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MEARLY MANAGEMENT OF T2 DIABETES SAVES LIVES HbA1c = 8.4% Early management of type 2 diabetes can result in a 17% and 25% reduction in risk of CVD and all cause mortality respectively over 6 years HbA1c = 6.5% It’s crucial to motivate patients to tightly control their HbA1c and other factors as early as possible Figure LegendSimulated incidence of the composite cardiovascular outcome by treatment group with and without delays in diagnosis and treatment in the ADDITION-Europe trial. *Outcome defined as stroke, MI, revascularization, amputation, or cardiovascular death. The error bars indicate SDs calculated from 100 simulations. From: Early Detection and Treatment of Type 2 Diabetes Reduce Cardiovascular Morbidity and Mortality: A Simulation of the Results of the Anglo-Danish-Dutch Study of Intensive Treatment in People With Screen-Detected Diabetes in Primary Care (ADDITION-Europe). Diabetes Care. 2015;38(8):1449-1455. doi:10.2337/dc14-2459 Copyright © 2022 American Diabetes Association. All rights reserved.wnload: 10/24/2022 MSTRONG EVIDENCE FOR HOW TO CONTROL HBA1C Sustained Lifestyle Changes lower HbA1c Medication (Metformin) lowers HbA1c 1.12% no weight loss small weight loss (0 to 8%) large weight loss (0 tWing R et al., Diabetes Care (2016) Hirst et al., Diabetes Care (2012) M NHS AUDIT DATA SHOW ROOM FOR IMPROVEMENT 1 It’s crucial to motivate patients to tightly control their HbA1c and other factors as early as possible But ‘Treatment Targets Achievement’ and ‘Attendance of Structured Education Programs’ data show there is room for improvement 2 MPOLL QUESTION 1 HWE NEED BETTER MOTIVATION TO ENGAGE To engage people in prevention we need a strong motivator that frames the benefits of specific lifestyle changes that we know will improve health in the longer term HMOST MOTIVATING OUTCOMES FOR PATIENTS Most motivating outcomes: ● Reducing complications ● Living a longer, healthier life ● Getting blood glucose down ● (Avoiding/reducing meds) Younger Lives Patient Survey, n=500 (2022) HWHY AN ‘AGE BASED’ APPROACH WORKS ● Ageing happens to everyone & is progressive ● Everyone wants to delay it ● ‘Staying young for your age’ is a emotionally powerful short hand for living a longer and healthy life (and avoiding complications) “[...] sort of nails things that you actually know… it actually ● Powerful motivator especially with people 40+ nails it down, hang on a minute you’re actually running out of time here and you’ve got to do it” Shefer et al., 2016 (BMC Public Health 16:1221-1232 ) HTHE EFFECTIVENESS OF THIS APPROACH (HEART AGE CLINICAL TRIAL) Clinical trial shows that Heart Age has a significantly better impact on health one year on versus telling someone their risk ● 13% lower cardiovascular risk ● 4 times more likely to quit smoking ● 3 times more likely to lose weight ● 2 times more likely to lower blood pressure ● 2 times more likely to lower blood glucose and blood cholesterol We are the original inventors of Heart Age in 2007. Since launch, Heart Age has now been used by millions of people around the world MEFFECTIVE ‘AGEING’ IS OBSERVED IN DIABETES TRIALS In the ADDITION Trial, a delay in treatment was associated with an event rate that would not be seen until a later age if it had been treated earlier MNEW FOR 2022: DIABETES AGE MSIMPLE TEST THAT TAKES 2 MINUTES, UNDERPINNED BY THE EVIDENCE BASE User Data All Cause Meta-Analyses* Mortality Risk Diabetes Age Longitudinal Risk Factor Diabetes Age in Risk Factor Modelling* Trajectories 5 Years RCT’s* Risk Reduction “Years Off” * Leal et al., (2021) Estimating risk factor progression equations for the UKPDS Outcomes Model 2(UKPDS 90) Diabetic Medicine. 38:(10)e14656aemic thresholds. Diabetologia 55:636-643 Wing et al., (2016) Association if weight loss maintenance and weight regain on 4 year change in CVD risk factors:The Action for Health in Diabetes (LOOKAHEAD) clinical trial. Diabetes Care 39(8): 1345-55. MSHOWS LIFESTYLE CHANGE & TREATMENT CAN TAKE ‘YEARS OFF’ THROUGH GLUCOSE CONTROL HSHOWS HOW DELAYING ACTION INCREASES ‘AGEING’ Your Diabetes Age Now Your Diabetes Age in 5 years time if you ‘do nothing’ if you ‘do nothing’ MTHE RESPONSE “I interpret it as I need to do what the GP is telling me to do - to lose weight gradually... but this is a lot more "Wow. I like that! That is really appealing, You can see a “I’m shocked you can take off 3 powerful. Makes me more difference. No one wants to years. That’s good. I still need determined to keep on doing feel older than they really are” weight loss. That pushes me to what I’m doing” try harder. Seeing it there it does AK, Female, 58 make you think”. SS. Male, 49 AJ, Female. 