The document provides details of a webinar on diabetes held on September 29th, 2020 from 12:30-1:30pm. It includes the speakers, agenda, and housekeeping details. The key speakers are Professor Wasim Hanif, Tony Kelly, and Jennifer Jones-Rigby. The agenda includes welcome/introductions, presentations from the speakers, and a Q&A session. Details are provided on recording the webinar and the BHealthy webinar series. Prof. Hanif's presentation focuses on COVID-19 and diabetes, and the increased risk. Tony Kelly discusses engaging with communities and dispelling myths about diabetes. Jennifer Jones-Rigby presentation is not summarized.

1. 29th September 2020,12:30 -1:30pm
Part of the BHealthy webinar series
Long term conditions:
Diabetes
Speakers:
Professor Wasim Hanif - Professor of Diabetes & Endocrinology, Consultant Physician UHB
Tony Kelly - Diabetes Strategic Patient Partner & Diabetes Ambassador and Advocate
Jennifer Jones-Rigby - Chief Operating Officer, Health Exchange

2. Agenda
12:30 – 12:35
Welcome, introductions and housekeeping -
Stacey Gunther
Public Health, Birmingham City Council
12:35 – 13:15
Speakers:
Prof Wasim Hanif
Tony Kelly
Jennifer Jones-Rigby
13:15 – 13:30
Q&A and Discussion –
Prof Wasim Hanif
Tony Kelly
Jennifer Jones-Rigby

3. HOUSEKEEPING
Please stay muted and turn your cameras off during this webinar.
Please turn off any VPNs (e.g. Netmotion, Cisco, etc.) to save bandwidth.
Please use the chat function to ask questions for the Q&A or you can email
your questions to healthybrum@birmingham.gov.uk
To make this webinar available to those that are unable to join us, today’s
webinar will be recorded. The recording, with both audio and visual will be
shared next week via email and online platforms.

4. BHealthy
A series of practical resources
to enable leaders and
professionals with direct
reach to communities and
an established, trusted
relationship, for example
community leaders, social
prescribing link workers and
faith leaders, to support their
communities to reduce their
risk of becoming seriously ill
from Covid-19
Webinar bookings via:
https://www.birmingham.gov.uk/info/50238/wellbeing_during_the_coronavirus_covid-
19/2247/bhealthy

5. Diabetes in COVID Times
Prof. Wasim Hanif MD FRCP
Professor Diabetes & Endocrinology
Consultant Physician University Hospital Birmingham, UK
Board of Trustee Diabetes UK
wasim.hanif@uhb.nhs.uk
Twitter: @docwas

6. COVID-19 and Diabetes: A Collision and
Collusion of Two Disease- The Perfect Strom
Feldman et al: Diabetes.diabetesjournals.org

7. Predictors of COVID-19 risk
Khunti K, Routen AC, Patel K, Ali SN, Gill P, Banerjee A, Lad A, Patel V, Hanif W Actions to protect ethnic minority populations
from Covid-19 post-lockdown BMJ 2020 Submitted

8. Unadjusted in-hospital COVID-19 mortality per 100,000 persons between 1st
March and 11th May by Type of Diabetes
Emma Barron , Chiraj Bakhai, Partha Kar, Andy Weaver, Dominique Bradley, Hassan Ismail, Peter Knighton, Naomi Holman, Kamlesh Khunti, Naveed Sattar, Nick
Wareham, Bob Young, Jonathan Valabhji: Data for 0-39 years suppressed due to small number of events
NHS England Website accessed 20/5/2020 Lancet Diabetes & Endocrinology
Rateper100,000over72dayperiod
1400
0
200
400
600
800
1000
1200
0-39 yrs 40-49 yrs 50-59 yrs 60-69 yrs 70-79 yrs 80 + yrs
Adjusted odds ratios for in-
hospital death with COVID-19*
Diabetes Type
• General Population 1.0
• Type 2: 2.03
• Type 1: 3.50
Age Group
• Age < 40 : 0.01
• Age 40-49: 0.11
• Age 50-59: 0.36
• Age 60-69: 1.00
• Age 70-79: 2.63
• Age 80+ : 9.14
Gender
• Female 1.0
• Male 1.94

