A refreshed version of the EASD e-Learning website launches this week, with a cleaner, more user-friendly design.

As part of a wide-ranging redesign, changes to EASD e-Learning’s site navigation make it easier for learners to access the different types of information they want, to identify the experts who have contributed to a specific course, and to share content with other people.

Welcoming the new site’s launch, EASD e-Learning Programme Director Dr Eleanor D Kennedy, commented: “Course content is now presented in a way that allows learners to see at a glance who the authors are before enrolling on a course. And it’s much easier to share Horizons content with other colleagues, so they too can keep up to date with new innovations in diabetes care and research. We hope these and other changes to the site will help build a thriving community of EASD e-Learning users, improving diabetes knowledge and treatment around the world.”

Bigger reach, greater scope

The redesign follows a period of rapid expansion for the EASD e-Learning platform. Since its launch in 2018, the platform has grown to include over 80 modules on a wide range of topics. It now has around 8,000 healthcare professional subscribers and is regularly accessed by thousands more, from every region of the world. In addition to its e-Learning modules, the site now offers additional types of content – in particular in its ‘Horizons’ section, which includes weekly news reports on diabetes innovations from journals and conferences, and films on hot topics in diabetes.

“Providing a range of content types, not just modules, has enabled us to offer greater immediacy to learners and respond more quickly to important changes in the diabetes environment – such as COVID-19,” said Dr Kennedy. “With so much content, though, it had become a challenge to make sense of it all within the old site design. By making the navigation clearer and establishing distinct areas for our course content and Horizons, learners can now move more easily between the different types of information.”

Other innovations include:

  • Well-structured, easy-to-follow navigation, with new portals and crumb trails to guide learners through the site
  • A new ‘My account’ page, making it easier for learners to track their progress through a course and download certificates of completion and reflective learning
  • Module authors credited on the course listing, so learners can see who writes and presents course content before enrolling
  • A new ‘Meet the experts’ section detailing all the course content authors, complete with biographies
  • Easy-to-use options for sharing Horizons content by email or Tweet

Improvements will not stop there, though. “This redesign was inspired and informed by learner feedback,” says Dr Kennedy. “It’s very much an ongoing project and needs ongoing feedback from users to help us make more improvements to the content and user journey – improvements that will bring us closer to our goal of being the world’s leading information hub for diabetes knowledge.”

Educational activities have been a core priority of the EASD since its foundation, but recent years have seen those activities expand significantly in number and variety. To help guide the future delivery of its educational activities, the EASD is looking for new members of its post-graduate education committee.

The aim of the EASD’s post-graduate education (PGE) is to educate, inform and engage healthcare professionals around the world by addressing standard themes in practical diabetology as well as novel and complex themes in modern diabetology that overlap with other medical disciplines.

The EASD’s educational portfolio consists of five different tracks, ranging from e-Learning to basic hands-on training courses, ranging from workshops and focused meetings on specific topics of diabetes research and care to collaborations with national associations world-wide.

Its chosen presentations enrich local and regional conferences with EASD expertise in diabetes research and care. Its courses offer young researchers the opportunity to be trained by an outstanding clinical team on the basic requirements for clinical research. New talents are promoted and diabetes research in centres throughout the world is fostered. Its workshops and seminars offer an educational exchange, bringing together senior scientists and young investigators; they are aimed at the promotion, enhancement and dissemination of scientific and medical knowledge. Finally, its e-Learning platform reaches thousands of interested healthcare professional worldwide through diverse learning formats.

The PGE committee currently has 12 members, including a chair, who is also a member of the EASD Executive Board. Each member has an allocated area of expertise, e.g. collaborations with India, basic scientist training courses, clinician training courses. The term of office is four years, which can be extended. EASD membership is mandatory for all members of PGEC.

