“You can easily check your risk through the &�Բ�����;�ٴǴDZ�.”

The paper Referral to the NHS Diabetes Prevention Programme and conversion from non-diabetic hyperglycaemia to type-2 diabetes mellitus in England: a matched cohort analysis is available

New research presented today at the Diabetes UK Professional Conference 2022 has revealed the life-changing benefits of Flash blood glucose (sugar) monitoring for people with type 1 diabetes.

The study shows that the technology not only helps improve blood glucose levels in people with type 1 diabetes, but also has a positive effect on their quality of life. The findings help make the case for more people having access to this life changing technology, particularly because the device has been found to be cost-effective for the NHS, by enabling safer blood glucose levels and, in turn, reducing the risk of devastating diabetes complications.

Funded by Diabetes UK, Dr Lalantha Leelarathna and his team at The University of Manchester led a clinical trial to learn if second-generation Flash technology is better and more cost-effective than traditional finger-prick testing at helping people with type 1 diabetes manage their condition.

The trial involved 156 people with type 1 diabetes who had above-target blood glucose levels. For 24 weeks, half of the participants monitored their blood glucose with Flash and the other half continued using finger prick testing.

At the start of the study both groups had similar 3-month average blood glucose levels (assessed by an HbA1c blood test).

After 24 weeks, those participants who used Flash had reduced their HbA1c from an average of 71.6 mmol/mol to 62.7 mmol/mol - a reduction of 8.49 mmol/mol. Lowering HbA1c by this amount can decrease the risk of developing diabetes complications in the future by up to 40%. In comparison, those in the finger prick group had reduced their HbA1c on average by only 2.2 mmol/mol by the end of the study.  

In addition, those using the Flash technology spent an extra 2 hours a day with their blood glucose levels in the target range and 80% less time with dangerously low blood glucose levels.

The researchers further discovered that Flash had a positive impact on quality of life. Participants in the Flash group reported they were happier with their diabetes treatment and that using the technology reduced the day-to-day burden and emotional strain of living with the often-relentless condition.

Crucially, the researchers also assessed the long-term cost-effectiveness of the two approaches, by estimating the cost of using the two different blood glucose monitoring systems and their benefits to a person’s physical health and quality of life. 

While Flash was found to be slightly more expensive than finger-pricking over a lifetime, it was shown to be highly cost-effective. This is because Flash was predicted to help people with type 1 diabetes stay healthier for longer, meaning the extra costs to the NHS would be justified.

Type 1 diabetes is a serious and life-long condition. Close monitoring of blood glucose levels is an essential – but often disruptive – part of daily life for people living with it in order to avoid complications.

Flash involves a small sensor that sits just underneath the skin and continuously measures glucose in the fluid that surrounds the body’s cells. To get a reading, you can painlessly swipe a reader or smartphone over the sensor to see what blood glucose levels are doing minute by minute. The device will also alert people when their levels are going too low or too high.

Flash glucose monitoring technology was first made available through the NHS in 2017. Currently, about half of people living with type 1 diabetes are prescribed Flash on the NHS. At the end of 2021, the National Institute of Health and Care Excellence consulted on new guidelines which proposed recommending Flash for all people with type 1 diabetes.

Dr Elizabeth Robertson, Director of Research at Diabetes UK, which funded the study, said:

“We want as many people as possible to have access to innovative diabetes technologies. This study confirms the radical improvements Flash can bring to the lives of people living with type 1 diabetes, helping                them to reduce their blood glucose levels – protecting against short and long-term diabetes complications – and removing some of the relentless burden of managing the condition. 

“By demonstrating the benefits to people living with type 1 diabetes and the value for money to the NHS – which currently spends 10% of its budget on diabetes care – we hope these results encourage healthcare professionals and people with type 1 diabetes to consider flash glucose monitoring as a cost-effective and life-improving intervention.”

Dr Lalantha Leelarathna, Diabetes UK-funded researcher at University of Manchester, said:

“Ability to monitor glucose without painful finger-sticks is life-changing for many people living with type 1 diabetes. With the use of second-generation Flash technology, we found significant improvements in average glucose levels and a reduction in both high and low glucose levels, helping people to spend more time with normal glucose levels thereby reducing their risk of long-term diabetes related complications. This intervention was highly cost-effective and led to high level of treatment satisfaction. We call for universal funding of this life changing technology for all people living with type 1 diabetes.”

New data suggests that the healthy living programme resulted in a 7% reduction in the number of new diagnoses of Type 2 diabetes in England between 2018 and 2019, with around 18,000 people saved the dangerous consequences of the condition.

Someone completing the nine month NHS scheme reduces their chances of getting the condition by more than a third (37%), according to new University of Manchester research due to be presented at the annual Diabetes UK Professional Conference this week.

Prevention is a key part of the NHS Long Term Plan, which set out a major expansion of the Diabetes Prevention Programme.

People enrolled in the programme get advice on healthy eating and exercise that can prevent them developing the condition, avoiding the need for medication and complications such as amputations.

Evidence has shown that the NHS spends around £10 billion a year on diabetes – around 10% of its entire budget – and the NHS DPP is highly cost effective in the long-term.

Almost one million people have been referred to the programme since it was first launched in 2016, with participants who complete achieving an average weight loss of 3.3kg.

Since then, the NHS Long Term Plan expanded access so that up to 200,000 people a year will benefit as part of radical NHS action to tackle rising obesity rates and to prevent type 2 diabetes.

The country’s top diabetes experts are expected to say that the programme will improve the health of hundreds of thousands of people.

Being diagnosed with type 2 diabetes can have a devastating impact on people and their families – it is a leading cause of preventable sight loss in people of working age and is a major contributor to kidney failure, heart attack, stroke and many of the common types of cancer.

NHS national clinical director for diabetes and obesity, Professor Jonathan Valabhji, said: “The evidence is now clear – the NHS is preventing type 2 diabetes and is helping thousands of people to lead healthier lives.

“Summer 2018 saw England become the first country to achieve universal coverage with such a programme. This latest evidence shows that the programme can have a major impact on peoples’ lives.”

Emma McManus, a Research Fellow at The University of Manchester, said: “Type 2 diabetes is a growing problem. According to Diabetes UK, over 4 million people in the UK live with the condition and millions more are at an increased risk of developing it. It is a leading cause of sight loss and a major contributor to a range of conditions including kidney failure, heart attack, and stroke.”

“However, if you change your lifestyle, the risk of developing type 2 diabetes reduces. This is why the National Diabetes Prevention Programme, an evidence-based programme which delivers personalised support on weight management, healthy eating and encouraging physical activity, was set up. Our research has shown that the programme has been successful in reducing the number of new cases of diabetes.”

Emma Elvin, Senior Clinical Advisor at Diabetes UK, said: "This research adds to the evidence that many type 2 diabetes cases can be delayed or prevented with the right support and further highlights how the NHS Diabetes Prevention Programme can be a real turning point for people at risk of type 2 diabetes.

"For some people, combined lifestyle interventions - including diet, physical activity and sustained weight loss - can be very effective in reducing the risk of type 2 diabetes. That is why we need to ensure that all who can benefit from the programme know of it and are able to access it."

Tariq Khan, a 35-year-old chef from Birmingham, started the DPP programme in November 2019 after a blood test revealed that he was at high risk of type 2 diabetes. He has lost over 6kg on the programme and says:

“Life as a chef can be really hectic. I also had a sweet tooth which meant that I was eating unhealthily and often very late.“

The programme has enabled me to get control of my health by making small changes to my lifestyle. I’ve learnt so much about how my body works and how the choices I make can affect it. I’ve cut a lot of fried food and sweet treats from my diet as well as having smaller portions.

“The classes have been great because they have helped to keep me motivated when it could have been tempting to go back to old ways with being at home a lot during the pandemic. I’ve been staying active using an exercise bike as well as walking and doing the exercises shared in the classes which are helping me to burn calories at home.

“I haven’t missed a class and I know that what I’ve learnt will stay with me forever. Losing 6kg is such a big achievement for me and I feel fresher and lighter. I’m sharing what I’ve learned with my family and my work colleagues to encourage them to be healthier too. I couldn’t recommend the programme enough!

