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  2. Prevent the progress of diabetes
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  4. I want to achieve remission of my type 2 diabetes
  5. How can I reduce my risk factors for type 2 diabetes?
Important: please update your RDS app to version 4.7.3

Welcome to the March 2025 update from the RDS team

1.     RDS issues - resolutions

1.1 Stability issues - Tactuum implemented a fix on 24th March which we believe has finally addressed the stability issues experienced over recent weeks.  The issue seems to have been related to the new “Tool export” function making repeated calls for content when new toolkit nodes were opened in Umbraco. No outages have been reported since then, and no performance issues in the logs, so fingers crossed this is now resolved.

1.2 Toolkit URL redirects failing– these were restored manually for the antimicrobial calculators on the 13th March when the issue occurred, and by 15th March for the remainder. The root cause was traced to adding a new hostname for an app migrated from another health board and made live that day. This led to the content management system automatically creating internal duplicate redirects, reaching the maximum number of permitted redirects and most redirects therefore ceasing to function.

This issue should not happen again because:

  • All old apps are now fully migrated to RDS. The large number of migrations has contributed to the high number of automated redirects.
  • If there is any need to change hostnames in future, Tactuum will immediately check for duplicates.

1.3 Gentamicin calculators – Incidents have been reported incidents of people accessing the wrong gentamicin calculator for their health board.  This occurs when clinicians are searching for the gentamicin calculator via an online search engine - e.g. Google - rather than via the health board directed policy route. When accessed via an external search engine, the calculator results are not listed by health board, and the start page for the calculator does not make it clearly visible which health board calculator has been selected.

The Scottish Antimicrobial Prescribing Group has asked health boards to provide targeted communication and education to ensure that clinicians know how to access their health board antimicrobial calculators via the RDS, local Intranet or other local policy route. In terms of RDS amendments, it is not currently possible to change the internet search output, so the following changes are now in progress:

  • The health board name will now be displayed within the calculator and it will be made clear which boards are using the ‘Hartford’ (7mg/kg) higher dose calculator
  • Warning text will be added to the calculator to advise that more than one calculator is in use in NHS Scotland and that clinicians should ensure they access the correct one for their health board. A link to the Right Decision Service list of health board antimicrobial prescribing toolkits will be included with the warning text. Users can then access the correct calculator for their Board via the appropriate toolkit.

We would encourage all editors and users to use the Help and Support standard operating procedure and the Editors’ Teams channel to highlight issues, even if you think they may be temporary or already noted. This helps the RDS team to get a full picture of concerns and issues across the service.

 

2.     New RDS presentation – RDS supporting the patient journey

A new presentation illustrating how RDS supports all partners in the patient journey – multiple disciplines across secondary, primary, community and social care settings – as well as patients and carers through self-management and shared decision-making tools – is now available. You will find it in the Promotion and presentation resources for editors section of the Learning and support toolkit.

3.     User guides

A new user guide is now available in the Guidance and tips section of Resources for providers within the Learning and Support area, explaining how to embed content from Google Calendar, Google Maps, Daily Motion, Twitter feeds, Microsoft Stream and Jotforms into RDS pages. A webinar for editors on using this new functionality is scheduled for 1 May 3-4 pm (booking information below.)

A new checklist to support editors in making all the checks required before making a new toolkit live is now available at the foot of the “Request a new toolkit” standard operating procedure. Completing this checklist is not a mandatory part of the governance process, but we would encourage you to use it to make sure all the critical issues are covered at point of launch – including organisational tags, use of Alias URLs and editorial information.

4.Training sessions for RDS editors

Introductory webinars for RDS editors will take place on:

  • Tuesday 29th April 4-5 pm
  • Thursday 1st May 4-5 pm

Special webinar for RDS editors – 1 May 3-4 pm

This webinar will cover:

  1. a) Use of the new left hand navigation option for RDS toolkits.
  2. b) Integration into RDS pages of content from external sources, including Google Calendar, Google Maps and simple Jotforms calculators.

Running usage statistics reports using Google analytics

  • Wednesday 23rd April 2pm-3pm
  • Thursday 22nd May 2pm-3pm

To book a place on any of these webinars, please contact Olivia.graham@nhs.scot providing your name, role, organisation, title and date of the webinar you wish to attend.

5.New RDS toolkits

The following toolkits were launched during March 2025:

SIGN guideline - Prevention and remission of type 2 diabetes

Valproate – easy read version for people with learning disabilities (Scottish Government Medicines Division)

Obstetrics and gynaecology induction toolkit (NHS Lothian) – password-protected, in pilot stage.

Oral care for care home and care at home services (Public Health Scotland)

Postural care in care homes (NHS Lothian)

Quit Your Way Pregnancy Service (NHS GGC)

 

6.New RDS developments

Release of the redesign of RDS search and browse, archiving and version control functionality, and editing capability for shared content, is now provisionally scheduled for early June.

The Scottish Government Realistic Medicine Policy team is leading development of a national approach to implementation of Patient-Reported Outcome Measures (PROMs) as a key objective within the Value Based Health and Care Action Plan. The Right Decision Service has been commissioned to deliver an initial version of a platform for issuing PROMs questionnaires to patients, making the PROMs reports available from patient record systems, and providing an analytics dashboard to compare outcomes across services.  This work is now underway and we will keep you updated on progress.

The RDS team has supported Scottish Government Effective Prescribing and Therapeutics Division, in partnership with Northern Ireland and Republic of Ireland, in a successful bid for EU funding to test develop, implement and assess new integrated care pathways for polypharmacy, including pharmacogenomics. As part of this project, the RDS will be working with NHS Tayside to test extending the current polypharmacy RDS decision support in the Vision primary care electronic health record system to include pharmacogenomics decision support.

7. Implementation projects

We have just completed a series of three workshops consulting on proposed improvements to the Being a partner in my care: Realistic Medicine together app, following piloting on 10 sites in late 2024. This app has been commissioned by Scottish Government Realistic Medicine to support patients and citizens to become active partners in shared decision-making and encouraging personalised care based on outcomes that matter to the person. We are keen to gather more feedback on this app. Please forward any feedback to ann.wales3@nhs.scot

 

 

Risk factors

The key risk factors for developing type 2 fall into two categories:

Modifiable risk factors

These are risk factors that you can change and control. 

Non-modifiable risk factors

These are risk factors you cannot change yourself. However you can still reduce your risk of developing type 2 diabetes by acting on the modifiable risk factors such as weight loss.

Find out more about each of these types of risk factor by clicking on the links below.

 

1.Excess body weight

Bathroom scales        tape measure

Your weight plays a large role in developing  type 2 diabetes, especially if your extra weight is around your waist. 

What is a healthy weight to aim for?

This is about working out your Body Mass Index (BMI).  BMI uses your height and weight to work out if you're a healthy weight.  You can work your BMI out for yourself using this NHS tool  – it will show you your target range.

For many people living with obesity, aiming for a healthy BMI may not be realistic. Research shows that  even losing just 5% of extra weight will improve your health. The more weight you lose, the greater the health benefits.

What is a healthy waist size?

BMI  doesn’t look at how much fat you have around the middle. That is why you need to measure your waist too.

Healthy weight size all depends on your gender and ethnicity. For a healthy measurement you need to aim to be less than:

  • 80cm (31.5in) for all women
  • 94cm (37in) for most men
  • 90cm (35in) for South Asian men.

This video from Diabetes UK shows you how to measure your waist size.

2. Physical activity 

physical activity

 It is estimated that 1 in 3 women, and 1 in 4 men in the UK do not undertake enough activity to stay healthy.

It is recommended that we all undertake at least 150 minutes of moderate-intensity exercise, or 75 minutes of high-intensity exercise per week.

Being active can:

  • Contribute to weight loss
  • Increase the way your body uses insulin, reducing the period of time blood glucose levels remain high. 
  • Use fat for fuel in endurance exercise such as running or swimming. This reduces levels of fat around your waist.

Exercise videos

This playlist of short videos from Diabetes UK gives you lots of exercise options to choose from. They range from gentle arm and leg movements to dance and a full body workout.

3. Smoking

smoking

In the UK, 15% of people aged 18 years and over are said to be active smokers. This means that there are  some 7.2 million active smokers that are putting themselves at risk of type 2 diabetes.

Smokers are estimated to be 30% to 40% more likely to develop T2DM than nonsmokers. Cigarette smoke has been found to contain more than 7000 harmful chemicals, many of which can decrease the effectiveness of insulin as a result of  inflammation and damage cells as a consequence of oxidative stress.

Additionally, the nicotine from smoking can reduce the effectiveness of insulin, resulting in active smokers finding it harder to manage blood glucose levels. 

If you have prediabetes or a previous diagnosis of gestational diabetes, you already have an increased chance of developing cardiovascular disease, such as a heart attack, stroke or circulatory problems in the legs.

Combine this with smoking and you make the chances of developing these diseases and their complications even higher.

Help to stop smoking

NHS inform provides a suite of support and resources to help you to stop smoking. This includes the Quit your Way Scotland service. This is staffed by a team of trained advisors who will give you advice tailored to your needs.  

4. Stress 

 stress

Stress  hormones cause an increase in blood glucose levels and reduce the effectiveness of insulin. 

For some people, stress can also trigger overeating behaviours. The change in body chemicals resulting from eating “comfort foods'' can dampen stress related responses and emotions. Over time, this can lead to prolonged levels of comfort eating and, ultimately, an increase in body weight and the development of T2DM. 

1.Age

image of ageing

You’re more at risk of developing type 2 diabetes if you’re:

  • White and over 40 years old
  • African-Caribbean, Black African, or South Asian and over 25 years old.

As we age, our bodies naturally begin to function less efficiently than they did when we were younger. This includes our body becoming less efficient in producing insulin. That can increase our risk of developing type 2 diabetes as we get older. 

2.Genetics

image of DNA

  • You’re two to six times more likely to get type 2 diabetes if you have a parent, brother, sister or child with diabetes.

The genetic risk comes from changes in the parts of our DNA that help to control our blood glucose levels. Some of these changes can reduce our body's ability to release insulin. This leads to increases in blood glucose levels. Over time, elevated levels of blood glucose increases the risk of developing T2DM. 

3.Ethnicity

image representing ethnic diversity

  • Type 2 diabetes is two to four times more likely in people of South Asian descent and African-Caribbean or Black African descent.

While the exact cause of this increased risk among different ethnicities is not fully understood, it is likely that our genetics that are passed down to us and determine who we are play a large role.