The PGEC meets virtually (60 minutes) every two months to decide on the strategy for educational activities, to report on the planned activities and to give feedback on the executed activities. Efforts are made to have one face-to-face get-together during the EASD Annual Meeting and one brainstorming (120 minutes) per year.

If your interest has been awakened and you have time in your busy life to help support this activity, self nominations to the committee are welcome. Please contact Mary Hata on [email protected]

Owing to COVID-19 restrictions, the acclaimed EASD-Robert Turner clinical research training course will now be held online as a virtual interactive course.

As we reported back in December, the EASD-Robert Turner course was due to return to a face-to-face format in April this year. This has since had to be postponed due to COVID-19 restrictions. However, in its place the EASD has organised a virtual course, which will be provided from 27th-30th June 2022.

The virtual synchronous interactive course is targeted at young physicians interested in research and offers candidates the opportunity to:

  • Design clinical experiments in diabetes/endocrinology
  • Consider ethical aspects of clinical research
  • Gain an introduction to ‘R’ for statistical analysis
  • Brush up your statistics
  • Join the elite international group of Robert Turner Course alumni

Sponsored by Lilly Diabetes and the EASD, this course is hosted by Oxford Universities Clinical Departments and is open to clinically qualified physicians with a research interest in endocrinology and diabetes.

Interested candidates should submit their application to Mary Hata ([email protected]) by the 22nd April 2022.

For more information on the course and the application process, go to: https://www.easd.org/education/enthuse-meetings.html

Are you a junior doctor interested in research? Have you just started your research fellowship? Do you need training in clinical research design and analysis?

The interactive and highly successful EASD Robert Turner Clinical Research Training Course will be returning to the face-to-face format in 2022 – hosted once again by Oxford University’s Clinical Departments.

The course, sponsored by Lilly Diabetes and the EASD, provides an introduction to research in the fields of clinical diabetes and endocrinology. Applications are welcomed from clinically qualified doctors with an interest in research in endocrinology and diabetes, who are considering or have recently begun clinical research but have not received a higher (post-graduate) qualification. Applicants should be members of the EASD and have received their medical degree not more than seven years before 1 January 2021.  

Interested candidates should submit their application to Mary Hata ([email protected]) before 14 January 2022.

For more information on the course and the application process, go to: https://www.easd.org/rtc-2022.html

Another two EASD e-Learning modules have been accredited for CPD by the UKs Royal College of General Practitioners (RCGP).

As of today, the modules ‘Hypoglycaemia in older people’ by Professor Brian Frier and ‘An introduction to real-world evidence’ by Dr Marc Evans will carry the RCGP’s quality mark.

EASD e-Learning Programme Director Dr Eleanor D Kennedy commented: “This is wonderful news for EASD, our authors and the many learners who access our e-Learning platform each month. The RCGP accreditation mark is an identifiable symbol of quality assurance that associates educational activities with professionalism, expertise and commitment to the highest possible standards of general practice. Its presence helps to demonstrate the important contribution these modules can make to the delivery of high-quality care for people at risk of or living with diabetes.”

RCGP-accredited modules on the platform are clearly indicated by the presence of the RCGP accreditation mark. Course cards for any EASD e-Learning courses that include accredited modules will also be marked with an orange ‘CPD’ button. The same button will also appear on the course content ladder. 

All accredited modules are also listed in the RCGP’s own register of accredited CPD courses.

Access the newly accredited modules:

For more on CPD accreditation and what it means for learners, read our CPD guide.

Listening and responding to feedback from our learners continues to be at the forefront of ensuring the EASD e-Learning programme is up-to-date, evidence based and meets the needs of our learners. It is also important that you know your feedback is taken seriously.

CPD accreditation

We have regularly received feedback from learners asking for continuing professional development (CPD) points for the modules they successfully complete. Further to our previous update, we have now been awarded educational accreditation for seven of our modules by the UK’s Royal College of General Practitioners (RCGP) – the professional membership body for GPs in the UK. We will be applying for accreditation of further modules by the RCGP in the coming months.