9. UHB Experience
• 2217 patients admitted to UHB with a proven diagnosis of COVID19 were
included. 58.2% were male, 69.5% White and the majority (80.2%) had co
morbidities. 18.5% were of South Asian ethnicity, and these patients were more
likely to be younger (median age 61 years vs.77 years), have no co morbidities
(27.8% vs. 16.6%) but a higher prevalence of diabetes mellitus (48.0% vs 28.2%)
than White patients.
Elizabeth Sapey, Suzy Gallier, Chris Mainey, Peter Nightingale, David McNulty, Hannah Crothers, Felicity Evison, Katharine Reeves, Domenico Pagano, Alastair
K Denniston, Krishnarajah Nirantharakumar, Peter Diggle, Simon Ball
doi: https://doi.org/10.1101/2020.05.05.20092296

10. Diabetes with
Complications
driving
mortality in
COVID
Krishna M Gokhale, Samiul A Mostafa, Jingya Wang, Abd Tahrani, Christopher Sainsbury,
Konstantinos Toulis, Neil Thomas, Zaki Hassan-Smith, Elizabeth Sapey, Suzy Gallier, Nicola J
Adderley, Parth Narendran, Srikath Bellary, Thomas Taverner, Sandip Ghosh, Krishnarajah
Nirantharakumar, Wasim Hanif Diabetes Care Submitted 2020

11. “The Perfect Strom”- Age, Male, Obesity and
Metabolic inflammation

13. Diabetes
Care in the
Time of
COVID-19
Does Type 1 and Type 2 diabetes increase the vulnerability
of patients to
• Become infected with coronavirus
• Increase risk of poor outcome
• What mechanism are driving this increased risk?
What is the particular importance of achieving and
maintaining glycaemic control during the pandemic?
• Acute Complications
• Chronic Complications
Practical tips for primary care:
• Communicating the critical importance of optimal
metabolic control
• Monitoring glycaemic control
• Therapeutic management of oral therapies including
SGLT2 inhibitors
• Insulin management
• Management of hyperglycaemia and associated
metabolic conditions
• RAS blockers
• Statins
• Obesity/overweight
What should the practice do about:
• Maintaining contact with high-risk, older patients
• Regular follow-up
• Altering medication

14. • Most people (80%) will have mild disease
and can be managed at home.
• Usual sick day rules apply – stop SGLT2i
and metformin if unwell and not eating
or drinking normally, other medication
(eg SUs) may need adjustment
• Never stop insulin
• Monitor glucose frequently (every 2-4
hours) – ketone testing needed for type 1
diabetes
https://www.diabetesonthenet.com/journals/issue/607/article-details/glance-factsheet-covid-19-and-diabetes-dpc
Please consult individual product SmPCs for full product information
Specific considerations for primary care management of people with
COVID-19 and suspected COVID-19 infection

15. Updated to meet guidance, 29.09.2020

16. Welcome
Tony Kelly
Diabetes Strategic Patient Partner
Diabetes Ambassador and Advocate

17. Disclaimer: I am not a health care professional.
However since diagnosis with type 2 diabetes 17
years ago which runs in my family, I have never
taken medication for this medical condition.
The knowledge gained since then along with
being trained as a Diabetes UK Community
Champion volunteer 7 years ago and now as a
Diabetes Strategic Patient Partner for NHS
Birmingham & Solihull Clinical Commissioning
Group, enable me to share my experience of
living with, managing and controlling my
diabetes.

18. Hard to
Reach?

19. Community Engagement – Community
Cohesion
As a starting point please do not use the often-heard term:
‘Hard to reach communities’ . It is a myth or misnomer as we are all part of a community. None of us are
in the jungle/rain forest, on Mount Everest, a desert island or on another planet.
The proverbial saying ‘ If Mohammed cannot go to the mountain then the mountain must go to
Mohammed’’ is a positive and proactive stance to adopt. Be proactive instead of reactive as diabetes
prevention is all about getting people to do the same, change their lifestyle in terms of diet and physical
activity, i.e. behavioural changes or if they have the medical condition manage/control it to avoid the
complications. Lots of communities are marginalised, including sight and hearing impaired and those with
learning disabilities.
‘Prevention is better than cure’ hammers home the message or ‘If in doubt check it out.’
Branch out from the usual tried and tested method of health clinics, medical centres or hospitals and
engage with communities on the health and well-being agenda in other creative ways. On average I do
140 community engagements each year.
I was headhunted to sit on the National Health Service, Birmingham and Solihull Clinical Commissioning
Group. It is important for patient representatives to be on august bodies in order to ensure policies,
practice guidelines/procedures are implemented and reviewed. That is equity which encourages a more
joined up approach instead of working in isolation/silos.

