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Keen to discover the effectiveness of short healthcare videos as a communication tool for patients, Dr. Seth Rankin, the managing partner of Wandsworth Medical Centre, London, emailed his patients living with diabetes short videos about their condition, and surveyed their opinions afterwards, which we report.
 
The clinicians
"Healthcare information in video format distributed directly to patients' mobiles is a more effective way to educate people living with diabetes, and propel them towards self management with an eye to slowing the onset of complications," says Rankin.    

According to Dr. Sufyan Hussain,an endocrinologist and lecturer from Imperial College, London, Clinical Lead on the Wandsworth project,  "Despite accounting for 10% of the NHS budget and 8% of UK's population diabetes healthcare systems still need considerable improvement, particularly in management, strategy and infrastructure. Communicating important health information via video, can help significantly to improve the quality of care and efficiency in an over burdened healthcare system."
 
Patient survey
 
During the six- week project, over 50% of diabetes patients opened the emails sent, and watched the information videos about their condition.
  • 75% of respondents say that they would like to have more reliable information to help them to manage their diabetes
  • 44% regularly search the Internet for healthcare information about diabetes, and 20% are undecided
  • Only 9% say that they can differentiate between good and bogus online healthcare information about diabetes
  • 68% found the video information they received by email helpful
  • 21% regularly visit Diabetes UK website
  • 71% want GPs to provide more healthcare information via email
  • 50% prefer to receive healthcare information about diabetes in video format, and 23% are undecided
  • 71% believe it's important to access healthcare information about diabetes at anytime, from anywhere and on any device.
It's important for me to quickly access premium and reliable healthcare information about my condition at anytime, from anywhere and on any device
NICE relaxing guidelines
These findings, if indicative of patient views, are significant. Recently, the National Institute of Health and Care Excellence (NICE) issued new draft guidelines to make more people eligible for weight-reduction surgery. According to NICE, such surgery would reduce the debilitating complications associated with type 2 diabetes.

Until now, people with type 2 diabetes only could be considered for weight loss surgery at a BMI of 35. The new guidance could mean that more than 850,000 people could be eligible for a stomach-reduction surgery if their doctors think they are suitable.

A costly therapy
Over the past five years, there has been a significant increase in the number of people receiving weight loss surgery. According to the UK's Health and Social Care Information Centre's latest report: in 2012-13, about 8,000 people received stomach-reduction surgery for potentially life threatening obesity when other treatments failed.

A mounting body of evidence suggests such surgery improves symptoms in around 60% of patients, which in turn, may result in a reduction in people taking their type 2 diabetes medications, and even in some cases needing no medication at all.

Stomach-reduction surgery, which costs between £3,000 and £15,000, does not mean that type 2 diabetes has been cured, and there are raised concerns that the NHS will not be able to afford the treatment, even if there are savings in the longer term. Furthermore, an irreversible procedure that does have surgical risks attached to it does not make it an attractive option for everyone. 
 
Takeaways
"We know about the escalation of the diabetes burden. We know that established therapies, diets and lifestyles could effectively reduce the burden of diabetes. And yet the burden shows no signs of slowing. IF patient data from the Wandsworth Medical Centre are indicative of the situation more generally, we should seriously consider the way doctors communicate with patients. Doing 'more of the same' is not the answer. We need to find new innovative solutions to engage, interact and motivate as many people as possible," says Dr. Hussain.

 

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The UK's National Institute for Health and Care Excellence (NICE) recently recommended that primary care doctors should identify people eligible for state-funded slimming classes run by private companies, such as Weight Watchers, an American company that offers various products and services to assist weight loss and maintenance.

UK facts
Obesity costs NHS England £5.1bn a year
25% of adults in England are obese
42% of men & 32% of women are overweight
A BMI of 30-35 cuts life expectancy by up to four years
A BMI of 40 plus cuts life expectancy by up to 10 years

Lose weight and save millions
NICE suggests that health professionals should raise the issue of weight loss in a "respectful and non-judgmental" way, by measuring their body mass index (BMI) to identify people who are eligible for referral for lifestyle weight management services. BMI is a person's weight in kilos divided by their height in meters squared.