Educational resources accredited by the RCGP are considered to be of high quality and relevant for general practitioners’ CPD and revalidation needs. Accreditation follows an independent assessment of these modules’ quality, judged against the standards set by the RCGP. The accredited modules are:

  • Non-alcoholic fatty liver disease, Module 1
    • NAFLD – epidemiology, pathophysiology and diagnosis
  • Diabetes and the kidney, Module 1
    • Overview of diabetes and the kidney
  • Management of hyperglycaemia in type 2 diabetes, Modules 1 and 2
    • ADA/EASD 2018 consensus report
    • ADA/EASD 2019 update
  • Hypoglycaemia, Module 1
    • Reducing hypoglycaemia
  • Insulin resistance, Module 1
    • Insulin resistance, the metabolic syndrome and type 2 diabetes
  • Phenotypic variability, Module 1
    • Phenotypic variability in type 2 diabetes

Over the next year we will be looking to secure educational accreditation from other international organisations and we will be amending the certificate of completion to reflect the accreditation and CPD points for each accredited module.

Case studies

We have had feedback from a number of learners highlighting case studies/clinical scenarios as being one of the most useful parts of a module (e.g. “Case studies were very helpful with diagnoses the patients and using of current medications”) and feedback asking for case studies in each module. In order to address this feedback we began working with our assessment setters asking them to write case studies for modules where they had not been added when the module was launched. We are also aiming to include at least two case studies in all of our new modules. This is a major project for us and we hope it will be completed by Spring 2022.

Periodic review of courses and modules: The value of learner feedback

As part of our process for keeping modules up to date, we have a periodic review process for each course, usually undertaken on a three-year rolling cycle based on the launch date of the first module in a course. However, there is flexibility to trigger the process earlier on receipt of feedback and/or the publication of new research or guidelines which is judged to necessitate a major amendment to a current module or development of a new module. Minor amendments, for example typographical errors, change to a module title or change to correct a minor error in content accuracy will be made as quickly as possible following receipt of feedback.

A key part of the periodic review process is learner feedback, which is included in the documentation and reviewed by the module authors to influence changes in content, delivery and assessment.

Please continue to provide us with your feedback when you complete a module by clicking on the green button that appears on the left hand side of the screen and links to a short questionnaire.

Communication and reporting problems

We have received feedback saying: “It would be useful to have a support center where any participant can ask for information or claim any problem with the course”.

To address this, back in May 2021 we introduced a new feedback system, which has separate buttons for different types of enquiry, as shown below:

Modules on the EASD e-Learning platform have now received formal educational accreditation for continuous professional development (CPD) from the UK’s Royal College of General Practitioners (RCGP), it was announced today at the EASD’s 57th Annual Meeting.

EASD President Stefano Del Prato told delegates during his address at the Annual Meeting’s opening ceremony that two modules submitted to the RCGP have already received formal educational accreditation and accreditation for a further five modules is pending.

Educational resources accredited by the RCGP are considered to be of high quality and relevant for general practitioners’ CPD and revalidation needs. Accreditation follows an independent assessment of these modules’ quality, judged against the standards set by the RCGP.

EASD e-Learning Programme Director Dr Eleanor D Kennedy commented: “This is a huge step forward for our platform. User feedback has consistently highlighted significant demand for formal CPD accreditation of our courses. The RCGP accreditation quality mark is an identifiable symbol of quality assurance that associates educational activities with professionalism, expertise and commitment to the highest possible standards of general practice. This helps to demonstrate the important contribution our modules can make to the delivery of safe, high-quality care for people at risk of or living with diabetes.”

Dr Kennedy also paid tribute to the assistance the site has received from its authors, expert reviewers and assessment setters – and many of the EASD’s study groups. “This achievement reflects an enormous amount of hard work and dedication from our expert supporters, who have enabled us to ensure that the courses we provide attain the level of quality required by accrediting bodies such as the RCGP. Over the last 12 months, with their assistance, we have been busy improving systems for assessment within all of our modules and expanding the practical clinical content of what we provide.”