Previous estimates suggest that the number of people with diabetes could rise to 4.2 million people by 2030, affecting almost 9% of the population.

Just under half (45%) of those taking part in the prevention programme are men – a much higher proportion than typically attend weight loss programmes.

Some communities are affected disproportionately by diabetes, with people of South Asian and Black ethnicity between two and four times more likely to develop type 2 diabetes than those of white ethnicity.

Data suggests that people living with type 2 diabetes have double the risk of in-hospital death from Covid-19, compared to people without the condition.

• You can find more information on the NHS Diabetes Prevention Programme on our website
• This research was funded by the National Institute for Health Research (Health Services and Delivery Research, 16/48/07 – Evaluating the NHS Diabetes Prevention Programme (NHS DPP): the DIPLOMA research Programme (Diabetes Prevention – Long Term Multimethod Assessment).

Image: Tariq Khan

The study was carried out by University of Manchester, and scientists, and funded by the .

It is the first study to show the effectiveness of , a group of medicines that can help in lowering all types of bad cholesterol for patients with diabetes, which is in line with official guidance recently updated by the (NICE).

in the blood, known as non-high-density lipoprotein cholesterol (non-HDL-C), can build up within the walls of blood vessels, putting people at risk of dangerous blood clots.

For the first time, the meta-analysis of more than 20,000 adults evaluated the effectiveness of seven statins on lowering non-HDL-C levels, and is published in thetoday (24/03/22).

Scientists already know which of the seven statins reduce low-density lipoprotein cholesterol (LDL-C).

However, until the study, they did not know which reduced non-HDL-C, which measures LDL-C and the other types of bad cholesterol.

Therefore, non-HDL-C is a more powerful risk predictor for cardiovascular disease and has now become the primary target for reducing cardiovascular risk with cholesterol lowering treatments.

Non-HDL-C can be simply calculated by doctors at no additional cost by subtracting HDL-C (or ‘good cholesterol’) level from the total cholesterol level.

Rosuvastatin administered at moderate and high doses, and Simvastatin and Atorvastatin administered at high doses were the most effective treatments in patients with diabetes by using non-HDL-C as a primary measure.

The drugs lead to between a 2.20 to 2.31 millimoles per litre (mmol/l) reductions in non-HDL-C over 12 weeks.

In patients at high-risk of major adverse cardiac events, Atorvastatin administered at high doses was the most effective at reducing non-HDL-C by around 2.0 mmol/l.

The findings firmly support and extend new NICE guidelines for adults with diabetes, which were updated in April 2021.

NICE was the first in the UK to recommend the use non-HDL-C rather than LDL-C as a better way to measure CVD risk reduction when using cholesterol lowering treatments.

However, NICE does not endorse the three drugs specifically, which is why, say the team, the analysis is important because it ranks the statins best at lowering all bad cholesterol using the preferred non-HDL-C target.

It also tells us specifically that certain doses of three statins are more favourable in patients with diabetes.

Lead author Dr Alexander Hodkinson, a health data scientist from The University of Manchester, said: “Patients with type 2 diabetes, which will affect 380 million people worldwide by 2025, are at increased risk of cardiovascular disease.

“Statins are considered the cornerstone of cardiovascular disease prevention by helping to lower the levels of cholesterol in the blood.

“They have been found to be the most effective agents in reducing the risk of coronary heart disease in patients with diabetes.

“However, we suggest that clinicians should, as NICE suggests, use all bad types of cholesterol –  or the level of non-HDL-C –  as a more powerful measure of cardiovascular risk. It’s simple to calculate and represents little additional workload.

“By using non-HDL-C as a primary measure, we found that the three statins –  Rosuvastatin, Simvastatin and Atorvastatin –  were ranked most effective in the meta-analysis.”

Martin Rutter is a Professor of Cardiometabolic Medicine at The University of Manchester and an Honorary Consultant Physician at the Diabetes, Endocrinology and Metabolism Centre within 91ֱ�� Royal Infirmary, part of MFT.

Professor Rutter said: “These findings will serve as a helpful guide to clinicians on statin selection and the doses they should be given at, and they will help support clinical judgements when balancing the benefit-harms profile.

“They also importantly support NICE’s policy guidelines for cholesterol management using a measure that contains all the ‘bad’ types of cholesterol for patients with diabetes.”

The study of English and Welsh data – led by University of Manchester and scientists, is published in Diabetes Care - a leading clinical journal in the field.

Different medications are available to people with type 2 diabetes, all of which work in different ways to lower blood glucose levels. The study team looked at two newer types of medication called and .

They compared the risk of serious heart or stroke problems in people with type 2 diabetes when using the newer diabetes treatments to the risk in people using more traditional therapies, such as metformin and sulphonylureas.

The researchers showed the odds of developing heart failure was 51% lower for people using SGLT2 inhibitors, 18% lower for GLP-1RAs users and 57% lower for people using both drugs.

The odds of having a heart attack or stroke was 18% lower for SGLT2 inhibitors, 7% lower for GLP-1RAs and 30% lower for them given in combination.

Though SGLT2 inhibitors have been licensed since 2012, and GLP-1RA therapies since 2005, doctors routinely prescribe more traditional therapies for diabetes management which either have neutral or modest effects on reducing the risk of heart problems.

The researchers conclude that cost, regular prescribing practices and limited emphasis in current clinical management guidelines, may explain why these drug classes are less routinely prescribed.

Clinical trials looking at the effectiveness of the newer type 2 medications have mainly involved people with type 2 diabetes who have a high-risk of heart disease. But the new study focused on people with a lower risk, who make up two thirds of people with type 2 diabetes.

The study, funded by , was a collaboration between , , and the .

The team linked primary care data from the and the Databank to hospital and mortality records.

Co-author Professor Martin Rutter is a researcher at The University of Manchester and Honorary Consultant Physician at the , , part of MFT.

He said, “There are around 4 million people with type 2 diabetes in the UK, and sadly more than one in three of these people will die from cardiovascular disease.

“The good news is that SGLT2 inhibitors and GLP-1RA drugs not only control diabetes, but they also reduce the risk of developing serious cardiovascular events such as heart attack or stroke.

“And that could save thousands of lives every year - not to mention the avoidance of chronic illness in those who survive heart attacks and strokes.

“The protective effect of these two types of medication can be seen as soon as patients start to receive them - though the longer they take them, the greater the protection.”

Co-author Professor Darren Ashcroft, a researcher at The University of Manchester, said: “The mechanism by which these drugs provide their protective effects is an active area of research. However, their life-saving effects may be partly explained by their beneficial effects on weight loss and the fact that they don’t cause low blood sugar levels (hypoglycaemia), which can be harmful to the cardiovascular system.”

Lead author Dr Alison Wright, a statistician at The University of Manchester, said: “While GLP-1RA and SGLT2 inhibitors are expensive treatments, we believe the cost-effectiveness of such treatment options in terms of primary prevention should be seriously examined.

“This is because 80% of diabetes care costs are related to managing complications, with the largest contributor being cardiovascular disease.

“We believe these data make a strong case for trials evaluating the efficacy and cost-effectiveness of these interventions and their combination in lower risk people with type 2 diabetes.”

Dr Faye Riley, Senior Research Communications Officer at Diabetes UK, said: “Cardiovascular disease remains the leading cause of reduced life expectancy in people with diabetes so finding the right care at the right time to support people to reduce their risk could be life-saving.

“This study contributes to the evidence base about the effectiveness of different medications for type 2 diabetes to protect against serious cardiovascular complications.  However, it remains essential that healthcare professionals make individual care decisions when offering treatment options, as not all medications are suitable for everyone with type 2 diabetes.”

The paper Primary prevention of cardiovascular and heart failure events with SGLT2 inhibitors, GLP-1 receptor agonists and their combination in type 2 diabetes is available as an online-only version that is scheduled to be published in a future issue of Diabetes Care, currently available  

The research*, published today in journal, BMJ Quality and Safety was funded by the National Institute for Health Research Greater 91ֱ�� Patient Safety Translational Research Centre (NIHR GM PSTRC). The Centre is a partnership between The University of Manchester and The Northern Care Alliance NHS Foundation Trust.

