1. Diabetes update Gillian Clarke Diabetes Lead/Advanced Dietitian

2. Diabesity 21.7% of the patients referred to the service have diabetes. 21.7% of the patients referred to the service have diabetes. Diet and lifestyle is the cornerstone of good diabetes management Diet and lifestyle is the cornerstone of good diabetes management

3. SIGN 116 Grade A recommendation: Obese adults with Type 2 diabetes should be offered individualised interventions to encourage weight loss (including lifestyle, pharmacological or surgical interventions) in order to improve metabolic control. Obese adults with Type 2 diabetes should be offered individualised interventions to encourage weight loss (including lifestyle, pharmacological or surgical interventions) in order to improve metabolic control.

4. Encouraging patients to take control Becoming aware of the changes in blood and physical changes due to weight loss. Recognising links between eating, weight and glucose control. Recognising the need for medication ‘Activity increase’ helps with glucose control. Interacting with our team more intensively for up to 18 months. Interacting with others in the same situation.

5. What are we doing to support patients with diabetes? Patients asked to report their most recent results/medication to group leader. Encouraging self-efficacy of their diabetes care. Patients asked to report their most recent results/medication to group leader. Encouraging self-efficacy of their diabetes care. Conversation Map education sessions run by specialist dietitians. Well evaluated. Conversation Map education sessions run by specialist dietitians. Well evaluated.

6. Linking more closely with acute and community diabetes services: Linking more closely with acute and community diabetes services: - liaising with GP’s over diabetes medications that may be affecting weight loss progress. - liaising with GP’s over diabetes medications that may be affecting weight loss progress. - Consultant Diabetologists consulted prior to patients on insulin commencing the programme. - Consultant Diabetologists consulted prior to patients on insulin commencing the programme. - liaising with diabetes teams when patients are being considered for bariatric surgery. - liaising with diabetes teams when patients are being considered for bariatric surgery.

7. CONVERSATION MAPS 78% found Conversation Map session extremely useful. 22% found it very useful. “Very informative and educational.” “Very informative and educational.” “This has helped me to understand more about Diabetes – I am not so worried about it now.” “This has helped me to understand more about Diabetes – I am not so worried about it now.” “I liked the style of the group, as very encouraging for myself and others.” “I liked the style of the group, as very encouraging for myself and others.” “Dietitians were very knowledgeable and motivating.” “Dietitians were very knowledgeable and motivating.” “The map was informative and relevant as well as colorful and interesting.” “The map was informative and relevant as well as colorful and interesting.”

9. Pilot outcomes from GCWMS Diabetes patients Patients with type 2 diabetes on insulin (who are less amenable to weight management interventions than those not on insulin) Patients with type 2 diabetes on insulin (who are less amenable to weight management interventions than those not on insulin) Completed at least Phase 1 of the GCWMS programme Completed at least Phase 1 of the GCWMS programme Showed a mean weight loss of 6.03% Showed a mean weight loss of 6.03% Showed a mean reduction in HbA1c of 0.56% Showed a mean reduction in HbA1c of 0.56% (SD + 1.57) over a mean of 11 months (SD + 1.57) over a mean of 11 months UKPDS study has shown that a 1% reduction in HbA1c is associated with a decreased risk in diabetes complications. UKPDS study has shown that a 1% reduction in HbA1c is associated with a decreased risk in diabetes complications.

10. Case Study – Mr F (55yrs old) Attended ax with T2DM, hypertension. Attended ax with T2DM, hypertension. Wt=107.1kg, ht=1.67m, BMI=39.4kg/m 2 Inactive sedentary job as driving instructor. Irregular meal pattern, frequent takeaways, large portion sizes at meals. Inactive sedentary job as driving instructor. Irregular meal pattern, frequent takeaways, large portion sizes at meals. Dm medication – Insulin – 60u with meals, 100u evening and Metformin. Dm medication – Insulin – 60u with meals, 100u evening and Metformin.

11. Weight loss over the course of the programme. Phase 1 Phase 2 Phase 3 Weight loss (kg) 12.9 12.9 9 9.5 9.5 Cumulative weight loss (kg) 12.9 12.9 24.9 24.9 35.2 35.2

12. HbA1c levels March 2012 (started phase 1 of programme) 62 mmol/mol (7.8%) November 2012 (insulin discontinued, only on Metformin) 46 mmol/mol (6.4%) April 2013 (discharged from DM clinic at Stobhill, for annual r/v at GP) 40 mmol/mol (5.8%)