20. Thinking creatively and as the cliché says
‘Outside of the box’ as one cannot engage effectively with
communities behind an office desk or on laptop computer.
Target the following:
• Churches, mosques, temples and other places of worship
• Markets/shopping centres, Post Offices
• Residential, nursing and care homes and day centres
• Hair dressers, barber shops, bars/pubs, domino clubs
• Community centres, bingo halls, sports venues/fixtures/events such as
cricket/swimming/ track and field athletics/football/tennis/ festivals ,rugby, bowls,
concerts, dances, carnival, gyms/car boot and jumble sale
• Colleges/Universities/primary/high schools. Parents Teachers Associations
• Trade unions and other allied professional associations.
• Service clubs e.g.Kiwanis, Rotary, Lions, Women’s Guilds, Senior Citizens Groups,
and Resident’s Associations, Youth clubs, Scouts/Rangers, Guides/Boys Brigade,
Brownies.
• Business places in public and private sector

21. Effective ways of
engaging with communities
• Print contact cards, ‘T’shirts with logos and catchy straplines
• Badges and wristbands with logos
• Social media: Facebook, Email, LinkedIn, Twitter, Hashtaq, Tumblr, webinars,
• Radio and television
• Phone calls/text messages, Word of mouth
• Newspapers and magazines in communities
• Posters/flyers on community centre display & notice boards
• Waiting/reception areas at health clinics, optician, dentist & doctor
• Bars/shops/stores/supermarkets/markets/police stations/Courts

22. Misconceptions

23. Getting rid of the cultural myths and
misconceptions that are truly believed
Enabling and empowering communities is of vital importance. Giving them the
knowledge and information to help them make life style changes is a powerful
tool to adopt.
Some classic myths that one hears regularly are:
1. Diabetes is a mild condition and ‘a touch of sugar’
2. It is God’s will that you should get it and the Bible or Koran are used to justify that cultural
cultural myth.
3. If one is fasting during Ramadan and tests your blood sugar level one has broken the fast.
4. ‘Being big is beautiful’.
5. Only people who are overweight or obese can develop diabetes.
6. A lot of people firmly believe that all one needs to do is cut down on sugar consumption.
However it must always be stressed that all carbohydrates (starchy food) break down in
the body into glucose or sugar.
7. People especially in their 50s, 60s 70s, claim blurred vision is because they are getting
In most cases it is the building up of sugar/glucose (diabetes) in the blood vessels at the
back of the eye.

24. Some do’s and don’ts
• Avoid using the word exercise as it conjures up images that the person must go to a gym.
Try instead to each time say physical activity.
• Examples of physical activity: Fast paced walking, gardening, jogging, line dancing, Zumba,
yoga, Pilates, swimming, cycling, house work, sweeping, washing the car, hoovering, using
the stairs instead of the lift/elevator/escalator and travellator.
• Recruit volunteers to become Community Champions and Ambassadors so they can assist
in spreading the health and well-being message.
• Pro-social modelling. Lead by example.
• Seek out in religious places the person in charge of health. I learnt from experience that the
priest, imam, vicar, rector, pastor is not always the best person to approach regarding
health issues.
• Speak plain/simple language. Cut out medical terms /jargon /acronyms when engaging
with communities. A classic term used by doctors is impaired glucose regulation. Is the
average person going to understand that term? Say instead pre-diabetes or borderline as
both are clear. Another is digital/diabetic retinopathy screening. Preferable to say diabetes
eye screening. It is about speaking the language that people will readily understand.

25. Literacy Skills
• This is often a taboo subject but one must be conscious and aware of it.
Some people pretend that it is not an issue when that might be the reason for
lack of engagement on health issues. Observe the body language.
• Verbal communication i.e. the spoken word as opposed to the written word is
key at times. This has to be done in a sensitive way in order not to humiliate
or embarrass anyone. Culturally competent service delivery.
• A classic example which comes up often in diabetes awareness training events
is ‘I forgot my reading classes.’

26. Diabetes
• Apart from the well known symptoms referred to as the 4 ‘T’s of tired, toilet,
thirsty and thinner. Two other symptoms are slow healing of cuts & wounds
and blurred vision.
• Empower people to know that sometimes there are no symptoms at all and
diabetes can remain in the body for 10 years and if undetected can lead to
serious complications: strokes, blindness, heart attacks, kidney damage/renal
failure and limb amputations and premature or early death.
• Black people are 2 – 4 times more likely than white people to develop type 2
diabetes and at an earlier age, 25 as opposed to 40. So it is important that they
are screened/tested on a regular basis, eat healthily and do physical activity
often. Their DNA, genetics/metabolism is a factor as well as leading a
sedentary/’couch potato’ lifestyle.
• Train, lorry, bus and taxi drivers ALL have a higher rate of diabetes. Why?

27. Prevention of Type 2 Diabetes
You can now self-refer into the NHS Healthier
You Programme delivered by WW by accessing
the Diabetes ‘Know Your Risk’ Tool
https://riskscore.diabetes.org.uk/start
Alternatively contact your GP for support and
referral into the programme
Reduce your risk
• Eat a healthy balanced diet
• Be more active regularly
• Stop smoking

28. Gender differences
to be mindful of at all times
• Most women are well versed in accepting, seeking help and discussing their health
problems. It very rarely is a problem for them.
• Most men are the complete opposite in that regard and I was one of those men who
went for nearly 8 years without visiting my doctor. Pride springs to mind in my case but
not anymore as I have an annual diabetes review and always for the past 15 years get a
clean bill of health.
• Men are well known for being in denial, suffering in silence and burying their head in the
sand like the ostrich hopping that the problem will go away. Of course it never does but
instead gets worse. Men are often too embarrassed to own up to having any problems
as it is not the macho/manly thing to do. To deviate from that norm is viewed as a sign
of weakness.
• Encourage men to speak up, seek help, advice and show them more empathy in an effort
to engage them. Once you have them in your trust they will open up and therein lies the
difference. It is about men being in touch with their feelings/emotions as a starting point.
Not easily done but cannot be overlooked and health care professionals need to aid
that process.

29. Personal Experience
• HbA1c i.e. Blood Glucose
vs Fructosamine
• Pernicious Anaemia?
• Kidney Stones

30. Comorbidities vs other relevant factors
Heart disease
Kidney disease
Diabetes
Hypertension (high blood pressure)
Dementia
Lack of vitamin D
Never lose sight of the following
Systemic racism, disparities/health inequalities and socio-economic
factors.

31. Final thoughts to share with you
• Make perseverance and persistence your buzz words. Remember it is a marathon and
not a sprint. If at first you don’t succeed, then try and try and try again. Sometimes it is
not necessarily about losing weight but get the body to be more toned. When I hear
someone say to me that they have now stopped taking their medication after being to
one of my events, with of course advice from doctor that is the most uplifting thing to
hear and makes me feel what I am doing is worth it.
• Do not give up or be despondent. Never readily and hurriedly accept ‘no’ for an answer
when dealing with change as remember you are trying to motivate, enable and
empower people to change habits of a lifetime. My grandmother used to say to me
‘’Habits are easy to make but hard to break.’’ People often need time, reassurance and
encouragement to make the lifestyle changes.
• Be patient, show empathy (putting yourself in their shoes)and not sympathy which is
feeling sorry for a person as that can viewed as patronising/condescending.
• It is never a one size fits all approach as no two individuals are alike.
• Always remember to enable and empower anyone on their journey to bring about
effective and lasting change but accept too that people will have relapses and struggles
along the way. It is hard and challenging work but is also very rewarding.

33. Thank You
Any Questions?
Contact: Tony Kelly
E: tonykellydiabetes@hotmail.com

34. Managing Your Diabetes
Programme
Supporting self-care and
empowering patients for
over 11 yearsJennifer Jones-Rigby BA(HONS) PGCE FRSA
Chief Operating Officer

35. Outcomes and
objectives
Overall Objectives:
• Supporting self-care and
empowering patients through
high quality education and self-
care resources and programmes
• The aim of the Managing Your Diabetes
Programme is to provide structured
patient education to individuals who are
having difficulty managing their type 2
diabetes. This will be done by following
NICE guidelines CG66 and CG87.

36. Current extended
options:
Patients can now be
12 months plus T2
diagnosed - if they
have never been
offered /accessed
structured Education
Zoom - Weekend Options +
Telephone support
Zoom 4 X week
Programme in planning
additional telephone
support offered to all
+Telephone Support
Increased geographical reach
within the BSOL remit. New
areas include Sutton Coldfield,
Solihull increased Birmingham
GP coverage
Increased referrals
Reduced DNAS
Enhanced Self Management
achievement