The research involved analysing the primary care healthcare records of 618,161 people with type 2 diabetes to estimate how many health checks had been missed during the pandemic in 2020 and who had been most affected.

The checks include measuring blood pressure and weight, urine tests for protein and blood tests for cholesterol, kidney function and average sugar level. These processes are essential to minimise the risk of developing long-term complications caused by type 2 diabetes.

The results have shown older people with type 2 diabetes from deprived areas were most likely to miss out on having health checks.

The researchers also estimated that across the UK between March and December 2020, there were ~31,800 fewer people with type 2 diabetes prescribed a new type of diabetes medication and ~14,600 fewer were prescribed a new type of blood pressure lowering medication. This almost certainly means that large numbers of people are being left with poorly controlled diabetes and high blood pressure which increases the risk of developing serious complications such as heart attacks, strokes, kidney failure and amputations.

Dr Matthew Carr from The University of Manchester, and lead for this study at the GM PSTRC, said: “Health checks for people with type 2 diabetes are generally carried out in general practice and as face-to-face appointments aren’t yet back up to pre COVID levels delays are likely to continue. As a result, there’s an urgent need to reduce the harm caused by these changes to the way care has been delivered.

“Although it’s not possible to estimate the number of people who have missed out on a check, we are able to analyse health care records to identify the number of processes that took place. This has allowed us to understand the size of the problem, along with the sectors of the population that have been most affected by looking at how trends varied by age, sex, ethnicity and deprivation.”

The research revealed that, between May and December 2020 the number of health checks did increase, but they remained between 28-47% lower than expected.

Co-author, Professor Martin K Rutter, from The University of Manchester and 91ֱ�� University NHS Foundation Trust, said: “Health checks for type 2 diabetes are essential in the long-term management of the condition. As we recover from the pandemic, our research will help UK healthcare services focus their efforts on how to provide support for people living with diabetes who have been most affected by changes in the way that care has been provided.”

Nikki Joule, Policy Manager at Diabetes UK, said: “It’s incredibly concerning that both diabetes checks and prescriptions of new medicines for people living with type 2 diabetes were reduced during the pandemic. Blood cholesterol, blood pressure and longer-term blood sugar levels are vital indicators of how type 2 diabetes is being managed, and missing these checks puts people at greater risk of diabetes-related complications such as heart attacks, strokes and kidney failure.

“That older people from deprived backgrounds have been disproportionately affected is yet another stark example of how the pandemic has exacerbated health inequalities. It is vital that this is addressed, and the backlog of care urgently dealt with to avoid people developing life-changing complications of diabetes that may have been preventable.

“While we welcome the recent Government commitment to invest more in the prevention of type 2 diabetes, measures to help people already living with diabetes should be prioritised equally to allow more people the best chance to live well with the condition.”

To find out your risk of developing type 2 diabetes and steps you can take to reduce it, visit

The research, ‘Impact of COVID-19 on diagnoses, monitoring and mortality in people with Type 2 diabetes in the UK’ was published in The Lancet Diabetes Endocrinology today. It was funded by the National Institute for Health Research Greater 91ֱ�� Patient Safety Translational Research Centre (NIHR GM PSTRC) which is a partnership between The University of Manchester and Salford Royal hospital.

In April 2020 alone, according to researchers, there was a drop of 70% in recorded diagnoses of the condition compared to expected rates based on 10-year trends in 23 million people. Also, in April, rates of diabetes monitoring (HbA1c blood tests), in people with type 2 diabetes, was reduced by 77% in England, with an 84% reduction across Northern Ireland, Scotland and Wales.

Dr Matthew Carr from The University of Manchester, and lead for this study at the GM PSTRC, said: “Outcomes significantly improve for patients when type 2 diabetes is diagnosed early and regularly monitored. When the condition goes unchecked complications can develop which can be more complex to treat. Prior to the pandemic, diagnosis and monitoring relied upon face-to-face contact so it is no surprise to see an initial reduction, as it just wasn’t possible for patients to receive the necessary level of monitoring. However, to see such a significant drop over the course of 9 months is concerning and is an indication of the challenges faced by healthcare services during the pandemic.”

The research also revealed a significant reduction in the prescribing of the two drugs commonly used to manage the condition, insulin and metformin. The rates of diagnosing and monitoring were particularly evident in older people, in men and in those from deprived areas.

Dr Carr continued: “Importantly, our research has identified the scale of the problem, along with information on population characteristics. This will help healthcare services to address the backlog of diagnosing, testing and prescribing. Effective communications should ensure that people living with diabetes remain engaged with diabetes services. There also needs to be a greater emphasis on providing relevant information and, when appropriate, glucose monitoring systems with easy data uploads to enable remote support.”

The research looked at mortality rates for people with type 2 diabetes during April 2020 and reported a 110% increase in England. Mortality rate increases were less elevated in Northern Ireland, Scotland and Wales (increase 66%).

Professor Martin K Rutter, from The University of Manchester, 91ֱ�� University NHS Foundation Trust, and co-author of the research, said: “In recent years there has been excellent progress made in the management of type 2 diabetes. Resources have been put into early detection and management such that the development of the condition can be delayed and, in some cases, it can be reversed through weight loss interventions. As we recover from the pandemic, our research will help UK healthcare services to focus their efforts on identifying these missed cases and providing more support for people living with diabetes so that they can continue to benefit from these recent advances.”

Nikki Joule, Policy Manager at Diabetes UK, said: "It's incredibly concerning that rates of type 2 diabetes diagnoses in the UK were much lower than previous years during the first part of the COVID-19 pandemic. While figures showed a gradual increase in diagnoses from May to December 2020, they remained well below expected levels.

"These results point towards reduced engagement with healthcare during the pandemic, and highlight the urgent need to ensure that those previously identified by their GP as being at high risk of developing type 2 diabetes receive their annual review. Doing so will ensure that - as appropriate - individuals will receive either a diagnosis, or a referral to the NHS England National Type 2 Diabetes Prevention Programme, or its equivalent.

"Early diagnosis of type 2 diabetes is vital in reducing the risk of serious diabetes-related complications such as problems with the heart, kidneys and eyes. To find out your risk of type 2 diabetes, visit Diabetes UK's Know Your Risk Tool - and if you're concerned that you might be at an increased risk, it's important to speak to your GP."

Type 2 diabetes accounts for around 90% of all diabetes diagnoses and is often linked to being overweight or inactive, or having a family history of the condition. It causes sugar levels in the blood to increase which leads to excessive thirst, weight loss and tiredness. Diabetes, especially when poorly managed, can cause serious long-term problems with the eyes, heart, kidneys and nerves.

The findings, published today in , could have benefits for diabetes patients in ensuring that a more improved insulin can be developed for future treatment.

The study was carried out by experts from the Universities of Nottingham and 91ֱ�� and Imperial College London, along with the Diamond Light Source - the UK's national synchrotron science facility.

Glulisine is a synthetic rapid-acting synthetic insulin developed by Sanofi-Aventis - with a trade name of Apidra. It is used to improve blood sugar control in adults and children with diabetes.

In this new study, scientists set out to establish the exact structure of gluisine, and how this structure might affect the way in which it behaves physiologically.

The team aimed to establish, by examining the structure, what fundamental role gluisine plays in diabetes management. These findings could potentially lead to an improved synthetic insulin for patients, with fewer side effects.

Dr Gary Adams Associate Professor and Reader in Applied Diabetes Health at the University of Nottingham, and Lead author of the study, said: “For the first time, our research provides novel, structural information on a clinically relevant synthetic insulin, glulisine, which is an important treatment for those patients presenting with diabetes.

“This information sheds light on the dissociation of glulisine and can explain its fast dissociation to dimers and monomers and thereby its function as a rapid-acting insulin. This new information may lead to a better understanding of the pharmacokinetic and pharmacodynamic behaviour of glulisine and, in turn, might assist in improving its formulation and reducing side effects of this drug.”