About 25% of UK adults are obese with a BMI over 30 and 74% are overweight with a BMI above 25. Just a 3% reduction in weight could extend life expectancy, and reduce the risk of Type2 diabetes, high blood pressure and heart disease.

NICE argues that the cost of funding private weight loss programs for overweight people would be outweighed by the benefits. For example, preventing just a 1% increase in obesity would save the UK government nearly £100 million a year.
 
Lifestyle change rather than yo-yo dieting
In a recent study published in The Lancet Diabetes and Endocrinology, researchers suggest that weight loss at any age in adulthood is worthwhile and even transitory weight loss is beneficial to health.
 
The research examined the impact of lifelong patterns of weight change on cardiovascular risk factors in a group of 1,273 British men and women, followed since their birth in March 1946. It concluded that the longer a person is overweight the greater their propensity of cardiovascular problems in latter life and the greater risk of diabetes.
 
According to the lead author Professor John Deanfield from University College, London, "Our study is unique because it followed individuals for more than 60 years, and allowed us to assess the effect of modest, real-life changes in adiposity. . . .  Losing weight at any age can result in long-term cardiovascular health benefits, and support public health strategies."
 
Professor Mike Kelly, the director of the centre for public health at NICE, said the guidelines were about lifelong change rather than yo-yo dieting, when the weight is piled back on after initial success.

He stressed the importance of achievable goals: "We would like to offer an instant solution and a quick win . . .  but realistically it's important to bear in mind this is difficult. It's not just a question of 'for goodness sake pull yourself together and lose a stone'; it doesn't work like that. People find it difficult to do  . . it takes resolve, it takes encouragement."
 
mHealth proven support for weight management
Scott Lonnee, a bariatric dietitian at St George's Hospital, London echoes Kelly's sentiment, "Sensible lifestyle changes, which include sustained dietary changes and physical exercise can have significant healthcare benefits. Planning is important, and there are simple techniques to help individuals lose weight, which include, setting realistic and achievable targets, keeping diaries of what you eat and what exercise you take."
 
Research commissioned by Weight Watchers, and recently published in the American Journal of Medicine, suggests that losing weight is significantly easier and more effective when individuals have access to online support, compared to weight loss among those who tried to lose weight on their own.
 
Takeaways
Pro-active mHealth strategies can help to change the way health professionals interact with patients. Information, guidance and support regularly sent to the mobiles of overweight individuals to help them lose weight and engage in lifestyle changes would save lives, prevent the onset of disease and save NHS England millions of pounds. Why is it not being done?   
 
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Insulin pumps are small-computerized devices that deliver insulin in a measured and continuous dose (basal) and in a surge dose (bolus) at your direction around mealtimes. Insulin pumps are generally for people with Type 1 diabetes, but also could play a role in the treatment for some people with Type 2 diabetes.

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Marc Cohen

Endocrinologist

Dr Mark Cohen provides a comprehensive and personally-tailored service for patients with endocrine and diabetic conditions.

Dr Cohen qualified in medicine from the University of Birmingham in 1994 with a 1st class honours degree in Physiology. After becoming a member of the Royal College of Physicians in 1998 he returned to London to become a Medical Research Council Clinical Research Fellow at Hammersmith Hospital under the supervision of Professor Steve Bloom.

His original research on the role of the gut hormones PYY, oxyntomodulin and ghrelin in the regulation of food intake culmunated in a PhD in Physiology, awarded in 2005.

Obesity surgery is believed to act through alterations in the release of these appetite-regulating hormones.

Dr Cohen was appointed Consultant in Endocrinology and Diabetes at Barnet Hospital in 2006 and continues to have a specialist interest in the clinical management of obesity.


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Ralph Abraham

Endocrinologist

Dr Abraham trained at Kings College Hospital, St Mary's Hospital and St Bartholomew's Hospital as an academic physician turning to full time private practice in 1984. He founded London Medical in 1991.

His special interests are diabetes and endocrinology, lipid disorders and heart disease prevention.


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Islet cell transplantation is a therapy for people with Type1 diabetes. Islet cells are harvested from donors' pancreases, purified, processed and infused into a patient’s liver. Once transplanted the islets begin to produce insulin, and actively start regulating your blood glucose level.

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