Evidence used

book libraryMedical evidence used in this website

Documents used include guides from UK Department of Health,  UK NHS National Institute for Clinical Excellence (NICE), NHS Choices, Charity Diabetes UK,  plus key international research papers, as follows.

  1. Low risk-factor profile and long-term CVD and non-CVD mortality and life expectancy: findings for 5 large cohorts of young adult and middle-aged men and women, Stamler J et al., JAMA. 1999; 282(21):2012-2018. [Good cholesterol & blood pressure, not smoking & not having diabetes, you’ll live longer.]
  2. The NHS Health Check in England: evaluation of the first 4  years, Sheikh A, et l, BMJ Open 2016; doi: 10.1136/bmjopen-2015-008840.  [reductions in CVDs.]
  3. Type 2 diabetes: prevention in people at high risk, NICE Public Health guideline [PH38], July 2012, update Sept. 2017. [Identify those at risk, risk-assess score &  blood test. Then lifestyle-change plan to prevent T2, and offer place on intensive lifestyle change programme].  Info for the public is here
  4. Diabetes in adults, NICE quality standard [QS6], March 2011. [NICE treatment standards for blood glucose, cholesterol & blood pressure, and reducing risk of complications – with evidence base. 3 out of 4 people with diabetes die from heart & blood vessels diseases].
  5. Diabetes in pregnancy: management from preconception to the postnatal period, NICE [NG3], Feb. 2015. Info for the public here.
  6. Diabetic foot problems: prevention and management, NICE, NG19, August 2015. [Foot check at least once a year, or at once if problems]. Info for the public here.
  7. Type 1 diabetes in adults: diagnosis and management, NICE, NG17, August 2015; [Your diabetes care team will work with you to agree your personal care plan]. Info for the public here.
  8. Type 2 diabetes in adults: management, NICE, NG28, Dec. 2015, updated:  [Your diabetes care team will work with you to agree your personal care plan, and a detailed annual review every 12 months]. Info for the public here.
  9. Type 2 diabetes prevention: population and community-level interventions, and preventing the progression from ‘pre-diabetes’ to type 2 diabetes, NICE Public Health Guidelines PH35, May 2011. [Develop integrated plan for local actions to prevent T2 diabetes & heart diseases. Consult with local health experts and communities at high risk. Increase exercise, improve diet & manage weight].
  10. 10-year follow-up of diabetes incidence and weight loss in the USA Diabetes Prevention Program Outcomes Study. Hamman RF, et al., Lancet 2009; 374(9702):1677-86. [Diabetes starts, in the 10 years since DPP start, reduced by 34% in lifestyle change group & 18% in metformin group. T2 diabetes could be prevented or delayed in persons at increased risk, by losing a small amount of weight and getting 30 minutes of moderate-intensity exercise, such as brisk walking, five days a week].
  11. Cardiovascular disease: risk assessment and reduction, NICE Clinical Guideline CG181, updated Sept. 2016. [Change your diet, stop smoking, reduce alcohol, take more exercise to lower cholesterol & to reduce your heart and blood vessels diseases risks. Medication may help].
  12.  Cardiovascular disease prevention, NICE Public Health guidelines PH25, June 2010. [Reduce salt, saturated and Trans fats, simple traffic lights labelling in shops, & more exercise].
  13. Quality standard on secondary prevention following a myocardial infarction (heart attack),  NICE QS 99,  Sept. 2015. ; [have a scan,  an assessment within 10 days of leaving hospital, an agreed heart rehabilitation programme]. Info for the public here.
  14. New quality standard to reduce the risk of heart attacks and strokes, NICE QS100, Sept. 2015. [risk assessment using QRISK2,  statins,  lifestyle changes, review 3 months after]. Info for the public here.
  15. Predicting risk of type 2 diabetes in England and Wales: prospective derivation and validation of QDScore, Julia Hippisley-Cox et al., University of Nottingham, BMJ 2009;338:b880;
  16. Predicting cardiovascular risk in England and Wales: prospective derivation and validation of QRISK2, BMJ 2008;336:a332,  doi:10.1136/bmj.39609.449676.25.
  17. Leisure-Time Physical Activity Reduces Total and Cardiovascular Mortality and Cardiovascular Disease Incidence in Older Adults, Noël C. Barengo et al, Journal of the American Geriatrics Society, 2016; DOI: 10.1111/jgs.14694 . [moderate & high levels of physical activity decreased risk of heart diseases and strokes].
  18. Primary prevention of cardiovascular disease with a Mediterranean diet, Estruch R, Ros E, Salas-Salvadó J, et al., N Engl J Med, 2013. 368(14): p. 1279-90. DOI: 10.1056/NEJM oa1200303 [A Mediterranean diet, plus virgin olive oil/nuts, much reduced risk of heart diseases/strokes among high-risk persons].