To carry out the research, the team created a perfect crystal of glulisine.

The researchers then applied a combination of methods to provide a detailed insight into the structure and function of glulisine.

Dr Hodaya Solomon, a member of the Imperial College team, and joint first author said: “The key molecular level comparisons between this crystal structure of glulisine and of previous insulin crystal structures showed that a unique position of the glutamic acid (an amino acid), not present in other fast-acting analogues, pointed inwards rather than to the outside surface. This reduces interactions with neighbouring molecules and so increases preference of the more-active-for-patients dimer form, giving the experts a better understanding of the behaviour of glulisine”.

John Helliwell, Emeritus Professor of Chemistry at the University of Manchester, and one of the authors of the paper, said: “An unexpected finding was that the glulisine formulation is documented as a zinc-free insulin analogue for its rapid absorption action. Insulin crystallography has shown that zinc is pivotal for hexamer formation. The new glulisine crystal structure showed zinc bound in the same way as in native insulin, by three histidine amino acids. This finding must mean that traces of zinc ions are present in the commercial, as supplied, formulation solution. A further optimisation for glulisine is now clear, that of finally removing the zinc.”

Well managed adults with have a 21% higher risk of developing (CVD) compared to the general population, according to new research.

The research from The University of Manchester, led by Professor Martin Rutter and Professor Darren Ashcroft, in collaboration with the University of Edinburgh, is published in the journal Circulation and was supported by Diabetes UK.

“People with type 2 diabetes should attempt to lead healthy lifestyles and be treated for cardiovascular risk factors as early as possible, regardless of whether they have cardiovascular disease or not,” said co-senior author Professor Martin Rutter.

Co-senior author Professor Darren Ashcroft added: “There is real potential here to reduce the overall impact of type 2 diabetes on future cardiovascular events, especially in patients with type 2 diabetes who have not yet been diagnosed with CVD.”

Dr Alison Wright based at the University’s Centre for Pharmacoepidemiology and Drug Safety, and first author for this study, said: “A Swedish study has suggested that people with type 2 diabetes had little or no excess risk of cardiovascular disease events or death when all risk factors are optimally controlled.

Professor Sarah Wild, co-senior author from the University of Edinburgh, added: “Our team sought to determine how the degree of risk factor control in people in the UK with type 2 diabetes affects CVD risk and mortality compared to people with type 2 diabetes who had all risk factors optimally controlled and to people who do not have type 2 diabetes.”

The research team analysed data between 2006 and 2015 from the Clinical Practice Research Datalink (CPRD) and the Scottish Care Information-Diabetes (SCI-Diabetes) dataset. More than 101,000 people with type 2 diabetes were matched with nearly 379,000 people without diabetes in England, with a further 331,000 with type 2 diabetes from Scotland.

They focused on five cardiovascular risk factors: blood pressure, smoking, cholesterol, triglycerides and blood glucose and examined the association between the number of these risk factors which were optimally controlled on future cardiovascular events and death. They also examined if the presence of heart and kidney disease (cardiorenal disease) impacted these connections.

Their analysis found:

• Only 6% of people with type 2 diabetes had all five risk factors within target range.
• Even when all five cardiovascular risk factors were optimally controlled, people with type 2 diabetes still had a 21% higher risk for CVD and 31% higher risk for heart failure hospitalization than people without diabetes.
• For each additional risk factor not optimally controlled, the risk of CVD events and mortality increased.
• The association between the number of elevated risk factors and CVD events and mortality was stronger in people with type 2 diabetes who did not have cardiorenal disease than in those with cardiorenal disease.
• Patients with diabetes and no history of impaired kidney function were more likely to be younger and use fewer medications for cardiovascular prevention.

Dr Elizabeth Robertson, Director of Research at Diabetes UK, said: “This research, funded by Diabetes UK, shows that although having type 2 diabetes adds to the risk of developing heart disease, by keeping blood sugars, blood pressure and blood fats in a healthy range, and having a healthy lifestyle – you can minimise that risk.

“It is also an important reminder that people with type 2 diabetes should not delay taking steps to prevent heart disease. Stopping smoking, eating a healthy, balanced diet and being physically active are all ways you can improve your heart health and this research reinforces how essential it is for people with diabetes to get the right care, at the right time to be able to reduce their risk of heart disease effectively. To find out ways to stay healthy and active, visit Diabetes UK’s .”

As the research is an observational study, it uses data from primary care medical records that may be incomplete so it may not provide the full picture of the health status for these patients.

The paper 'Risk factor control and cardiovascular event risk in people with type 2 diabetes in primary and secondary prevention settings' is publuished in

The research was funded by the National Institute for Health Research Greater 91ֱ�� Patient Safety Translational Research Centre (NIHR GM PSTRC), a partnership between The University of Manchester and Salford Royal hospital.

Overall, data from between March and July 2020 showed the rate of diagnosis for type 2 diabetes in English practices was reduced by 46% with smaller reductions of 37% in Northern Ireland, Scotland and Wales.

Over that period, the researchers estimate there were more than 45,000 missed or delayed diagnoses for type 2 diabetes across the UK.

In April, rates of diabetes monitoring (HbA1c blood tests) in people with type 2 diabetes reduced by 77% in England, with a 84% reduction across Northern Ireland, Scotland and Wales.

The study also found that the reduced rates of diagnosing and HbA1c monitoring in people with type 2 diabetes were particularly evident in older people, in men, and in those from deprived areas.

In April 2020, mortality rates in people with type 2 diabetes in England were more than twice as high compared to prior trends (mortality rate increase: 110%), but mortality rate increases were less elevated in Northern Ireland, Scotland and Wales (increase 66%).

The research team, who have published an early draft of the pre-peer reviewed study, say that further research is required to understand how population characteristics including ethnicity, population density and deprivation might explain the differences in mortality rate across UK nations.

Dr Matthew Carr from The University of Manchester, and lead for this study at the GM PSTRC, said: “The high rate of COVID-19 infection since August and the second national lockdown makes our results intensely relevant."

“Healthcare services will need to manage this backlog of work, and the expected increase in the severity of diabetes brought about by delayed diagnoses,” said co-author Professor Martin Rutter, from The University of Manchester.

“As we address this backlog of work, older individuals, males and people from deprived backgrounds may be a group to target for HbA1c testing and treatment intensification,” said co-author and Deputy Director at the GM PSTRC, Professor Darren Ashcroft from The University of Manchester.

Nikki Joule, Policy Manager at Diabetes UK, said: “These shocking results highlight the urgent need to ensure that those identified by their GP as being at high risk of developing type 2 diabetes, receive their annual screening for diabetes.

“In addition, while the challenges caused by the pandemic persist, if we are to ensure that people living with type 2 diabetes don’t miss out on annual health checks and HbA1C tests, it is vital that those who need an appointment, are offered one. To find out your risk of type 2 diabetes, visit Diabetes UK’s – and if you’re concerned that you might be at an increased risk, it’s important to speak to your GP.”

Type 2 diabetes accounts for around 90% of all diabetes diagnoses, and causes the level of sugar in the blood to become too high. It can cause symptoms like excessive thirst and tiredness and as well as serious problems in the eyes, heart and nerves.

Co-author, Alison Wright, from The University of Manchester added: “This second national lockdown could have devastating consequences on the care of people with diabetes without effective planning.“

The authors of the study feel the paper should be widely seen as a matter of urgency, hence their decision to make it available to the media before peer review.

The paper Impact of COVID-19 on the diagnoses, HbA1c monitoring and mortality in people with type 2 diabetes: a UK-wide cohort study involving 13 million people in primary care is available

The number of people with pre-diabetes who go on to develop Type 2 Diabetes has been reducing over the past 2 decades, according to a study led by University of Manchester epidemiologists.

However, the changes, says lead author Dr Rathi Ravindrarajah, are likely to be attributed to changes in the definition of pre-diabetes and recording practices, but also preventative work by the NHS.

The study also seems to show that the conversion risk, from pre-diabetes (more recently formalised as non-diabetic hyperglycaemia or NDH) to Type 2 diabetes, for those aged over 85 is very low.