64 90% of people want to take action after seeing their result Diabetes Age Users (Aug 2022) HFACILITATES READINESS TO CHANGE BY ASKING ABOUT MOTIVATION AND CONFIDENCE MPEOPLE ARE MOTIVATED TO CHANGE HAVING SEEN THEIR RESULT lifestyle changes, while a lower percentage are not motivated to take medication Diabetes Age Users (Aug 2022) MBUT SOME MAY BE LOOKING FOR MORE HELP DUE TO LACK OF CONFIDENCE It may be that those who are very confident already in making changes can self manage with guidance, but those ‘somewhat’ confident are more likely to benefit from greater support. Helpful to know in shared decision making conversations and when recommending support options Diabetes Age Users (Aug 2022) MDIABETES AGE USE WITH PATIENTS HPOLL QUESTION 2 HDIFFERENT PATIENT MOTIVATION TYPES Not Motivated “The other tablets I take are all in the morning, this one is at night, then one night I forget, then the next night I forget, and I can't be bothered taking these because I don't think - I can’t believe tablets would do (me any good) - you know?” Externally Motivated “Knowing that I’m going to see (practitioner) every so often….part of me says “well you’ve got to behave yourself girl because you're going to be going and seeing them, and they’ll know if you haven't been behaving yourself, your weight and your levels and everything else” Introjected “I’m going to be good and go back on my diet, it’s entirely my fault because I know the rights and the wrongs and the do’s and don’t do’s” Identified “I don't want to go blind, I don't want my legs chopped off and I’d like to live a bit longer….so I want to stay as healthy as I can for as long as I can, preferably with as little medication as I can” Integrated “I think I’ve entered now into a pattern and a way of life” Intrinsic “The exercise now has become so much a part of my life that….. I do it because I enjoy it, I go out, the hour walking sorts the brain out for the day, its relaxing, sometimes I’m out and I’m back before I’ve gone, before I realise. Yes I enjoy it” Sebire et al., (2018) BMC Public Health MPATIENT CONVERSATIONS SUPPORT PACK We are currently writing a HCP support guide to using Diabetes Age with your patients • A practical guide on how to motivate your patients to take action to control their HbA1c • The role of lifestyle change and medication to do this (recognising that not all patients are motivated by the same things) Not Motivated Discuss what patients want from future Show how small changes can be sustained and effective Motivated by HCP Make Diabetes Age a goal/target to reviewRelate prescribed recommendations to at each session years they can take off Set Targets Have patients set themselves a goal to Relate chosen lifestyle changes and med achieve adherence to achievement of goal Integrate into way of life Emphasise how Diabetes Age requires Relate lifestyle changes they feel they can sustainable changes they can make make and sustain to Diabetes Age Enjoyable new life Emphasise how Diabetes Age requires Help them find ways to both make sustainable changes that they will enjoy changes that are enjoyable as well as reducing HbA1c and Diabetes Age MPOLL QUESTION 3 HSUMMARY OF TALK • The importance of getting patients to control their HbA1c as early as possible • How improved patient motivation can help improve the current situation • Why Age-Based Interventions are so powerful • The new Diabetes Age test and evidence-based underpinning it • How the Diabetes Age test can be used within the patient journey We would like to offer everyone on this call the opportunity to use Diabetes Age with their patients Please email contact@youngerlives (or put your name and email in chat now) to let us know how you would like to use it and we will send you a link to the tool HQUESTIONS We would like to offer everyone on this call the opportunity to use Diabetes Age with their patients Please email contact@youngerlives (or put your name and email in chat now) to let us know how you would like to use it and we will send you a link to the tool H