So how will learners know which modules are accredited, and what will it mean? Dr Gillian Manning, Clinical Education Lead within the e-Learning team, explained: “The RCGP kitemark and logo will now appear on the homepage of all accredited modules – its presence will mean that GPs and other members of multiprofessional healthcare teams working in partnership with people with diabetes can be confident the education they select has been independently assessed to ensure a consistent and high-quality educational resource.”

Further modules are set to be submitted to the RCGP and discussions about seeking accreditation by the Royal College of Physicians are ongoing. Plans are now underway to submit the online courses to national accrediting bodies around the world.

EASD e-Learning modules now accredited for CPD by the RCGP include:

EASD e-Learning modules submitted to the RCGP for which educational accreditation is pending:

This year’s Robert Turner clinical research training course will be taking place on-line, according to an announcement from the EASD’s postgraduate education committee. The course, named in honour of the late Professor Robert Turner, principal investigator of the ground-breaking United Kingdom Prospective Diabetes Study (UKPDS), offers young researchers the opportunity to be trained by an outstanding team on the basic requirements for clinical research.

Over the last 15 years, the EASD’s Robert Turner course has gained a distinguished reputation for introducing clinically qualified doctors to research in the fields of diabetes and endocrinology.

This year’s virtual course will take place over four consecutive days, starting 11th May, from 13.00-17.00 Central European Time. Lectures, discussions and group work (all in English) will cover crucial research-related topics, including study design, methodology, statistics, critical analysis and presentation of data.

The deadline for applications is 14th March. It is open to all paid-up members of EASD who have received their highest medical degree no more than 7 years before 1st January 2021.

For more on the course and how to apply, visit the EASD website at https://www.easd.org/rtc-2021.html

Digital health has been much talked about as one of the great hopes of better diabetes management, and with so many new technologies now established in the market – continuous or flash glucose monitoring (CGM or FGM) in particular, as well as remote data-gathering platforms – the supply side of that expectation seems to be doing very nicely thank you.

But what about uptake? Are people with diabetes and their healthcare teams unlocking the full potential of digital health? And do some patient types (e.g. older or younger? type 1 or type 2?) make better use of it than others?

A recurring theme of this year’s EASD Annual Meeting was the way that, amidst all the devastation, COVID-19 has precipitated a major shift towards telemedicine. As Catarina Limbert reported in a presentation on type 1 diabetes and COVID-19, remote approaches implemented out of necessity have yielded marked benefits in terms of better autonomy for patients and a reduced burden of routine care. She also cited studies that suggest improvements in blood glucose control during lockdown.

Such improvements were the subject of another presentation, from Federico Boscari, who reported results from a study undertaken at the University of Padova, which gathered data from 33 type 1 patients using FGM who were remotely connected to the diabetes clinic via FreeStyle’s LibreView platform. The study compared glycaemic measures from three months prior to the COVID-19 outbreak in Italy; one week pre outbreak; the period of the first educational and sports activities restrictions; and the first week of complete lockdown. Patients were divided between those who continued working during lockdown (essential workers) and those who didn’t.

Interestingly, those who stayed at home showed better glycaemic control, reduced mean glucose and time in hyperglycaemia, and increased time in range. By contrast, those who continued to go out to work showed no change. This study had its limitations: for instance, no data was gathered on the number of injections or meals, so it is difficult to tease out exactly why the improvement took place. Nor was data gathered on subsequent weeks of lockdown (after the first week most patients were remotely contacted by their care team with advice on how to manage their diabetes, thereby introducing bias). Even so, this presentation was a great example of research enabled retrospectively by digital technology.