The NIHR funded study shows, based on data from the Clinical Practice Research Datalink of 148,363 participants with pre-diabetes/NDH from 2000 to 2015, how quickly these people go on to develop Type 2 Diabetes and what are their characteristics.

Between 2000 and 2015, before the introduction of the NHS Diabetes Prevention Programme, 1.6% of the sample converted to the illness after a month, 4.2% converted after 6 months and 20.4% converted after 4 years, according to the study published in BMJ Open.

The study found that a diagnosis pre-diabetes/NDH became much more common over time, rising from 0.07% in 2000 to 1.85% in 2015.

Although cases of pre-diabetes/NDH are rising, fewer of these people converted to Type 2 Diabetes, with the annual rate of conversion falling from 8% in 2000 to 4% in 2014.

NHS rightcare pathway estimates that around 5 million people have NDH, and Diabetes UK estimates that in January 2019, 3.9 million people had diabetes In the UK.

People with pre-diabetes/NDH are usually asymptomatic but will often be clinically obese. Many are diagnosed by chance- and are given dietary and lifestyle advice. Some are also prescribed the drug Metformin which is mainstream treatment for Type 2 diabetes.

Dr Ravindrarajah from The University of Manchester said: “This sample is large enough to give a good representation of what is going on across the UK.

“And intriguingly, our figures show that the number of these people with pre-diabetes/NDH who go on to develop Type 2 Diabetes is falling.

“We are not certain why this is, but we suspect it’s a combination of good preventative work by the NHS and changing definitions of non-diabetic hyperglycaemia.

“The reduction in conversion rates reflects changes in the definition of pre-diabetes and to some extent NDH, at least in the UK, with people diagnosed with NDH more recently having lower conversion risks. This has implications for interventions, like the NHS Diabetes Prevention Programme."

She added: “Non-diabetic hyperglycaemia refers to levels of blood glucose that are increased from the normal range but not yet high enough to be in the diabetic range.

“We hope this study will encourage policy makers to be consistent in their definition and recording of pre-diabetes, which has changed a few times in the last decade.

“Diabetic preventing programmes might need to target the individuals who are at higher risk of conversion to Type 2 diabetes, as identified in this study.

“Policy makers who aim to prevent conversion may wish to prioritise certain recipients who are at higher conversion risk, especially when resources might be limited.”

The paper “The epidemiology and determinants of non-diabetic hyperglycaemia and its conversion to type 2 diabetes mellitus, 2000-2015: cohort population study using UK electronic health records.” is available BMJ Open 2020;0:e040201. doi:10.1136/bmjopen-2020-040201

A University of Manchester study of tens of thousands of patients in England with type 2 diabetes has shown that 77% of them have at least one other physical or mental health condition.

The observational study highlights how some conditions, such as schizophrenia which is 2.4 times more likely to be present when compared to people without diabetes, are under-reported in diabetes guidelines and were previously not thought to be so strongly linked to type 2 diabetes.

The patients were also 1.8 times more likely to have depression when compared to people without diabetes, 1.6 times more likely to have asthma when compared to people without diabetes, and 1.6 times more likely to have COPD as people without diabetes.

However, the study also estimates the prevalence of conditions known to have an association with the condition - such as high blood pressure: around 52% of the 5 Million UK patients with diabetes are likely to have hypertension.

In addition, 18% of people with type 2 diabetes were also diagnosed with osteoarthritis, 24% with hyperlipidaemia, 12.4% with depression, and 5.6% with anxiety.

The prevalence of cardiovascular disease was double in people with type 2 diabetes than people without diabetes. The results also show the prevalence of depression in people with the condition aged 16-35 was higher compared with rates observed in people aged 76 and over.

And the association with other illnesses was generally higher in women compared with men with type 2 diabetes, though the reason for this difference remains unclear. The prevalence of hypothyroidism, for example, was nearly four-times higher in women than in men with the condition.

The study - published - is the first large study in England to compare the patterns of 18 major illnesses between people with and without type 2 diabetes using primary and secondary care data.

From the Clinical Practice Research Datalink GOLD data, the team compared 108,588 people with type 2 diabetes to 528,667 people without, registered in 391 English general practices.

Linking with hospital electronic health records, they examined the annual patterns of 18 physical and mental health conditions in people with and without type 2 diabetes over an eleven-year study period in England.

Lead author Dr Salwa Zghebi, Presidential Research Fellow at the University of Manchester, said: “Our findings have important clinical and public health implications in the UK and beyond.

“We address the current need for more research on the coexistence of physical and mental illnesses as highlighted in a recent Academy of Medical Sciences multimorbidity report.

“And we highlight the need for future clinical guidelines in diabetes to refocus patient-centred care on non-cardiometabolic conditions such as asthma, COPD, anxiety, depression, schizophrenia, and osteoarthritis.

“Mental health is of particular concern and our data highlight a profound clinical need in young people with type 2 diabetes who might benefit enormously from mental health interventions.”

She added: “These comorbidities are associated with a higher number of prescribed medications. So if clinicians were made aware of this vital information, that could help avoid dangerous drug-drug or drug-disease interactions and protect patients’ welfare.

“For example, some diabetes therapies should not be taken by people with kidney disease or heart disease - and this research will alert clinicians to that possibility.”

Zghebi SS, Steinke DT, Rutter MK, et al. Eleven-year multimorbidity burden among 637 255 people with and without type 2 diabetes: a population-based study using primary care and linked hospitalisation data. BMJ Open 2020;0:e033866. doi:10.1136/bmjopen-2019-033866

The higher mortality associated with poorly controlled type 1 and type 2 diabetes could produce a loss of 6 million life years in the UK, according to a study by 91ֱ�� data scientists.

The model devised by the team at The University of Manchester, Salford Royal NHS foundation trust and Res Consortium also calculated the impact of the disease on life expectancy.

Using National Diabetes Audit and Office of National Statistics mortality data from 2015, the team found that 1.7million life years are lost for Type 1 and 4.3 million for Type 2 Diabetes each year.

However, given the recent rapid growth in particularly Type 2 Diabetes, and COVID-19 related diabetes deaths the figures, say the team, are now likely to be significantly higher.

In an example calculated by the team, the average age of someone with Type 1 Diabetes is 42.8 years old, and that person has a life expectancy of 32.6 more years. That compares with someone of the same age without type 1 diabetes who can expect to live an average additional 40.2 years.

And the average age of someone with Type 2 diabetes is 65.4 years old; that person could expect to live an additional 18.6 more years. That, they say, compares with 20.3 years in an equivalent in the general population without the condition.

The team also estimated that Type 1 and type 2 Diabetes patients with poor blood glucose control of greater than 58mmol/mol will lose around 100 life days.

The consequences in terms of lost life years on women with diabetes are greater than for men according to the team’s model, though more work, they say, is required to understand why.

The study is published in Cardiovascular Endocrinology and Metabolism.

Dr Adrian Heald is from The University of Manchester and a Consultant in Diabetes and Endocrinology at Salford Royal.

He said: “This study highlights the importance of early effective engagement and long-term management in patients with Diabetes.

“And it’s especially important as numbers of people diagnosed with diabetes are on the rise and in light of the link between diabetes and COVID-19 deaths.

He added: “We hope our linking of poor glycaemic control to expected mortality in such a quantitative way will be helpful to both clinicians and people with diabetes

“Knowing the risks of poor control of their blood sugars will bring home its importance of and will support them in their efforts to achieve their targets.”

The team acknowledge the paper has used national level mortality data rather than GP practice level data.

And the impact of other factors such as smoking, inactivity, overweight, hypertension and taking of statins will be the subject of future study

However they still argue is likely the blood sugar level will remain a strong independent determinant of mortality.

The paper Estimating life years lost to diabetes: outcomes from analysis of National Diabetes Audit and Office of National Statistics data is available

Weight, blood pressure and blood fat elevations are greater in young people who develop type 2 diabetes according to scientists at the Universities of Glasgow and 91ֱ��.

