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Some variation in diabetes services, conference hears

Dr Ronan Canavan, Consultant Diabetologist, St Vincent’s University Hospital and HSE National Clinical Lead in Diabetes, made the comments following the recent third annual 3U Diabetes Conference. The conference is part of the partnership between the RCSI, DCU and NUI Maynooth. The theme of this year’s event, held at the RCSI, was ‘Current Challenges in Diabetes Research’.

“It was good to see a such a comprehensive conference on the serious subject of diabetes,” Dr Canavan said. “My main interest from my own personal point of view was in Dr Dermot Smith’s take on diabetes services nationally. He painted a very balanced picture as regards how diabetes services are rolled out, highlighting that there is quite a lot of variation across the country. Some things are improving but there are some areas where we have made little progress.”

””

Dr Ronan Canavan, Consultant Diabetologist, St Vincent’s University hospital and HSE National Clinical lead in Diabetes, speaking at the third annual 3U Partnership international Diabetes Conference entitled ‘Current Challenges in Diabetes research’ 

Some of the successes he pointed to include the establishment of the Diabetic Retinopathy Screening Programme, which invited approximately 145,000 people for screening last year.

“I know that up to half of those patients have responded so far but we’d like that to be much higher,” he said, adding that the growing number of podiatry posts being rolled out will hopefully help reduce amputations.

However, increasing the number of patients seen at primary care remains a challenge.

“We still don’t have our uncomplicated patients managed in primary care,” he told MI.

Care in the community

“The Diabetes Programme wants type 2 patients who are uncomplicated to get their services in the community and the complicated patients, who need some specialist input, could again be largely looked after in primary care.

“But that is pretty much dependant on resources and the structures being in place, and that’s keeping it from moving forward.

“We all want type 1 patients living fit and well and into their old age with the condition and that really depends on what happens in the first one or two decades of their diabetes care.”

Environmental factors

One of the topics discussed at the 3U Diabetes Conference was the ‘triggers’ and environmental factors associated with the development of type 1 diabetes.

“We hear less about type 1 diabetes, but we saw from the Irish data, presented by Dr Dermot Smith, that probably over the last 15 years there has almost been a doubling of type 1 diabetes in Ireland,” Dr Canavan said. However, the reasons why some people predisposed to the condition develop it, and some do not, are not fully understood.

””

Prof Mikael Knip, Professor of Paediatrics at the University of Helsinki, speaking at the third annual 3U Partnership international Diabetes Conference entitled ‘Current Challenges in Diabetes research’ at the RCSI

During the course of the conference, Dr Canavan recounted that Finnish expert on diabetes, Prof Mikael Knip, found that after “a very long and detailed, randomised, controlled trial,” removing cow’s milk from an infant’s diet did not cause any significant reduction in the tendency towards type 1.

Prof Knip also told the conference that he, along with colleagues in the US and Finland, have been able to identify potential triggers for the condition, including enteroviruses and an altered intestinal bacterial flora. These discoveries, he said, might be crucial and may ultimately lead to a preventative intervention for type 1 diabetes.

Implications for care

As well as being an opportunity to meet international colleagues, the research presented at the conference may have many implications for diabetes care in Ireland.

“As much as we’re thinking about services for the epidemic that is type 2 diabetes, we do need to make plans for the number of type 1 diabetic patients coming into being,” he said.

“The care that they get is better now and there are better interventions available. If they get type 1 diabetes now, the expectation is that they’ll have diabetes for several decades, so we need to have services available that allow them access to pumps, to ensure that they are supported through paediatric services, and that they slot into services such as the retinal screening programme.

“Retinal screening starts at the age of 12 and it’s important for the younger type 1 patients coming into the service that they know about those clinical preventative measures.”

Dr Ronan Canavan, Consultant Diabetologist, St Vincent’s University Hospital and HSE National Clinical Lead in Diabetes, made the comments following the recent third annual 3U Diabetes Conference. The conference is part of the partnership between the RCSI, DCU and NUI Maynooth. The theme of this year’s event, held at the RCSI, was ‘Current Challenges in Diabetes Research’.

“It was good to see a such a comprehensive conference on the serious subject of diabetes,” Dr Canavan said. “My main interest from my own personal point of view was in Dr Dermot Smith’s take on diabetes services nationally. He painted a very balanced picture as regards how diabetes services are rolled out, highlighting that there is quite a lot of variation across the country. Some things are improving but there are some areas where we have made little progress.”

We all want type 1 patients living fit and well and into their old age with the condition and that really depends on what happens in the first one or two decades of their diabetes care 

Some of the successes he pointed to include the establishment of the Diabetic Retinopathy Screening Programme, which invited approximately 145,000 people for screening last year.

“I know that up to half of those patients have responded so far but we’d like that to be much higher,” he said, adding that the growing number of podiatry posts being rolled out will hopefully help reduce amputations.

However, increasing the number of patients seen at primary care remains a challenge.

“We still don’t have our uncomplicated patients managed in primary care,” he told MI.

Care in the community

“The Diabetes Programme wants type 2 patients who are uncomplicated to get their services in the community and the complicated patients, who need some specialist input, could again be largely looked after in primary care.

“But that is pretty much dependant on resources and the structures being in place, and that’s keeping it from moving forward.

“We all want type 1 patients living fit and well and into their old age with the condition and that really depends on what happens in the first one or two decades of their diabetes care.”

Environmental factors

One of the topics discussed at the 3U Diabetes Conference was the ‘triggers’ and environmental factors associated with the development of type 1 diabetes.

“We hear less about type 1 diabetes, but we saw from the Irish data, presented by Dr Dermot Smith, that probably over the last 15 years there has almost been a doubling of type 1 diabetes in Ireland,” Dr Canavan said. However, the reasons why some people predisposed to the condition develop it, and some do not, are not fully understood.

During the course of the conference, Dr Canavan recounted that Finnish expert on diabetes, Prof Mikael Knip, found that after “a very long and detailed, randomised, controlled trial,” removing cow’s milk from an infant’s diet did not cause any significant reduction in the tendency towards type 1.

Prof Knip also told the conference that he, along with colleagues in the US and Finland, have been able to identify potential triggers for the condition, including enteroviruses and an altered intestinal bacterial flora. These discoveries, he said, might be crucial and may ultimately lead to a preventative intervention for type 1 diabetes.

Implications for care

As well as being an opportunity to meet international colleagues, the research presented at the conference may have many implications for diabetes care in Ireland.

“As much as we’re thinking about services for the epidemic that is type 2 diabetes, we do need to make plans for the number of type 1 diabetic patients coming into being,” he said.

“The care that they get is better now and there are better interventions available. If they get type 1 diabetes now, the expectation is that they’ll have diabetes for several decades, so we need to have services available that allow them access to pumps, to ensure that they are supported through paediatric services, and that they slot into services such as the retinal screening programme.

“Retinal screening starts at the age of 12 and it’s important for the younger type 1 patients coming into the service that they know about those clinical preventative measures.”

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