Category: EASD

The EASD’s entire e-Learning platform has been accredited for continuing professional development (CPD) by the UK’s Federation of the Royal Colleges of Physicians (RCP). 

Whole-platform accreditation, encompassing all 85 modules currently on the platform – approximately 125 hours of learning in total – means that learners who successfully complete any EASD e-Learning modules will earn formally accredited CPD points.

Making the announcement, EASD President Professor Chantal Mathieu said: “I have great pride in announcing that our e-Learning platform now has – for all of the modules on the platform – site-wide accreditation by the Federation of the Royal Colleges of Physicians of the UK, a very prestigious entity providing accreditation. So do join us for more learning on diabetes and everything related to diabetes, going from prevention to obesity to complications, and the right therapies for people living with diabetes.”

The announcement coincides with the fifth anniversary of the e-Learning platform’s launch. 

RCP accreditation follows an independent validation of quality of the platform’s content, judged against standards set by the RCP. Commenting on the announcement, the RCP’s CPD Medical Director, Dr Adrian Jennings, said: “The Federation of the Royal Colleges of Physicians welcomes the addition of EASD e-Learning to the digital learning resources approved by the Federation.” He added that: “The Federation and the Colleges themselves have a long history of promoting high standards in continuing professional development.”

The RCP represents a global community of over 50,000 members and fellows in more than 80 countries, spanning every career stage. RCP accreditation of the whole EASD e-Learning platform means that members of the entire healthcare professional diabetes team, from all around the world, can be confident that the platform has been independently assessed to ensure a consistent and high-quality educational resource. 

EASD e-Learning Programme Director Dr Eleanor Kennedy commented: “This is a huge step forward for our platform. User feedback consistently highlights significant demand for formal CPD accreditation of our courses. RCP whole-platform accreditation is a mark of quality assurance that associates educational activities with professionalism, expertise and commitment to the highest possible standards of clinical practice.” 

Dr Kennedy also paid tribute to the assistance the platform 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 RCP.”

As rates of type 2 diabetes and prediabetes continue to soar, so too are rates of cardiorenal complications. What can we do to tackle this globally significant health challenge? For the third episode in our series ‘The briefing room’, under the sure-footed chairmanship of Professor Francesco Giorgino, five esteemed experts in the field join forces to explore cardiorenal metabolic challenges in type 2 diabetes.

The alarming rise in the prevalence of type 2 diabetes is mirrored by a growing understanding of the complexity of its associated complications. “Obviously, we are aware that type 2 diabetes is often associated with cardiovascular disease, but also with chronic kidney disease,” says Professor Francesco Giorgino. “And we’ve also discovered that cardiovascular disease is not just atherosclerotic cardiovascular disease. As diabetologists we have learned more and more about the existence of heart failure of different types.” 

The figures make alarming reading. Up to three out of 10 people with type 2 diabetes are expected to develop heart failure during their lifetime. That’s around 150 million people. Globally, around 56% of people with type 2 diabetes show signs of kidney disease – an important driver of cardiovascular disease. The good news, though, is the recent availability of new treatments which, as Francesco describes them, are capable of interfering with the natural course of this organ damage. So, given recent advances in knowledge and treatment, what is the best approach for a person with type 2 diabetes with signs of organ damage?

Getting to grips with such a wide-ranging topic requires a wide range of expertise – embodied here in a panel that includes nephrologist and diabetologist Per-Henrik Groop, endocrinologist and angiologist Eberhard Standl, diabetologist and professor of nutrition Paul Valensi, and endocrinologist with a special interest in diabetes, lipids and cardiovascular risk, Dr Roopa Mehta.

For Roopa, it’s important that we should take a holistic approach. “It’s about integral care and trying to give a more individualised approach to our patients. Obviously, glucose control is extremely relevant. We must do this. But we need to look at the patient in total. The minute they have organ damage we know that there are obviously other comorbid conditions that are probably influencing this. It’s not just sugar, it’s blood pressure control, lipid management, weight management. So, we need to look at the patient in a more holistic manner and control all these factors in order to prevent the progression of this kind of organ damage.”

Such an approach is one of the central messages in recent guidelines for type 2 diabetes management from the ADA/EASD, which prioritise evaluation of patients for cardiorenal risk – and the prompt initiation of newer medications such as SGLT-2 inhibitors and GLP-1 receptor agonists. This episode of the briefing room takes on many of the key associated issues – from the question of how to identify those with ‘silent’ heart disease to the potential interventions and targets physicians should aim at when treating people with type 2. Says Francesco: “That includes weight control, blood pressure control and lipid control – in addition, of course, to glucose lowering, which remains a cornerstone of our approach. We’ve also discussed the recent evidence around GLP-1 receptor agonists, SGLT-2 inhibitors and the recent antagonist to the mineralocorticoid receptor, finerenone. And we’ve tried to think about what could happen if we combined these agents together in terms of clinical outcomes, especially referring to the heart, vessels, the kidney and the overall health of our patients.”

Get the full story in the third episode of ‘The briefing room’, ‘Cardiorenal metabolic challenges in type 2 diabetes’, launching today on Horizons.  

For more on the ADA/EASD consensus report on type 2 diabetes management, enrol on our course ‘Management of hyperglycaemia in type 2 diabetes’.

Any opinions expressed in this article are the responsibility of the EASD e-Learning Programme Director, Dr Eleanor D Kennedy.

As Muslims around the world embark on a month of Ramadan fasting, for the latest episode in our series ‘The long and the short of it’, Professor Wasim Hanif and Dr Sarah Ali deliver a timely reminder of the importance of pre-Ramadan assessments for people with diabetes – and highlight recent developments that mean it may be time to reassess our approach to risk stratification.

Fasting during the month of Ramadan is one of the Five Pillars of Islam – the obligations Muslims must satisfy in order to live a good and responsible life. For those with diabetes, however, Ramadan fasting poses certain serious risks, including hyper- and hypoglycaemia, diabetic ketoacidosis (DKA), hyperosmolar hyperglycaemic state (HHS) and dehydration.

Nevertheless, despite the fact that the Qu’ran specifically exempts people with serious medical conditions such as diabetes, many people with diabetes still prefer to fast. Says Dr Sara Ali: “It’s important to remember that people who live with diabetes quite often do not perceive themselves as being ill or unwell. Indeed, that’s something we encourage as diabetes healthcare professionals. We encourage people to live a full life whilst having diabetes. So that means that when they come to the month of Ramadan, they want to be like other people, people who don’t have diabetes. They want to be able to fast.”

Steps healthcare professionals need to take to support their patients with diabetes who wish to fast during Ramadan – whether by empowering them to do so safely or, where appropriate, advising them against it – are briefly covered here, though the presenters recommend exploring this in more detail via the EASD’s eight e-Learning modules on the topic (several of which are presented by Professor Hanif himself).

What makes this film so compelling, though, is its reflection on recent developments that promise to have a profound effect on our approach to assessing the risks relating to Ramadan fasting for people with diabetes. Chief among these is the impact of new technologies, testing technologies in particular. Continuous glucose monitoring (CGM) has made it safer for people with diabetes to fast, particularly those with type 1 or insulin-treated type 2, who previously might have been advised not to fast. Says Dr Ali: “This is a really exciting time for people. Anecdotally, we all know, we’ve had people with type 1 diabetes who’ve wanted to fast and this is actually now giving them the opportunity to do so, safely.”

Professor Hanif agrees: “It used to be a battle telling people with type 1 diabetes not to fast, or just to fast for one day. But now with the closed loop systems, I am feeling more confident. There’s a lot of data coming from across the globe, small studies and small subsets of patients, but giving a kind of indication that people with type 1 diabetes on closed loop systems who monitor themselves closely, can fast safely. And I think that is a big shift because a lot of people with type 1 diabetes would like to fast for religious reasons, social or cultural reasons, and I think that is going to be quite fascinating.”

There is also the question of Ramadan’s timing, which changes every year according to the lunar calendar. In the northern hemisphere the fasts are getting shorter and there will come a time when Ramadan falls in winter months, putting it at odds with guidelines that were written at the time of summer when the fasts were very much longer.” Says Professor Hanif: “Somebody with type 1 diabetes cannot go without food for 18–20 hours. But now that’s changing, it’s time to really look at these risk scores and see how we could allow more people to fast.”

Might that include women with diabetes who are pregnant? “There still isn’t enough data on pregnancy and fasting,” says Dr Ali. “Pregnancy itself is an exemption to fasting. But of course, we do see people who wish to fast when they are pregnant. And if you’ve got diabetes, I think our recommendations will still be that you should not fast. Things may change with the advent of the technology and we’re giving technology a lot more to women with pregnancy and diabetes. But I think that we would still say that women with pre-existing diabetes who are pregnant should not fast. One thing that might be more interesting in the future is gestational diabetes. There are some studies coming from the Middle East… I still don’t think we’re in a place to say that women with or without diabetes should fast, but that might come in the future.”

See the full-length version of Professor Hanif and Dr Ali’s discussion on Horizons this week or watch the short version.

For more on this topic, enrol on the EASD e-Learning course Diabetes and Ramadan.

Any opinions expressed in this article are the responsibility of the EASD e-Learning Programme Director, Dr Eleanor D Kennedy.

---

Courses for which transcripts translated into Arabic are now available include the following:

• Technology and type 1 diabetes
  • Module 1: Basics of insulin pumping
  • Module 2: Continuous glucose monitoring
  • Module 3: Closed-loop systems
• Time in range
  • Module 1: Time in range – a new concept in glycaemic management

Translated transcripts are also available in Chinese (Mandarin) for the following courses:

• Hypoglycaemia
  • Module 1: Reducing hypoglycaemia
  • Module 2: Hypoglycaemia in older people
  • Module 3: Fear of hypoglycaemia
• Therapeutic inertia
  • Module 1: Therapeutic inertia in primary care
  • Module 2: Therapeutic inertia in type 2 diabetes

---

Suzie Normanton, EASD e-Learning’s Accreditation and Feedback Lead, reports on the feedback we’ve received over recent months – and what’s been done to address it.

Learner feedback aims to give learners a voice and help the EASD e-Learning team to understand what is working well but also to enable us to make changes that will improve the experience for learners engaging with our programme. Feedback helps us to keep our courses up to date and evidence based – and to identify and resolve technical issues.

It is also important that learners know their feedback is taken seriously. The e-Learning team aims to review regularly the learner feedback it receives from learners who complete the module feedback form or email us via [email protected]. We try to respond as quickly as possible to resolve reports of technical or content issues and to keep the person providing feedback informed of our actions.

September to December 2022

This four-month period saw a fall in the number of learner feedback forms about individual modules submitted. Eight learners provided feedback, with some learners completing forms about more than one module they engaged with, resulting in 16 forms being completed.

As you engage with one or more of our e-Learning modules, we would encourage you to complete our short learner feedback form as this does help us monitor the quality of our courses and modules, identify any errors and feed into our periodic review process to ensure our courses and modules remain up to date and relevant. Alternatively, we welcome feedback on any aspect of our e-Learning programme and you can contact us direct via: [email protected]

What you have said recently about our courses and modules?

When asked to rate their satisfaction with a module, every learner said they were either very satisfied (87%) or satisfied (13%) with the module they had engaged with.

Which parts of the module were most useful?

• 57% of the forms we received reported that all parts of the module were useful

Qualitative feedback included the following:

• I enjoyed the presentation. The lecture and transcript format were helpful to review. (Technology and type 1 diabetes, module 1)
• The explanation of the cause of type 2 diabetes and the details about trials (Lifestyle intervention, module 1)
• Clear explanations. The suggested ways to counsel patients. (Lifestyle intervention, module 1)
• Explaining how in the future we could guide our treatment using genetics and microbiome (Phenotypic variability, module 1)
• Clinical cases (Obesity and diabetes, module 1)

How could our modules be improved?

Of the 16 forms received, 13 (81%) stated that no improvements were needed. The specific suggestions for module improvement included:

• Perhaps a brief explanation of the drugs in the case studies. I’m a health coach for DPP, so we only discuss lifestyle interventions. (Lifestyle intervention, module 1)
• More case discussions, especially on unexpected complications. (Diabetic ketoacidosis, module 1)

Clinical application of learning

One type of feedback we are always particularly interested to receive is information about how learners plan to apply what they have learnt from our modules to their own practice. Here are some of the examples from recent months of how learners stated they would apply learning from a module in their practice:

• Improving my DKA management skill, educating on DKA prevention. (Diabetic ketoacidosis, module 1)
• Being better able to explain the cause of prediabetes and diabetes to my patients (Obesity and diabetes, module 1)
• Being better able to deal with more detailed questions from the group as I now have a greater understanding of the mechanisms involved, so I’ll be better equipped to explain why group members who are not overweight a) are prediabetic and b) would benefit from weight loss. (Lifestyle intervention, module 1)
• Having developed a better understanding of the topic and certainly will do my clinics with better confidence now. (Technology and type 1 diabetes, module 1)

Please do continue to send us your feedback, either by filling in the learner feedback form when you complete a module or directly via: [email protected].

Any opinions expressed in this article are the responsibility of the EASD e-Learning Programme Director, Dr Eleanor D Kennedy.

As populations age around the world, multimorbidity is an increasingly significant global challenge. The latest module launching today on the EASD e-Learning site explores the impact of multimorbidity and its corollary, polypharmacy, on people with type 2 diabetes and on healthcare systems, and looks at the practical steps care providers can take to provide co-ordinated, tailored solutions.

Cees Tack, Professor in Diabetology at the Netherlands’ Radboud University Medical Hospital, begins his module with a lesson in demographics. Comparing current population patterns in Europe with those in Japan over the past half century, the trend points inexorably towards the emergence of a ‘super-aged’ population.

“An ageing society will lead to a higher percentage of people that are elderly and thus to a higher prevalence of diabetes,” Professor Tack warns. “Secondly, as people become older, nowadays not 75 but perhaps even 90 or 95, there will be a higher prevalence of diabetes. And finally, the success of our treatments – people that are diagnosed with diabetes nowadays live longer with their diabetes. This is also called the triple wave or the triple ageing of diabetes. And with these huge numbers, then this will also be a costly matter. While diabetes in itself is not that expensive as a disease, if there are such huge numbers, that is going to be very costly for society.”

Ageing is, of course, not the only determinant of type 2 diabetes’ rising prevalence. Other factors are at play here – not least obesity and socio-economic background. Nevertheless, ageing is a particularly accurate predictor not just of diabetes but of multimorbidity – the presence of two or more chronic conditions. As Professor Tack points out: “Between 60 and 65, about 50% of people already have two or more diseases – and that increases with age, particularly with diabetes.”

The focus of Professor Tack’s module is on the impact of the rising prevalence of diabetes and multimorbidity on people with type 2 diabetes, healthcare professionals and healthcare systems. He examines in detail the ‘treatment burden’ faced by people with multiple conditions, having to juggle the demands of multiple, potentially conflicting treatment targets and medications. In particular, he examines the characteristics associated with polypharmacy in people with type 2 diabetes and multimorbidity, and the need to balance potential benefits and harms. The module also includes practical case studies to support healthcare professionals in planning a co-ordinated approach to the care and management of people with type 2 diabetes and multimorbidity.

For Professor Tack’s module ‘Diabetes in an ageing society – the role of multimorbidity’, which launches today, enrol on the EASD e-Learning course ‘Multimorbidity and diabetes’.

Any opinions expressed in this article are the responsibility of the EASD e-Learning Programme Director, Dr Eleanor Kennedy.

Huge advances have been made in treatments and technologies for type 1 diabetes, ‘but there are many people who still do not reach the target levels of glucose that we would need in order to prevent long-term complications,’ says Richard Holt, Professor of Diabetes and Endocrinology at the University of Southampton. He was EASD co-chair of the ADA/EASD consensus report on the management of type 1 diabetes in adults that was designed to help address this problem.

Alongside updating guidance to match rapid advances, the report was also deemed necessary because guidance for type 1 diabetes is often found in places where there is also guidance for type 2 diabetes. ‘What we wanted to do was to bring together within a single report the major areas that healthcare professionals need to consider,’ says Professor Holt.

In Module 1 of our new course, The management of type 1 diabetes in adults, Professor Holt takes you on a tour of the consensus report. ’The idea of the module is to give you an overview of the report to help you manage people with type 1 diabetes better,’ he says, ‘and help support them through their journey with type 1 diabetes.’

It takes you through a vast range of topics from the report, from diagnosis and management of new-onset diabetes to transplantation and psychosocial care. The latter is covered as an important standalone topic, recognising the burden of living with type 1 diabetes for both the person and their family, ’but it was really influential on many of the sections of the report,’ says Professor Holt. Personalised care and individual targets also come through as important recurring themes.

The module also gives you an insight into the level of detail and advice given in the report. For example, in the section on hypoglycaemia, Professor Holt discusses the report’s endorsement of the latest International Hypoglycaemia Study Group’s definition for hypoglycaemia, as well as the recognised and recommended treatments for it. However, there’s even more detail for individual circumstances, such as for those using automated insulin-delivery systems. ‘We provide advice for perhaps using slightly lower quantities of carbohydrates in an individual who is using an automated insulin-delivery device where the insulin will have been suspended as a result of the predictive or low glucose,’ says Professor Holt.

Case studies are interspersed throughout the module, helping you to think about how to bring the learning from the report into clinical practice. When the report was presented, there was a co-publication in Diabetes Care and Diabetologia [https://pubmed.ncbi.nlm.nih.gov/34590174/]. ‘I would strongly encourage you to read the paper in full and really gain those very useful clinical nuggets that are included within the report,’ says Professor Holt.

For Professor Holt’s module ‘ADA/EASD 2021 consensus report’, enrol on the new EASD e-Learning course, Management of type 1 diabetes in adults, launching today.

Any opinions expressed in this article are the responsibility of the EASD e-Learning Programme Manager, Dr Eleanor D Kennedy

The epigenome plays a crucial role in regulating gene expression, cell differentiation and X-chromosome inactivation – and can contribute to disease when dysfunctional. In her new module for EASD e-Learning, Professor Charlotte Ling explores the ways in which epigenetic modifications contribute to type 2 diabetes.

As a principal investigator in the Epigenetics and Diabetes Unit at Lund University Diabetes Centre, Sweden, Professor Charlotte Ling is more than amply qualified as a guide to the epigenetic mechanisms implicated in type 2 diabetes. Over the last decade or so, her research group has pioneered this field of investigation, making several ground-breaking discoveries – such as genome-wide epigenetic modifications in the pancreatic islets, skeletal muscle, adipose tissue and liver of people with type 2.

“We have identified epigenetic modifications in pancreatic islets from donors with type 2 diabetes compared with controls,” says Professor Ling. “However, the question is which is the chicken and which is the egg? Do these epigenetic modifications contribute to the development of type 2 diabetes? Or are they just a consequence of the disease?”

To investigate this question, she and her team have performed a series of experiments, testing whether exposure to high glucose and lipids had direct effects on the DNA methylation and gene expression patterns already seen in pancreatic islets from non-diabetic human donors. Much of this module details the results of those studies and a wealth of other evidence in support of epigenetics playing a causal role in the pathogenesis of type 2 diabetes.

The basic science subject matter takes the lead in this module, but always with a watchful eye on how this work might be applied to clinical care. Throughout the module, basic research is interspersed with clinical application scenarios and case studies, demonstrating its relevance to clinical practice. As Professor Ling says: “It is very important to try to use our basic research – to bring it to the clinic. That is the ultimate goal.”

In this case, Professor Ling and her team have their sights set on developing blood-based epigenetic markers and new therapies. “We have analysed DNA methylation in the blood trying to develop blood-based epigenetic markers that can predict future type 2 diabetes, future diabetic complications and response to therapy in people with type 2 diabetes. Some preliminary data look promising but future research will look into this further.”  Other work by her and her team supports the tantalising prospect that epigenetic mechanisms might also provide new therapeutic targets for type 2 diabetes.

Find out more about this fascinating topic by enrolling on Professor Ling’s module, Epigenetics and the beta cell – module 2 in the EASD e-Learning Beta cell biology course.

For more on this topic, see module 1 of the Beta cell biology course, Stimulus-secretion coupling in pancreatic cells.

Any opinions expressed in this article are the responsibility of the EASD e-Learning Programme Manager, Dr Eleanor D Kennedy.