The study, published in Diabetologia, examined known risk factors for heart disease between people with and without type 2 diabetes at similar ages. Its findings confirm that younger people diagnosed with diabetes have a greater difference in weight relative to people without the disease.

The difference in weight between those with and without type 2 diabetes was most marked for white people, especially women. The same was also true for blood pressure: young, White people had a higher difference in blood pressure when diagnosed with type 2 diabetes when measured against those without the disease. While the work confirmed the same patterns were seen in South Asian and Black people, these groups tended to develop type 2 diabetes at much lower BMIs, with less difference in weight between those who did and did. Similar, though less marked patterns by age were seen for blood fat levels.

Previous studies have shown that there is a greater loss of life from type 2 diabetes in White people, and the researchers believe these findings may help to explain why.

Overall the researchers found that the difference in weight for individuals with and without type 2 diabetes was 20kg, between the ages of 20 and 39 years old. While for those diagnosed over 80 years old, the weight difference was only 5kg. Similarly, the difference in blood pressure was highest in the younger age bracket for those who were diagnosed with type 2 diabetes. There was no difference in blood pressure for those with or without type 2 diabetes at over 80 years old.

People who develop diabetes at a younger age develop more complications over their lifetime, and die younger than people who develop diabetes much later in life. However scientists still don’t fully understand why this is case.

Researchers say these findings may explain why younger onset of type 2 diabetes could be more damaging to some individuals, as they develop it on top of other health risk factors.

Professor Naveed Sattar of the University of Glasgow, who led the study, said: “Our findings could help explain why younger diabetes onset is more damaging, and offer important insights into different groups for the development of type 2 diabetes.

“They also suggest a need for greater healthcare emphasis on diabetes and heart disease management in young people developing diabetes, regardless of their sex or ethnicity.”

Prof Martin K Rutter of The University of Manchester, and 91ֱ�� University NHS Foundation Trust, who col-led the study, said, “Our work also helps to understand why there may be a greater loss of life from type 2 diabetes in White people as we noted that risk factors differences between those with and without diabetes, across nearly all ages, were less in South Asians and Black people compared to White people

“Our study also further illustrates how South Asians and Black people are more sensitive to the adverse metabolic effects of weight gain than Whites. These findings may hold some relevance to the current COVID-19 findings where people with diabetes, and of specific ethnicities, are at greater risk for severe outcomes.”

The researchers used the UK Clinical Practice Research Datalink to identify 187,601 people with type 2 diabetes diagnosed between 1998–2015 in England. The study compared their weight and blood pressure at diagnosis with age-matched people without diabetes, by sex and ethnic group.

The study, ‘Age-, sex- and ethnicity-related differences in body weight, blood pressure, HbA1c and lipid levels at the diagnosis of type 2 diabetes relative to people without diabetes’ is published in Diabetologia, a journal of the European Association for the 91ֱ�� of Diabetes. The work was funded by Diabetes UK.

The paper is available here: 

A Professor of Infectious Diseases at The University of Manchester has taken part in an event in Cardif to honour his grandmother who was one of the first children in the world to be treated with Insulin. Elizabeth’s grandfather (David Charles Hughes) emigrated from Wales to the USA in 1855.

The Elizabeth Evans Hughes Medal, named after Professor David Denning’s grandmother, was awarded to people who achieved success in life while living with type 1 diabetes.

The Children and Type 1 Diabetes Day is organised by by Diabetes UK Cymru, is celebrated today at the Senedd, the Welsh Assembly.

The "Children and Type 1 Diabetes Day" also aimed to raise awareness of early symptoms, so that children can be diagnosed before they become seriously unwell.

It was almost 100 years ago when in 1922, Elizabeth was one of the first patients in the world to receive the life-saving treatment of insulin, in Toronto, Canada, at the age of 15.

She developed diabetes in 1918 at age 11 when life expectancy of someone with Type 1 diabetes without treatment was usually no more than a few months.

The only treatment was a starvation diet, though even with that, patients could only expect to live for a couple of years

Between 1921 and 1922, a team at the University of Toronto succeeded in isolating the hormone insulin, which people with  type 1 diabetes are unable to produce on their own.

Elizabeth's mother contacted Canadian doctor Frederick Banting, who agreed to treat her and she arrived in Toronto on August 15, 1922 and began receiving insulin.

She recovered rapidly and lived until she was 73.

Professor Denning presented the newly reissued Elizabeth Evans Hughes Medal at the ceremony

He said: “I would not be here today, had it not been for the pioneering research by Dr Fred Banting In the 1920’s.

“He discovered insulin and with it started treating my grandmother who then lived a full and active life for another 60 years. It is a real privilege to award the medal in my grandmother’s name to those afflicted with diabetes in Wales. As a medical researcher myself, this is particularly poignant."

Photos:

Professor Denning's grandparents Golden Wedding event, with David sitting next to his grandmother.

Elizabeth Evans Hughes Medal

A Diabetes UK-funded study suggests that Type 2 diabetes leads to a smaller increase in the risk of cardiovascular disease for women today than it has done in the past.

Researchers at the University of Manchester studied data from almost 80,000 people with newly diagnosed Type 2 diabetes, to look for differences between men and women in relation to their risk of having a cardiovascular event such as a heart attack or stroke.

Type 2 diabetes increases the risk of cardiovascular disease (CVD) in all people with the condition. While men with Type 2 diabetes have a higher overall risk of CVD than women, research to date has shown that when women develop Type 2 diabetes, their risk of CVD increases proportionately more than it does for men.

But this new study, published in Circulation, suggests that men and women now experience a similar relative increase in their risk of CVD when they are diagnosed with Type 2 diabetes.

The researchers used data from people diagnosed with Type 2 diabetes between 2006 and 2013, and they believe this newer data could reflect a greater focus on preventing CVD as part of Type 2 management in recent years, as well as initiatives to improve clinical care such as the Quality and Outcomes Framework (QOF).

However, the researchers warn that despite these improvements in treatment, women may not be receiving the same level of care as men – including being prescribed important medications, such as ACE inhibitors or statins, to protect against and reduce the risk of developing CVD in the future. This is despite the fact that women are more likely to have high blood pressure and cholesterol levels than men, and have more regular contact with a healthcare team. The researchers found this bias was even stronger in women already showing some signs of cardiovascular disease¹.

The research team believes that this prescribing gap may be due to differences in the symptoms of CVD between men and women. Alternatively, they suggest it may be due to differences in attitudes towards health and CVD risk between men and women – both among healthcare professionals and people with Type 2 diabetes. But they stress that more research is needed to understand the reasons for these prescribing differences.

Dr Elizabeth Robertson, Director of Research at Diabetes UK, said:

“These new results suggest that the outlook for women with Type 2 diabetes is better than previously thought, thanks to improved care. However, we need to make sure that everyone with Type 2 diabetes gets the best treatments and care, to reduce their risk of life-threatening cardiovascular complications like heart attack or stroke as much as possible.”

Dr Alison Wright, lead researcher of the study at the University of Manchester, said:

“The improved outlook for women as they develop Type 2 diabetes is good news, and likely to be a reflection of the improvements in Type 2 diabetes UK care. But we can’t be complacent; as healthcare professionals, we need to ensure that women receive better care, on a par with men, to address any potential prescription bias.”

Dr Martin Rutter, senior researcher at the University of Manchester, said:

“Further research is now needed to understand the reasons for these prescribing differences between men and women and to find ways to close the gap. Research in primary care is particularly needed, as this is where most people with Type 2 diabetes are treated.”

This research was funded by Diabetes UK and was conducted at the University of Manchester.

Babies born with congenital hyperinsulinism (CHI) are at risk of suffering from permanent brain damage and life-long disability.

Yet some will go on to suffer more severely than others as a result of their disease profile, report the researchers in an article published in

The research team have found that it is possible to predict when and how the disease may affect the child in the long-term.

“One of the problems facing clinicians is that it is really difficult to predict which babies will have problems after surgical treatment. Our new data give some important clues that will help clinicians to know how much extra care each baby is likely to need”, explains Dr Karen Cosgrove, a member of the research team from The University of Manchester.