  19. Prevalence of prediabetes in England from 2003 to 2011: population-based, cross-sectional study, Mainous III AG, Tanner RJ, Baker R, et al., BMJ Open 2014;4:e005002. doi:10.1136/bmjopen-2014-005002. [By 2011, prediabetes increased to 1 in 3 adults in England, & to half of those who are overweight and over 40 years old].
  20. A qualitative synthesis of diabetes self-management strategies for long-term medical outcomes and quality of life in the UK, Julia Frost et al.,  BMC Health Serv Res. 2014; 14: 348. doi:0.1186/1472-6963-14-348. [patients’ quotes given in various web pages above].
  21. Favorable Cardiovascular Health, Compression of Morbidity and Healthcare Costs, Forty-Year Follow-Up of the Chicago Heart Association Study, Norrina B. Allen et al,  May 1, 2017.  [people in good heart health in early middle age live a longer, healthier life. So prevention earlier, to preserve heart & blood vessels health, will reduce the burden of these diseases at older ages].
  22. National Diabetes Audit  2016-17:  Short Report Care Processes and  Treatment Targets, NHS Digital, November 10, 2017.
  23. The global economic burden of diabetes in adults aged 20–79 years: a cost-of-illness study, Prof. Sebastian Vollmer, PhD et al., Lancet, 26 April 2017; DOI: http://dx.doi.org/10.1016/S2213-8587(17)30097-9. [Estimates global cost of diabetes was US$1·31 trillion for 2015, or 1·8% of global gross domestic product.]
  24. Comparison of diagnostic performance of Two-Question Screen and 15 depression screening instruments for older adults, systematic review and meta-analysis, Samuel Y. S. Wong et al., British Journal of Psychiatry Feb. 2017, DOI: 10.1192/bjp.bp.116.186932 [Two-Question screen is simple and quick for depression screening. Performance is comparable with other tools. A ‘yes’ to either question should result in a visit to, and a formal assessment by a GP.].
  25. Risk factors for non-adherence to antihypertensive treatment,  Prof.  Maclej Tomaszewski et al., Hypertension 2017, Publication link: 36c1faa2-ab6f-4789-a8f0-08fdc957d529. [A urine test & discussion with your GP could convince you to take your blood pressure pills. Because 1 in 3 patients do not take their pills often enough, this could cut no. of strokes & heart attacks by half].
  26. Eating disorders: recognition and treatment, Information for the public, NICE Guideline NG69, May 2017. [An eating disorder is an unhealthy relationship with food that can take over your life and make you ill. Could involve eating too much or too little. If your GP thinks you may have one, should refer you to a specialist in eating disorders at a local eating disorder clinic. Or if aged under 18, at a clinic for young people.]
  27. Global report on diabetes, World Health Organization, ISBN 978 92 4 156525 7, 2016. [Encourages us all to eat healthily, be physically active, and avoid weight gain. No. of Adults with diabetes has multiplied by 4 since 1980, to 422 million. In 2012 diabetes caused 1.5 million deaths].
  28. Diabetes prevalence estimates for local populations, Public Health England, online press release, 13 September 2016. [Estimates almost 1 million adults with diabetes in UK have not been diagnosed or registered. South Asian and black ethnic people are twice as likely to have it compared with people from white, mixed or other ethnic groups].
  29. Socio-economic impact of mHealth – An assessment report for the European Union, PwC analysis, June 2013. [Potential hospitalisation days saved for diabetes could be 35%, and for heart and blood vessels problems 22%].
  30. Effect of telehealth on use of secondary care and mortality: findings from the Whole System Demonstrator cluster randomised trial, BMJ 2012;344:e3874. [RCT involved 6191 patients & 238 GP practices. Telehealth can deliver 15% reduction in A&E visits, 20% reduction in emergency admissions, 14% reduction in elective admissions, 14% reduction in bed days and 8% reduction in tariff costs.  Strikingly also demonstrate a 45% reduction in mortality rates].
  31. SACN Salt and Health report: recommendations on salt in diet, Public Health England, 31 August 2003. [max. target salt intake of 6g/day (2.4g/100 mmol sodium) for adults; less for children under 10; would reduce burden of CVDs.]
  32.  Guidance: Health matters: combating high blood pressure, Public Health England, 24 January 2017. [Normal adult blood pressure is between 90/60 mm Hg and 120/80 mm Hg. Obese men are twice as likely to develop high blood pressure and obese women 3 times more likely. Heavy regular consumption of alcohol raises blood pressure. High blood pressure is greatest among those from low-income households and those living in deprived areas. It affects 1 in 4 adults in England – 12.5 million people in 2015. For every ten people diagnosed with high BP, seven remain undiagnosed and untreated – this is 5.5 million people in England. Every 10 mm Hg reduction in blood pressure reduces coronary heart disease by 17%, strokes by 27%, heart failure by 28%.]
  33. BHF Cardiovascular Diseases (heart & blood vessels’ diseases) Statistics 2018,  factsheet compiled by the British Heart Foundation. Published online at https://www.bhf.org.uk/research/heart-statistics (accessed 05/05/18). [CVDs cause 1 in 4 of all deaths in the UK; that’s 160,000 deaths each year – an average of 435 people each day or one death every three minutes. 6 million people are living with a CVD. Healthcare CVD costs are £11 billion each year. CVDs cost to the UK economy are £15 billion each year. 3 UK adults in every 5 are overweight, and 1 in 4 are obese. Nearly 1 in every 3 children in the UK are overweight or obese. 2 out of 5 adults in the UK do not achieve recommended levels of physical activity. Only 1 UK adult in every 4, and 1 in 5 children consume the recommended minimum five portions of fruit and vegetables per day. 1 adult in every 4 in the UK exceed national guidelines for weekly alcohol intake; no level of use is without risk. 1 in 3 adults in England and Scotland have high blood pressure, and half are not receiving treatment. 3 in 5 adults in England have high blood cholesterol levels (5mmol/l or above).]
  34. Small molecule modulation of splicing factor expression is associated with rescue from cellular senescence, Elizabeth Ostler, Lorna Harries et al., BMC Cell Biology, https://doi.org/10.1186/s12860-017-0147-7 Pub. 17 Oct. 2017, (accessed 10/11/17)  [Scientists at Exeter Uni discover they can rejuvenate cells by using resveratrol analogues, based on a chemical naturally found in red wine & dark chocolate].
  35. The 2017 (USA) Clinical Practice Guideline for High Blood PressurePaul K. Whelton, MB, MD, MSc; Robert M. Carey, MD, JAMA. 2017;318(21):2073-2074. Doi:10.1001/jama.2017.18209, 5 Dec. 2017. [This guideline is a comprehensive USA update. High BP now starts at 130/80, based on 1000 recent studies, inc. SPRINT (2015), These show that aggressively treating BP down to 120 mmHg saves lives. This means another 14% of Americans will be diagnosed with high BP. Only 2% more will need prescriptions as the guideline relies heavily on lifestyle changes. It also calls for more team-based medicine, more reliance on telehealth and “between appointment” monitoring of blood pressure. So, get patients to take their BP at home. Take a patient’s BP more than once before diagnosing high blood pressure. “Lifestyle management is the challenge and the underlying issue for high BP, and we have to come to grips with it.” The guideline says a healthy lifestyle is: the DASH diet, which promotes fruits and vegetables, low-fat or non-fat dairy, whole grains, and less than 1500 mg of daily sodium (salt). Limit alcohol to 2 drinks a day for men and 1 per day for women. Exercise at least 30 minutes 3 times a week].
  36. Association Between Dietary Factors and Mortality From Heart Disease, Stroke, and Type 2 Diabetes in USA, Renata Micha, Jose L. Peñalvo, Frederick Cudhea, et al, JAMA. 2017;317(9):912-924. Doi:10.1001/jama.2017.0947.  [In 2012, suboptimal intake of dietary factors was associated with an estimated 318,656 cardiometabolic deaths (deaths due to heart disease, stroke, or type 2 diabetes), representing 45% of cardiometabolic deaths. The highest proportions of cardiometabolic deaths were estimated to be related to excess sodium intake, insufficient intake of nuts/seeds, high intake of processed meats, and low intake of seafood omega-3 fats.]
  37.  Randomized Trial of Intensive versus Standard Blood-Pressure Control, Sprint Research Group, N Engl J Med 2015; 373:2103-2116, DOI: 10.1056/NEJMoa1511939,  November 26, 2015 [Among patients at high risk for CVDs but without diabetes, targeting a systolic blood pressure of less than 120 mm Hg, as compared with less than 140 mm Hg, resulted in lower rates of fatal and nonfatal major cardiovascular events and death from any cause, although significantly higher rates of some adverse events were observed in the intensive-treatment group. Clinical trials show that treatment of hypertension reduces the risk of cardiovascular disease outcomes, including incident stroke (by 35-40%), myocardial infarction (by 15-25%), and heart failure (by up to 64%)].

    38. Animal-assisted therapy: A meta analysis, Nimer & Lundahl, 2007, Anthrozoös, 20, 225–238. [Concluded improves behavioural problems, medical difficulties and emotional dysfunction].

    39. Healthcare associated infections, NHS Improvement, March 2017. [Reduce the risk of healthcare associated infections by using the toolkits and guidance on how to tackle the likes of methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile (C. difficile)].

    40.  “Wipe it out” Essential practice for infection prevention and control, Guidance for nursing staff, Royal College of Nursing, January 2012.

    (Note: We are not responsible for the content of these external documents and websites).

page updated 12 May 2018.

 

 

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