More engagement with personal CGM data has been associated with better glycaemic outcomes over time. Other presentations addressing this topic at the conference included a study from CGM manufacturer Dexcom, which showed that type 1 and type 2 patients had similarly high levels of engagement with the various features offered by the Dexcom device. Another presentation, from Ken Snow, reported the effect on HbA1c of the One Touch Reveal Plus app. Again, use of this device showed significant improvements in blood glucose control and demonstrated a high level of engagement. Significantly, nearly 50% of the patients in the study were on oral medication only, a finding which counters the widely held belief that digital therapeutics mainly benefit people with insulin-treated diabetes.

Such benefits should translate into savings for the health system, and this was a clear finding in another presentation – from Nadege Costa, who presented evaluation results for the [email protected] telemonitoring and tele-education programme. As well as significant benefits for improved glycaemic control, use of this programme – which was designed for people with type 2 diabetes – was also associated with substantial reductions in pharmacy costs.

But what about access? Another session heard from Timothee Froment about the vast disparities in access to diabetes technologies between different populations with diabetes around the world. Even in countries where public coverage of the cost of diabetes treatments is extensive, out-of-pocket expenses are often required to access the latest in digital diabetes therapeutics. As Catarina Limbert emphasised in her presentation, we need to beware of advances in digital health that are restricted to ‘bubbles’ of excellence. Action is needed to mitigate disparities in access and skills, including funding to improve telemedicine.

For more on digital diabetes therapeutics, see our courses on Time in range and Technology and type 1 diabetes.

For more on global discrepancies in access to technology and telemedicine, see our series of films Around the Diabetes World in 80 Days.

Coming soon…

A new e-Learning course on telemedicine in diabetes is currently in development, for launch in 2021.

Any opinions expressed in this article are those of Dr Eleanor D Kennedy.

Want to see this session in full?
All posters and presentation recordings from this year’s virtual EASD Annual Meeting are now available for free to all online.

Sessions at the EASD 56th Annual Meeting 2020

COVID-19 and diabetes

Catarina Limbert. What have we learned from COVID-19 in persons with type 1 diabetes?

OP 18: Unlocking the potential of digital health

Federico Boscari. Glycaemic control among people with type 1 diabetes during lockdown against the SARS-CoV-2 outbreak in Italy.

R Dowd. Real-time CGM usage and estimates of glycaemic control among individuals with type 1 or type 2 diabetes.

Ken Snow. Beyond BG testing: digital health and intelligent monitoring.

Nadege Costa. Evaluation of the one-year efficiency of the [email protected] telemonitoring and tele-education programme for type 2 diabetic patients.

OP 42: Diabetes care is expensive

Timothee Froment. Economic burden associated with diabetes technologies: a cross-national comparison of out-of-pocket expenses.

Non-alcohol related fatty liver disease (NAFLD) is big news these days; already, a quarter of adults in the USA are estimated to have the condition, and prevalence looks set to rise globally in step with the obesity pandemic.

The disease covers a spectrum of liver damage which, if effective measures are not taken to halt or reverse its progression, ranges from simple steatosis (a build up of fat in liver cells, >5%), via the more severe, complex patterns of inflammation and hepatocellular injury known as NASH (non-alcohol related steatohepatitis), to cirrhosis and ultimately hepatocellular carcinoma. Around 75% of patients with type 2 diabetes also have some form of NAFLD.

So, what measures are effective at halting its progression? Weight loss and exercise can reverse NAFLD’s effects and thus far the primary focus has been on lifestyle adjustment – with predictably variable results. A series of presentations on the second day of the EASD’s Annual Meeting revealed some novel alternative approaches.