Although generally rare, affecting just 1 in 50,000 children in the UK, CHI can be as common as cystic fibrosis (1 in 2,500) in children of European Jewish descent or when born into communities where cousins marry.

Up until now, scientists have understood that there are two main subtypes of the disease- known as diffuse and focal.

Diffuse CHI affects the entire pancreas, whilst focal CHI affects just one area of the organ, forming a focal lesion.

The team from 91ֱ�� now understand that focal CHI can be further categorised into two types- spreading focal lesions and isolated focal lesions.

Spreading focal lesions are generally larger and spread outwards into areas of healthy cells.

Isolated focal lesions, on the other hand, have a capsule around them which keeps the diseased cells separate from healthy cells.

The research team investigated the cases of 25 infants with focal CHI to see how the two types of lesions influenced their long-term outcomes.

The researchers found that babies with spreading focal lesions suffered more severely from the disease and were diagnosed earlier.

These infants were more likely to suffer brain damage which permanently affected their development, learning and behaviour.

In contrast, in infants with isolated lesions, the disease was diagnosed later and surgery to remove the lesion was less complicated.

These new data help to explain why new-born babies diagnosed with the same disease may go on to have very different outcomes and could influence the way clinicians choose to manage each new case of CHI.

“Although the impact of these findings is limited to centres with surgical resources, for those centres the data is immediately applicable and translatable clinically” explains Professor Mark Dunne from The University of Manchester and lead author on the study.

To find out more about the impact that CHI has on families around the UK, visit the  . For more information on one of the specialised UK services that treats CHI patients, visit

University of Manchester and Salford Royal NHS Foundation Trust scientists have developed a lamp which could treat chronic ulcers with light.

The Arthritis Research UK funded trial led by Dr Michael Hughes tested the therapy – which combines infrared, red and ultraviolet light - on finger ulcers caused by a condition called systemic sclerosis, where the immune system attacks the body’s fingers and toes.

Dr Hughes said the results were so emphatic, the device is a potential treatment for other ulcers, including diabetic and venous ulcers, a huge problem for tens of thousands of patients

People with diabetes are at risk of ulcers or open wounds that don’t heal because of poor circulation, a complication of the condition.

Venous ulcers occur when blood doesn't flow from the lower legs back to the heart, causing a build-up of pressure in the veins.

The lamp built by Medical Physics team at Salford Royal has 32 different bulbs which emit infrared, red or ultraviolet light. Eight patients with 14 ulcers between them had the treatment.

In the study, published in the Journal of Dermatological Treatment today, the patients were treated using the lamp for 15-minute sessions, twice a week for three weeks.

After treatment, there was an average 83 per cent improvement in the ulcers, with no side-effects.

Scientists believe ultra-violet light, which cannot be seen by the naked eye, kill the bacteria and reduce the inflammation that prevents healing.

Red light is believed to boost blood circulation, increasing the supply of oxygen and nutrients needed for wound healing.

Dr Hughes  is Consultant Rheumatologist in Sheffield at the Royal Hallamshire Hospital, a specialist centre for scleroderma.

It is also thought to stimulate the production of the protein collagen in the skin, which provides the natural scaffolding to help new tissue grow.

And infrared light, used in TV remote controls, is associated with increasing blood flow and oxygen.

Patients having light therapy for ulcers, using lasers, are currently treated in hospital over five days and are forced to take medication which lower their blood pressure.

However, the new therapy can be administered at home and, says Dr Hughes, with SIM card technology can even be used to monitors patients’ progress remotely.

He said: “We believe this technology is a game changer; the implications are huge.

“Ulcers cause much distress to patients – and current treatments are costly to the NHS and problematic for patients who can only receive them in hospital.

“But this technology is cheap and practical- it’s really a no brainer as it can be administered at home.

“There are future possibilities as well: we think this device could be easily adapted to monitor ulcers remotely using cameras. They could also be programmed to recognise different parts of the body so that the treatment is given accurately.

“In the next 6 to 12 months we shall be refining the machine and within 12 months we hope to trialling it on diabetic ulcers.”

‘A feasibility study of a novel low-level light therapy for digital ulcers in systemic sclerosis’ is published in the 

The device was designed by Dr Stuart Watson, Head of R&D Services, Salford Royal and built by colleagues Nahzli Mir and Steven Bibby

A new method of measuring blood glucose levels in people with diabetes is a significant advance in the management of the disease, according to an independent assessment by University of Manchester, 91ֱ�� University NHS Foundation Trust and Derby Teaching Hospitals experts.

The FreeStyle Libre flash glucose monitor has been available on prescription in the United Kingdom from November 2017.

It works through a white disc adhered to the arm which connects remotely to a small monitoring device.

It is designed to replace the recommended 4-10 painful finger-stick blood glucose tests required each day for the self-management of diabetes.

The disc is replaced every 14 days and can also be purchased by people with diabetes.

Type 1 Diabetes can occur at any age but typically presents in childhood and requires lifelong insulin therapy. Type 2 diabetes is usually diagnosed in people over 30-year-old and is initially treated without medication or with lifestyle modification and/or tablets.

People with Type 1 Diabetes should measure their blood glucose many times a day so they are able to adjust their insulin dose.

Having a blood glucose which is too high increases the risk of diabetes complications such as eye disease, foot ulcers and kidney disease.

Glucose levels which are too low can make the person with diabetes feel unwell and unable to function. If left untreated, low glucose can cause coma and seizures.

Dr Lalantha Leelarathna, is a researcher from The University of Manchester and a Consultant Diabetologist at 91ֱ�� Royal Infirmary, 91ֱ�� University NHS Foundation Trust.

He said: “Despite major progress in the care of people living with Type 1 diabetes, many fail to achieve their target blood sugar level – and that risks major complications.

“A key barrier in achieving near normal glucose levels is this need for frequent fingerstick blood glucose monitoring and that’s down to pain and inconvenience.

“Our review concludes that The FreeStyle Libre flash glucose monitor works well for both adults and children.

“The studies show it is accurate, comfortable and easy to use. It is associated with a reduction in low blood sugar levels, improvements in glycated haemoglobin levels and adverse events are low.

“Our assessment of the available evidence shows that for most patients, it is a game changer.”

Dr Emma Wilmot from Derby Teaching Hospitals said: “From our perspective, the FreeStyle Libre is a significant advance in the management of diabetes. Many users describe it as ‘life changing’.

‘The challenge in the UK is to now ensure that it reaches people living with diabetes. We are delighted that this device became available on the NHS drug tariff in November 2017.

“However, it is clear from the Diabetes UK map of access that this does not necessarily mean that it will make it into the hands of those who might benefit:

‘The development of a postcode lottery for access would further add to the variation in diabetes care across the country and may adversely impact on outcomes.’

The Diabetes UK map of access is available 

The paper, , is published in Diabetic Medicine

Men with type 2 diabetes taking treatments for erectile dysfunction could be reducing their risk of a heart attack and improving their chances of surviving a heart attack, according to a study funded by the British Heart Foundation (BHF) and the National Institute of Health Research (NIHR).

The researchers at the University of Manchester were studying the electronic health records between January 2007 and May 2015 of almost 6,000 men with type 2 diabetes aged between 40 and 89 years old.

The findings, , provide strong evidence that erectile dysfunction treatments that block an enzyme called PDE5 act to reduce risk of death in type 2 diabetes, according to the researchers. Viagra is one example of an erectile dysfunction treatment that works by blocking the PDE5 enzyme.

Compared with non-users, the 1,359 men who were prescribed PDE5 inhibiting drugs experienced lower percentage of deaths during follow-up (19.1 per cent vs. 23.8 per cent) and lower risk of death (31 per cent) by any cause. Risk of death was still reduced after adjusting for age and other factors that affect heart disease risk. They also found that there were significantly fewer heart attacks in people taking erectile dysfunction treatment over the study period. And in a subgroup of patients who had a history of heart attack or had one during the study period, the drugs were associated with significantly lower risk of death.

3.5 million adults in the UK have been diagnosed with diabetes and 90 per cent of those people have type 2. Having diabetes can double the risk of developing cardiovascular disease.

