The meeting began with the news that the NHS is spending £1B a year on medication for diabetes, and around £10B in total, both figures are growing.
ESMA Research Project
We welcomed Charlotte A’Court, Research Assistant, Behavioural Science Group, University of Cambridge, School of Clinical Medicine, Department of Public Health and Primary Care. Charlotte told us about a research project ESMA – Economical Service for Medical Adherence that has recently begun. The project aims to develop a digital intervention supporting people by improving the way in which they take prescribed medications, particularly for high blood pressure. A recent study of 2 million participants showed that 41% of people had a lower than 80% adherence to taking medications on time. The most common reason given is forgetfulness.
The reminders to take medication are either via text or an app (Android only at the moment) and are personalised e.g. “Hello Emma, Have you taken your Ramipril yet? Taken? Yes/No”. The study is looking for volunteers and anyone wishing to take part in the study can contact Charlotte on 01223 330355 or ESMA@medschl.cam.ac.uk . The study consists of an initial interview at your preferred date, time and location, a 4 week trial of the service, followed by a final interview.
We had a good discussion about the merits of such a system, which was generally considered to be beneficial as long as it could be suspended when desired.
Apps and resources
Mike Willis then gave a talk and demonstration of various apps and resources he has used over the past 6 months to lose weight, reduce blood pressure and get his HbA1c into the ‘normal’ range. For all of the examples given there are equivalent apps for Android phones and most are free.
For general monitoring of health Mike used the Apple Health app to monitor a daily weight measurement and weekly fasting blood glucose and blood pressure measurements. Mike also uses this app to monitor activity and exercise.
Mike followed a low-carb diet based on The 8-week blood sugar diet book by Dr Michael Mosley https://thebloodsugardiet.com . Additional guides can be found on the Diabetes UK web site https://www.diabetes.org.uk and at https://www.diabetes.co.uk (there is no connection between the two sites/organisations). Of course we have our local GP Dr Simon Poole’s excellent The olive oil diet book http://www.oliveoildiet.co.uk . Nurse Marie Rouse from Firs House Surgery has compiled a document with dietary information – see the other attachment.
To monitor calories and carbs, the simplest way is to use a food diary. A table you can print out is available at https://www.diabetes.co.uk/food/food-diary.html but easier is the spreadsheet on the same page that adds up the totals automatically. If anyone doesn’t have access to a printer and would like copies of anything, please email email@example.com and I will print some for you.
Mike monitored his weight loss and calories/carbs using the LoseIt! App https://www.loseit.com . This enables you to scan barcodes and add foods from a large database for each meal, and then shows you the amount of carbs, protein and fat you’ve consumed by meal/day/week. There are many other apps that do this, both free and paid.
Mike also used an online coaching service, a trial run by AXA Healthcare and now discontinued. For a monthly subscription and using the MyCoach app, Mike had an initial telephone call from a coach to establish needs and circumstances, advise on diet and exercise and set goals. Mike then added data daily, such as weight, mood, steps taken, photos of meals etc. and the coach sent messages within the app with advice several times a week. Monthly phone calls also supported this. There are several similar services being trialled with the NHS at the moment, for instance Changing Health https://www.changinghealth.com but unfortunately none are available to the general public, only in trial areas with referrals from GPs. Mike found this type of service very motivating; having someone ‘watching’ you and giving professional advise worked very well. From the professional’s viewpoint, they have a ‘dashboard’ monitoring a few hundred users and can intervene according to need.
Mike also mentioned a friend of his in the US, whose son is Type 1, who is funding the development of AI-based tools to improve blood glucose control. At present remote monitoring of his son is possible via his blood glucose monitor and phone, and alerts are driven if a hypo is predicted so that action can be taken. The long-term target is to link this to an insulin pump to create an artificial pancreas. A first product, GlucoDyn, predicts the insulin dose required to balance carb input and a demonstration can be found here http://perceptus.org/about/glucodyn .
Finally, keeping stress-free is beneficial for many reasons, but with weight loss important its good to reduce the temptation to comfort eat. These days Mindfulness, a simple meditation approach is recommended, and Mike used an app Headspace https://www.headspace.com . This has a 10 day trial and then you pay, but other free alternatives are available.
If anyone has other recommendations for resources then please share them at future meetings. Even better, if everyone joined our Facebook group https://www.facebook.com/groups/1864088890365791/ or within Facebook search for HI Diabetes support group. It’s a closed group so Mike has to approve you and then all posts are only seen within the group.
Funding for 2019
Mike has applied for funding for the group from the HI Parish Council to cover meeting room hire charges, printing costs for the flyers Firs House hand out at clinics and a Feast Market stall. There is an alternative and lower cost meeting room being investigated at Homefield Community Centre. A back-up funding plan is from the Histon Beer Festival. It is intended to keep the meetings free of charge to attend.