37. What we currently
provide:• Each year we work with over 800 patients to provide an accessible
structured support programme to enable improved self management
of their Type 2 Diabetes Diagnosis
• Some comments from those on courses in the last quarter: October
– December 2019
• “I have implemented a lot of the information from the course and can honestly say
it has made a positive impact on my health. My metabolism has increased as well
as my energy levels. I am very pleased with the outcome.”
• “I was very happy with this program; this helped with my diet exercise and gave a
good understanding on diabetes. Thank you”
• “Most interesting & productive, how to look now at sugar levels and content of
what I eat. I have learnt more about my eating program for the future, to help my
health. Thank you very much.”
•
• “Was very helpful. Gave me a better understanding of how much sugar was in
different things, real eye opener”
•
• “Excellent service, learnt a lot how to control diabetes”
• “Customer Satisfaction – Net Promoter Score is 86%

38. Background to the
approach –
• Health Exchange has provided Type 2 diabetes
management structured education courses for over 11
years – based on the Turin Model and conforms to Nice
Guidelines
“I have implemented a lot of the information
from the course and can honestly say it has
made a positive impact on my health. My
metabolism has increased as well as my
energy levels. I am very pleased with the
outcome.”

40. Referral
Routes
• Managing Your Diabetes Referral Criteria:
• Allocated Birmingham and Solihull GPs
• Those diagnosed with T2 Diabetes Diagnosed in
the last 12 months and 12 months plus for those
who have been diagnosed for longer but never
offered a structured Education Programme
• Who can refer: (GP/Practice Nurse/Diabetic Nurse
referrals
• Self Referral options also available
• GP Lists of those diagnosed – we make contact and
provide opportunities to access the programme
• Telephone: 0121 663 0007 (Single Point of Access
Team)

41. What has Covid-19 meant for our delivery
• Back in March - Initially lots of patients wanted to cancel the face to face sessions due to worries concerning
their health and their underlying conditions
• We adapted quickly and used this as an opportunity to support many more than would have attended if it
were only face to face as an option…Changing the way we deliver we moved to:
• Telephone one to one sessions – with pre prep and post session support
• Zoom Groups – with pre prep and post session support
• Evening Support – increased
• Weekend courses and support continued where required
• Material sent out to all participants by email/post
• Lists from GPs to support the increased access to structured education
• 412 patients across the BSOL footprint have completed a Type 2 Programme with us and we are ahead of
our post COVID expectation numbers and is on track to see over 850 patients by the end of March 2021
• We were able to think differently about how we deliver now and, in the future,
• Sign posting to a range of apps – including ‘whisk’ Diabetes PA etc

42. Facilitator
feedback from
patients
regarding
having
courses run
on zoom –
• Many people who have been shielded during the COVID-19 can join the zoom
• People who less mobile find the zoom better particularly If the community venue is at a
distance
• Saves travel time and expenses - Helps people who are on benefits saving money
• Helps individual who have mental health issues, because it helps their anxiety being in
the comfort of their home, and do not have to mix with other people.
• Some clients are shy and nervous and switch off their video to allow audio
• Zoom is good for individual with visual impairment, the conference has allowed them
live audio interactions.
• Clients are working, during COVID working at home, so they can take an hour out to join
the zoom.
• Also, some clients are joining zoom at work, they can take a break for an hour, and they
do not need to take time off work.
• Zoom groups can be delivered anytime during the day, even in the evening and
weekend.
• Having zoom groups in home environment allows individual to be more relaxed and
more focused, which gives them more confidence to interact and explain their feelings
in the meeting.
• In the zoom group they feel more in control
• Saves money as the clients normally have someone at home to translate.
• They receive online chair exercise/ yoga exercise on zoom, which helps their breathing
exercise, controlling their weight, blood pressure and diabetes.
• Also, older patients bus pass starts after nine thirty, so it is difficulty for them to arrive
on time.

43. Thank you

45.  Important: Coronavirus and Diabetes
• https://www.diabetes.org.uk/about_us/news/
coronavirus
 My Diabetes My Way app:
• https://www.nhs.uk/apps-library/my-
diabetes-my-way/
 Translated information on Diabetes:
• https://www.diabetes.org.uk/diabetes-the-
basics/information-in-different-languages
 Diabetes UK:
• https://www.diabetes.org.uk/
 Information on free activities:
• https://theaws.co.uk/about-us/
Useful Resources

46. PAGE 46

47. KEEPING IN TOUCH
BHealthy handouts can be found on our website
https://www.birmingham.gov.uk/info/50238/wellbeing_during_the_coronavirus_covid-19/2247/bhealthy
The full list of BHealthy webinars
https://www.birmingham.gov.uk/info/50238/wellbeing_during_the_coronavirus_covid-19/2247/bhealthy/2
For support with BHealthy or general enquires email
healthybrum@birmingham.gov.uk
or for Covid enquires email
BCCCovid19@birmingham.gov.uk