One of the 91ֱ�� team, BHF Senior Research Fellow , has already shown in the lab that heart cells from a failing heart survive longer when they receive this treatment. This team is now looking to confirm whether the same drugs can also prevent abnormal heart rhythms which are responsible for killing up to half of heart failure patients. They hope that these two laboratory studies, in animals, will then lead to clinical trials in people with heart failure.

A group of scientists have found that a single molecule from a bacterial cell wall component can lead to the unusual behaviour of 100 million clotting molecules in blood, which may be a major contributor to many diseases including Alzheimer's, Parkinson's and diabetes. The discovery could help to explain many features of these kinds of diseases, and may lead to new methods of prevention or treatment.

A team from The University of Manchester, together with South African colleagues from The University of Pretoria, tested blood and plasma for its ability to clot when the normal clotting agent thrombin was added. Normal, healthy blood clots have a nice spaghetti-like appearance. However, the results showed that tiny amounts of cell wall molecules such as lipopolysaccharide (LPS), which are shed by dormant bacteria, caused a highly anomalous clot to form dense deposits with very different fibres.

These can contribute to the chronic inflammation that is part of many supposedly non-infectious diseases. These include Alzheimer’s, Parkinson’s, ‘auto-immune’ conditions such as rheumatoid arthritis, cardiovascular problems such as stroke, and metabolic diseases including type 2 diabetes.

The discovery could have considerable impact on the treatment of these conditions, since stopping the unusual clotting could stop its consequences. Existing treatments do not do this, as the new mechanism had not previously been known.

The work is part of an ongoing collaboration funded by the Biotechnology and Biological Sciences Research Council to understand unusual blood clotting.

Resia Pretorius, from the Department of Physiology at The University of Pretoria, said “The importance of LPS in inflammatory diseases has been mostly overlooked, and has been used to induce both Alzheimer's and Parkinson's disease in animal testing for many years. Inflammatory diseases are also closely linked to Leaky Gut Syndrome. Together with our new findings regarding the involvement of a (dormant) blood microbiome, this demonstrates that dormant bacteria can play an important role in all inflammatory diseases.”

Glucocorticoid (or steroid) therapy, prescribed to around half of patients with rheumatoid arthritis, is a known risk factor for developing diabetes. A study from The University of Manchester has found how the risk of diabetes increases in relation to the dosage, duration and timing of steroids.

In a paper published in the journal Arthritis and Rheumatology, the researchers looked at the records of more than 20,000 patients with rheumatoid arthritis in the UK and compared rates of new-onset diabetes in those who were prescribed glucocorticoids to those who didn’t receive glucocorticoids.

They found that glucocorticoids were associated with one new case of diabetes for every 150-200 people treated per year. However, within this group, risk was affected by the dose only in the most recent six months. Each increase of 5mg prednisolone per day carried a 25-30 percent increase in diabetes, although a dose of less than 5mg wasn’t associated with any measurable risk of diabetes compared to no treatment.

Dr Will Dixon, Director of at The University of Manchester and Honorary Consultant Rheumatologist at , led the study. He said: “Doctors treating people with arthritis have to make a decision how best to prescribe glucocorticoids by balancing the benefits against the risks. However, until now, no studies have considered how the risk changes with the dose and duration of treatment.

“This research provides important evidence for doctors to make this decision.”

As well as the 21,962 patients from the UK database, the research team also checked their results against a further 12,657 records held in the USA. Results also took into account patients’ BMI and smoking status, as well as their disease severity.

The research does not advocate that people stop using glucocorticoids as they have been used effectively since 1948 to treat flare-ups in joint pain and for longer periods at a low dose to help people who don’t respond to other treatments.

Mrs Stones is a patient with rheumatic diseases that have required steroid therapy for several decades. In this time, she has developed multiple steroid-related side effects including fractures and diabetes. She said: “It is important that health professionals communicate clearly, and transparently with patients, so that decisions can be made together. Understanding the risk of long-term steroids needs to be better communicated, as they can have life-long implications on quality of life.”

Dr Dixon said: “This research shows that low doses of steroids (below 5mg/ day) do not increase the risk of diabetes. However, there is an increased risk of acquiring diabetes for people who use them for long periods or at high doses which can now be quantified.”

The paper, ‘’, was published in the journal Arthritis and Rheumatology.

DOI: 10.1002/art.39537

Some 61 million rural children left behind by parents moving to China’s booming urban centres are at risk from increased fat and reduced protein in their diets, research from The University of Manchester, published in Public Health Nutrition suggests.

The study of 975 children from 140 rural villages in nine provinces carefully analysed nutritional intake and showed a particular risk to boys who were left behind in the care of grandparents or one parent while a mother or father sought work away from home.

The research was led by Nan Zhang from the University’s . She said: “There are sound financial reasons why so many people move from rural to urban areas in China, but the benefits that more money brings to a family can often be at the expense of child nutrition.

“The Chinese government needs to recognise this growing problem among rural communities and this research provides some evidence to target health policies on encouraging a balanced diet.”

The study found that ‘left behind’ boys in particular consumed more fat and less protein than those from complete families, which leaves them at increased risk of obesity and stunted growth. This finding has important policy implications in a specific cultural context where ‘son preferences’ are powerful.

Although the findings don’t provide reasons for this change in diet, the researchers speculate that mothers moving away from home generally earn less, and that these lower earnings act in combination with grandparents’ poorer dietary knowledge or willingness to spend more on food.  Another academic paper led by Nan Zhang has explored the intergenerational differences in beliefs about healthy eating for left-behind children among grandparents and parents and was published in Appetite.

Another factor at work could be that prices of protein-based foods such as eggs and meat have increased faster than many households’ incomes – meaning that even though money is being sent home from one or both parents, nutrition doesn’t always improve.

Nan Zhang said: “The process of parental migration is complex and the reasons for problems in boys’ nutrition are not straightforward, however we can see that both parents and grandparents in rural areas need to be educated about good diet. 

“Because raising children can fall on all members of the family, good care-giving practice needs to become more widespread.”

The paper, ‘ was published in the journal, Public Health Nutrition.

Funding came from an Economic and Social Research Council (ESRC) Postgraduate Scholarship

New research from The University of Manchester and the Babraham Institute has revealed how gaps between genes interact to influence the risk of acquiring diseases such as arthritis and type 1 diabetes.

Writing in Nature Communications, the scientists show gap regions within the folds of DNA that have a crucial effect on turning genes on and controlling their expression, actually physically interact with genes not previously thought to be important in disease.  Many of these genes are now thought to increase the risk of people developing diseases such as arthritis, psoriasis and type 1 diabetes.

Lead researcher from The University of Manchester said: “It used to be the case that researchers would seek to identify a gene which caused a particular disease by a ‘nearest gene’ approach, to the gap regions.
 

“The reality is much more complex than that.  Not only do the gaps between genes have an effect but, as we show in the new study, the gaps don’t necessarily affect the nearest gene – they can work over longer distances to turn distant genes on or off.”

This process is caused by the folding of the two metre DNA to make it fit within a cell. This folding, brings gap regions close to the ‘more important’ regions, and therefore controls the levels of genes. In certain parts of the folded DNA, regions that increase risk to different diseases can ‘meet’ at the same gene.

The findings also open up the possibility that some genes may be increasing the risk of more than one disease, depending on how they are regulated by the gaps and from where in the DNA structure.  This knowledge could lead to greater understanding of the diseases and insights into potential treatments. 

The next steps in the research are to identify more of these complex interactions and in different types of cell in order to build a more complete picture of how genes and gaps interact to increase disease risk. 

Dr Eyre added: “This research shows just how complicated the interactions within our cells are – much more so than was previously thought.  However, by gaining a better understanding of this process we open up many more possibilities for research into cures and treatments in the years ahead.”

The research was funded through and a Fellowship and has had support from The National Institute for Health Research (NIHR) . Researchers from the University of Cambridge and the Babraham Institute also contributed to the work.

The paper, ‘Capture Hi-C reveals novel candidate genes and complex long-range interactions with related autoimmune risk loci’ was published in the journal . DOI: