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.

Translated transcripts available

To coincide with the start of Ramadan, EASD e-Learning is now offering learners the option to download transcripts of some of its most popular modules translated into Arabic. This is part of an ongoing project to make our content available in languages other than English.

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

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

For other translated content coming onto the site over the coming months, watch out for the globe icon on the site.

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 []. ‘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.

Accreditation for 14 EASD e-Learning modules by the Federation of the Royal Colleges of Physicians of the UK (RCP) mean that learners now have even more opportunities to earn continuous professional development points on the EASD e-Learning platform.

Starting this week, 14 EASD e-Learning modules will carry statements indicating that they have been accredited for continuous professional development (CPD) by the RCP. Accreditation follows an independent assessment of these modules’ quality, judged against the RCP’s own defined standards.

Welcoming the news, EASD e-Learning Programme Director Dr Eleanor D Kennedy 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 all the modules we provide attain the level of quality required by accrediting bodies such as the RCP.”

Since September last year, formal CPD accreditation of 14 EASD e-Learning modules by the UK’s Royal College of General Practitioners (RCGP) has already led to a significant rise in the number of learners accessing CPD-accredited modules. “We hope to see a similar increase associated with this news from the RCP,” said Dr Kennedy. “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.”

The following modules have now been approved for CPD by the RCP:

  • Hypoglycaemia, module 3: ‘Fear of hypoglycaemia’ by Professor Frank Snoek
  • Diabetic neuropathy, module 3: ‘Management of painful diabetic neuropathy’ by Professor Solomon Tesfaye
  • Non-alcoholic fatty liver disease, module 2: ‘NAFLD – prevention and treatment’ by Professor Michael Roden
  • The pathogenesis of type 1 diabetes, module 1: ‘Introduction to the pathogenesis of type 1 diabetes’ by Professor Chantal Mathieu
  • The pathogenesis of type 1 diabetes, module 2: ‘Arresting type 1 diabetes’ by Professor Chantal Mathieu
  • Diabetic ketoacidosis, module 1: ‘Pathophysiology and diagnosis of diabetic ketoacidosis’by Professor Ketan Dhatariya
  • Diabetic ketoacidosis, module 2: ‘Managing diabetic ketoacidosis in adults’ by Professor Ketan Dhatariya
  • Diabetic ketoacidosis, module 3: ‘Preventing diabetic ketoacidosis’ by Professor Ketan Dhatariya
  • Diabetic ketoacidosis, module 4: ‘Paediatric diabetic ketoacidosis’ by Professors Thomas Danne, Catarina Limbert and Júlia Galhardo
  • Phenotypic variability, module 1: ‘Phenotypic variability in type 2 diabetes’ by Professor Stefano Del Prato
  • Islet transplantation, module 1: ‘An introduction to islet transplantation’ by Professor Francois Pattou
  • Technology and type 1 diabetes, module 1: ‘Basics of insulin pumping’ by Professor Pratik Choudhary
  • Technology and type 1 diabetes, module 2: ‘Continuous glucose monitoring’ by Professor Pratik Choudhary
  • Technology and type 1 diabetes, module 3: ‘Closed-loop systems’ by Professor Thomas Danne

Course cards for any EASD e-Learning courses that include accredited modules will be marked with a lozenge labeled ‘CPD’. The same lozenge will also appear next to the relevant module title on the course content ladder. Clicking the button marked ‘Contains accredited modules’ on the courses homepage will also bring up all courses with CPD-accredited content.

Learners who have successfully completed an accredited module will be given the option to download a personalised certificate of completion, stating the module’s accreditation by the RCP or the RCGP (or both), together with information on the module’s duration.

As part of the process of preparing modules for accreditation, the EASD e-Learning team made extensive improvements to the way modules are assessed and expanded their practical clinical content. Consequently, if you completed a module before it was accredited but want to obtain a certificate of completion that includes the RCP accreditation statement, you will need to retake the end-of-module assessment.

Further modules will be submitted for accreditation over the coming months, with a view to obtaining RCP accreditation of the whole platform by the fourth quarter of 2023. Plans are also in place to submit the EASD’s online courses to national accrediting bodies around the world.

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

Learner feedback helps to ensure that the EASD e-Learning programme is up to date, evidence based and meets the needs of learners. It is also important that learners know their feedback is taken seriously. 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.

The e-Learning team aims to review learner feedback it receives from learners who complete the module feedback form or email us via [email protected] every two to three working days. 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.

May 2022 to August 2022

Some 51 learner feedback forms were submitted. The table below compares the module level and learner satisfaction over two time periods – from May 2022 to August 2022 and from May 2021 to August 2022. Learner feedback demonstrates that in the last four months the majority of learners were happy with the module they studied.

QuestionsAll courses
May 22
to Aug 22
All courses
May 21
to Aug 22
Was the module content at the right level for your
current knowledge and experience? Yes or No
(% = learners responding who responded ‘yes’)
Overall, how would you rate your satisfaction with this module?
(% = learners responding who were very satisfied or satisfied)

Which parts of the modules were most useful?

  • 61% of the feedback forms we received reported that all parts of the module were useful

Qualitative feedback included the following comments:

  • I enjoyed the presentation. The lecture and transcript format were helpful in review (Lifestyle intervention: M1)
  • Breakdown into small useful parts, ability to reinforce learning through small aspects repeated during the module (Management of hyperglycaemia: M1)
  • All of them especially research (Therapeutic inertia: M1)
  • The short videos really helped explain the though process for the data shown alongside (Lifestyle intervention: M1)
  • Evidence from various studies like counter balance DiRECT study etc (Lifestyle intervention: M1)
  • Succinct and pitched correctly with enough depth (Insulin resistance M1)
  • Reinforced prior learning (Gestational diabetes mellitus: M1)
  • Medications and contraindications (Diabetic neuropathy: M1)
  • Cases (Therapeutic inertia: M1 and Management of hyperglycaemia: M1)

How could our modules be improved?

Of the 51 forms, received 34 stated that no improvements were needed.

Content suggestions for improvement are usually reviewed as part of the periodic review process. Over the last four months feedback has included the following suggestions:

  • More information about diet (constraints) and composition for formula diet (Lifestyle intervention: M1)
  • More case studies (Gestational diabetes mellitus: M1)
  • More about the prevalence of diabetes in other developed countries (The pathogenesis of type 1 diabetes: M1)
  • Clearer layout of medication doses, etc. alongside contraindications (Diabetic Neuropathy: M1)
  • More algorithm pictures (Diabetic ketoacidosis: M1)
  • Current research updates (Diabetes and the kidney: M1)
  • None really, I do always like to hear of patient experiences though (Lifestyle intervention: M1)

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 a module to their own practice. Here are some of the examples we’ve received in recent months.

Learners commented that they would:

  • Be better able to discuss gestational diabetes mellitus (GDM) with women. Have downloaded the app which will be handy for information and can be recommended to women. (Gestational diabetes mellitus: M1)
  • Explain to patients what is important to do (Lifestyle intervention: M1)
  • Look at multiple oral medication regimes differently (Lifestyle intervention: M1)
  • Certainly improve vigilance in scoping for patterns of metabolic syndrome, I already apply principles of cardiovascular disease (CVD) risk reduction (Insulin resistance M1)
  • Manage my DKA patients more efficiently in the future with the help of this module. (Diabetic ketoacidosis: M1)

CPD educational accreditation update

Currently, 14 of our modules have gained educational accreditation from the UK’s Royal College of General Practitioners (RCGP) and the process of the required submission for reaccreditation after 12 months is on-going. We have also submitted an application for accreditation for some of our modules to the UK’s Royal College of Physicians. We are currently exploring opportunities for international accreditation, endorsement and recognition.

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.

The European Association for the Study of Diabetes (EASD) welcomed delegates to Stockholm in September, with its first in-person conference for three years. Dr Susan Aldridge reports.

After a two-year hiatus due to COVID-19, EASD 2022 attracted nearly 8000 ‘live’ participants, while more than 3000 joined the hybrid meeting online. In his opening address, EASD President Stefano Del Prato reflected on COVID-19’s impact on people with diabetes, society at large, including healthcare systems, as well as on scientific and professional organisations such as the EASD. He then discussed how EASD is keeping diabetes on the agenda, with advocacy, research support and education. 

“EASD e-Learning has been a real growth area in our educational activity,” he said. “There is a lot of discussion about precision medicine in diabetes now, and the precision concept is also being applied on the e-Learning platform, because it has so many different formats, which help provide an individualised experience for the learner.”

Paying tribute to the contributions of Professor Chantal Mathieu (who is currently Senior EASD Vice President and Chair of Postgraduate Education) and EASD e-Learning’s Programme Director Dr Eleanor D Kennedy, he told conference delegates: “Our e-Learning platform is doing so well, that I’m proud to announce its been shortlisted for Learning Technologies Awards 2022.”

He concluded his presentation with the announcement that Professor Mathieu will be taking over from him as EASD President from the start of 2023. 

Conference highlights

Over the four days of the annual meeting, delegates were spoiled for choice with a programme jam-packed with lectures, sessions and symposia on all aspects of diabetes. Horizons will be bringing you highlights from these over the coming weeks.

EASD e-Learning also had its own stream at the conference, where new and future courses were highlighted. The e-Learning conference sessions showcased three recently launched courses: lifestyle intervention, multimorbidity and diabetes, and technology and type 1 diabetes.  

Lifestyle intervention

Roy Taylor, author of the lifestyle intervention course, is Professor of Medicine and Metabolism at Newcastle University, and a pioneer of the low-calorie diet approach to type 2 diabetes remission, with his work in the DiRECT trials.

The findings of DiRECT show that a major factor in achieving remission through diet is the duration of the diabetes. “Sometimes the ‘lights have just gone out’ in the beta cells,” he said. Longer duration means that remission is less likely. For remission, forget aiming for a particular body mass index (BMI) to achieve a ‘healthy weight’ – instead, the goal should be to lose 15 kg or 15% of body weight (10% for those of near normal weight). But, even if someone doesn’t go into remission, they will be able to reduce their medication and maybe come off insulin – so it is worth encouraging people to find the motivation to try.  

Multimorbidity and type 1 diabetes

The type 1 diabetes and comorbidity module went live during the conference. “I think the treatment of comorbidity should be an integral part of the care provided by the diabetes team, so that people with type 1 diabetes and comorbidity have a single person to address, if they have questions about their disorders,” said module author Bruce Wolffenbuttel, Professor of Endocrinology and Metabolism at the University of Groningen.

Obesity is an important comorbidity, because the BMI of those newly diagnosed with type 1 is increasing. And the problem is perpetuated when people get into a vicious circle of frequent snacking on carbs to avoid a hypo.

People with type 1 diabetes often have another autoimmune disease, including vitiligo, hypothyroidism or adrenal insufficiency – and the module discusses each of these in detail.

Technology and type 1 diabetes

Professor Thomas Danne of the Auf der Bult Children’s Hospital in Hannover, co-author of the technology and type 1 diabetes course, took questions from delegates. He noted that although closed-loop has shown good results in children, most systems are not yet approved for pre-schoolers. “This is a huge problem in the European system, because they can’t be used off-label – the clinician has to take responsibility if something goes wrong,” he said. “So we need to speed up the regulatory process.”

Then there is the issue of affordability. Closed-loop is expensive, although, as he said: “Automatic insulin delivery is definitely worth the investment because you avoid the costs of kidney failure and blindness.” Access can still be a problem though, which is why every consultation with a person with type 1 diabetes should include a discussion about technology – something that does not always happen.

He concluded by encouraging participation in immunotherapy trials. “This is the next exciting step. For it means people will need less insulin which could possibly be delivered by a smart pen.”   

Incretin-based medications

Professor Michael Nauck, Head of Clinical Research in the Diabetes Division at St Josef Hospital, Bochum, showcased the just-launched episode of ‘The briefing room’, which focuses on dual incretin receptor agonists, with a discussion chaired by Professor Chantal Mathieu looking at how these drugs really work. “We don’t know whether tirzepatide is a ‘super’ GLP-1 receptor agonist or really a dual agonist,” Michael said. “There is much still to be discovered.”

Tirzepatide is useful for people with type 2 diabetes who have struggled for decades to lose weight. But it’s been noted that the impact of this weight loss can go either way – it’s either motivating, or people think they don’t need to try so hard with their weight, as the drug can do the work for them.

Trials are showing that tirzepatide can improve non-alcoholic fatty liver disease (NAFLD) and kidney disease. Results from an ongoing trial will show whether tirzepatide has cardiovascular benefit, and there is even the possibility that the dual agonists could induce type 2 remission.

Professor Mathieu’s take-home message was that this new ‘Briefing room’ “looks amazing” and will be essential viewing for anyone wanting to familiarise themselves with this new class of diabetes medication.

Coming soon

Richard Holt, Professor in Diabetes and Endocrinology at the University of Southampton, was one of the writing team for the new EASD/ADA consensus management of type 1 guidelines, which is the subject of an upcoming e-learning course. He chaired a lively Q&A session with Anne Peters, Professor of Clinical Medicine at the University of Southern California. 

Richard has a special interest in mental health and psychosocial care. “There aren’t enough psychologists to go round – but that doesn’t mean we shouldn’t be providing good psychosocial care. So, everyone in the diabetes team must be as familiar with the psychosocial issues and treatment as they are with any of the other complications that come with type 1 diabetes.”

Turning to the impact the consensus report has had since its publication, Anne said. “It’s helped me convince payers to pay for continuous glucose monitoring (CGM) and for hybrid closed-loop systems. I use the document and its references to say ‘this is the standard of care that we expect’. It’s made my work in lobbying for patients easier and it provides a basic framework for how we manage people with type 1 diabetes that didn’t exist before.”

Richard added. “Like Anne, I think the paper is having influence in the delivery of care. For example, in the UK NHS England have now actually agreed for funding for CGM for all people with type 1 diabetes. I wouldn’t say that the consensus was the only thing that led to that decision, but it was something that influenced it.”

He continued: “There is no point writing a document if it’s only read by the 14 people who wrote it, so I think it’s important to ensure that the document is well disseminated. One of the things we did was to create tables that could be downloaded and used easily, such as the algorithm for diagnosis. This can be helpful, even if you haven’t got time to read the full document.” 

On the EASD e-learning module coming out towards the end of the year, he said. “It will cover many of the topics we’ve discussed today, and others we didn’t have time for. There are many areas within the consensus report that are modules in their own right, like the use of technology, so rather than covering those again, we signpost to other e-learning modules. So, there’s lots of good learning and good information that can come from the course.”

He ended with a call to delegates. “If you find these consensus reports useful in your practice and you find areas where the information getting out of date, then please do get in touch, so we can tell ADA/EASD that there is a desire for an update from you as the diabetes community.”

For more on the topics covered in this article, access the following EASD e-Learning modules and films:

Professor Richard Holt’s module on the ADA/EASD consensus statement on the management of type 1 diabetes in adults is due to launch later this year.

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

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]