Pharmacotherapies dominated this session. Multiple mechanisms are implicated in the pathogenesis of NAFLD. Four out of the six presentations reported results from mouse studies illuminating aspects of underlying signaling pathways to investigate new compounds or new combinations of existing compounds to treat NAFLD, fibrosis and NASH. Jae Hyuk Choi from Korea presented results on the use of a novel long-acting glucagon/GIP/GLP-1 triple agonist (HM152110) on NASH and fibrosis in mice. This approach sought to combat disease by harnessing the glucose-, weight- and lipid-lowering effects of incretins, mediated through glucagon. Benefits for weight reduction and improvement of fibrosis have led to this drug candidate being fast tracked. A Phase 2b clinical study is currently ongoing in patients with NASH. 

Nikolaos Perakakis and his team focused instead on the metabolic role of adipokine hormones – specifically adiponectin – with a selective PPAR gamma modulator, CHS-131. Studies of its use in mice showed improved insulin sensitivity, but without significant reduction in body weight. Interestingly, there was also a lack of impact on steatosis. More encouragingly, however, lipid composition in the liver was improved, with reduced inflammation, ballooning and fibrosis markers. Studies of CHS-131 treatments in people with NAFLD are planned.

Also in the spotlight was the effect of SGLT-2 inhibitors, specifically empagliflozin, with a study presented by Xiadong Sun showing that empagliflozin improves obesity-related NAFLD in mice by regulating the Sestrin2-mediated AMPK/mTOR signaling pathway. AMPK (activated protein kinase) was the target of another study, presented by Karly Mather, which investigated the use of a systemic, small molecule AMPK activator C455 to treat NAFLD and NASH – also in mice. C455 significantly reduced liver weight and lipid content but had no effect on liver fibrosis. Cardiac issues and a lack of significant effect on hepatic collagen led the investigators to conclude that a systemic AMPK agonist may not be a viable strategy for NASH therapy, although making it more specific to liver tissue might improve the effect.

As well as SGLT-2 inhibitors, small clinical trials have shown efficacy against NAFLD in other diabetes medications, such as pioglitazone and GLP-1 receptor agonists. In the last of the pharmacological studies in this session, this time based on human patients rather than mouse models, Olga Lavrynenko presented encouraging results from comparison of the effects of triple therapy (pioglitazone, exenatide and metformin) versus conventional therapy (metformin, sulphonylurea and insulin) on hepatic fibrosis and liver fat content in people with new-onset type 2 diabetes over a two years of treatment.

By way of contrast, in the final presentation of this session Maria Francesca Russo shared results from a five-year follow-up study of 46 people who had had bariatric surgery (specifically, biliopancreatic diversion). This study showed clear improvement in steatosis and fibrosis measures, improved lipid and metabolic profiles, and amelioration in liver functions in those patients with lower fibrosis score before surgery.

For more on NAFLD, see module 3 in our course on GLP-1 receptor agonists, ‘GLP-1 and obesity, NAFLD and NASH’.

Coming soon…

A new EASD e-Learning course on NAFLD, written and presented by Professor Michael Roden, is currently in production.

OP 22: ‘New treatments for NAFLD – Hope or hype?

Jae Hyuk Choi. Therapeutic effect of a novel long-acting GLP-1/GIP/Glucagon triple agonist (HM15111) in CDHFD-induced NASH and fibrosis mice.

Nikolaos Perakakis. The selective PPAR gamma modulator CHS-131 improves liver histopathology and metabolism in a biopsy-confirmed mouse model of NASH and obesity.

Xiaodong Sun. Empagliflozin ameliorates obesity associated fatty liver disease by regulating Sestrin2-mediated AMPK-mTOR signaling pathway in obese mice.

Karly Mather. A direct AMPK activator reduces liver steatosis in a mouse model of NASH.

Olga Lavrynenko. Triple therapy with pioglitazone/exenatide/metformin prevents hepatic fibrosis and steatosis in type 2 diabetes.

Maria Francesca Russo. Effects of biliopancreatic diversion (BPD) on NASH: 5 years follow up.

The opinions expressed in this article are those of Dr Eleanor D Kennedy.

Want to see this session in full?
All posters and presentation recordings from this year’s virtual EASD Annual Meeting are now available for free to all online.