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Medical evidence used in this website

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Medical evidence used in this website

Medical evidence used in this website includes guides from UK Department of Health,  UK NHS National Institute for Clinical Excellence (NICE), the UK NHS, charity Diabetes UK,  plus key international research papers, as follows.

 The medical evidence used in this website, listed below, comprises comprehensive reviews in big professional randomised controlled trials printed in independent, reliable published sources. These include recent peer reviewed articles in reputable scientific journals, and the recommendations of nationally recognised expert consensus panels based on this medical evidence.

With every item of evidence listed you are given the detailed reference so that you can look up online and study the published report or guide if you wish.

1. Health state life expectancies by national deprivation deciles, England: 2017 to 2019. Life expectancy and years expected to live in “Good” health and disability-free using national indices of deprivation to measure socioeconomic inequalities in England. England Office for National Statistics, Release date: 22 March 2021. [Good cholesterol & blood pressure, not smoking & not having diabetes, you’ll live longer.]

2. Evaluation of the uptake and delivery of the NHS Health Check programme in England, using primary care data from 9.5 million people: a cross-sectional study, Riyaz Patel et al. BMJ Open 2020;10:e042963. doi: 10.1136/bmjopen-2020-042963. [reveals an uptake rate of 56% and no significant evidence of inequity by ethnicity or deprivation. To maximise value of the NHSHC, we suggest continued action to invite more eligible people for a check, reduce geographical variation in uptake (from 25% to 85% in different areas), prioritise engagement with non-attendees and promote greater use of evidence-based interventions especially where risk is identified.]

3. Type 2 diabetes: prevention in people at high risk, NICE Public Health guideline [PH38], July 2012, updated Sept. 2017. [Identify those at risk, risk-assess score &  blood test. Then lifestyle-change plan to prevent T2, and offer a 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. Ten-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, NHS NICE Clinical Guideline CG181, updated Sept. 2016. [Change your diet, stop smoking, reduce alcohol, take more exercise to lower cholesterol & reduce blood pressure. This will 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 QRISK3,  statins,  lifestyle changes, review 3 months after]. Information 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. Development and validation of QRISK3 risk prediction algorithms to estimate future risk of cardiovascular disease: prospective cohort study,  J Hippisley-Cox et al. BMJ 2017; 357 doi:, 23 May 2017.

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. Favourable 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  2017-18:  Short Report Care Processes and  Treatment Targets, NHS Digital, 8 November 2018. [less than 40% of those with diabetes are achieving their 3 new NICE recommended treatment targets (for HbA1c glucose control, blood pressure and statins). Those with Type 1 diabetes were less likely to achieve them than those with Type 2].

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: [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 number of strokes & heart attacks by half].

26. Eating disorders: recognition and treatment, Information for the public, NICE Guideline NG 69, 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 diabetesWorld Health Organization, ISBN 978 92 4 156525 7, 2016. [Encourages us all to eat healthily, be physically active, and avoid weight gain. Number 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. People of South Asian and black ethnic backgrounds 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 6 g/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 (accessed 29/07/18). [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 is £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 (5 mmol/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, 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 [ref. 37 below, 2015], These show that aggressively treating BP down to 120 mm Hg saves lives. This means another 14% of Americans will be diagnosed with high BP.  Only 2% more will need prescriptions as this part of 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, low intake of some foods was linked with an estimated 318,656 deaths due to heart disease, stroke, or type 2 diabetes. The highest proportions of such 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 MRSA and Clostridium difficile].

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

41. American Association of Clinical Endocrinologists & American College of Endocrinology: Guidelines for management of dyslipidemia and prevention of cardiovascular disease, Paul S. Jellinger, MD, MACE, Chair. et al., Endocrine Practice Vol 23 (Suppl 2) April 2017 [recommendations on treatment goals. testing, fitness therapy, diet, statins, ezetimibe, fish oil, measurement of homocysteine and inflammatory markers, etc.]

42. Dementia and comorbidities – Ensuring parity of care, Jonathan Scrutton and Cesira Urzì Brancati, The International Longevity Centre – UK, April 2016.  Download from [a failure to prevent, diagnose, and treat depression, diabetes and urinary tract infections in people with dementia could be costing the UK’s health and social care system up to nearly £1 billion per year.]

43. Association between systolic blood pressure and dementia in the Whitehall II cohort study: role of age, duration, and threshold used to define hypertension, Abell JG et al., Eur Heart J. 2018 Sep 1;39(33):3119-3125. doi: 10.1093/eurheartj/ehy288. [People with longer exposure to high blood pressure (SBP ≥ 130 mm Hg) between mean ages of 45 and 61 years have an increased risk of dementia compared to those without it.]

44. Patient explanations for non‐attendance at structured diabetes education sessions for newly diagnosed Type 2 diabetes: a qualitative study, K. Winkley et al,  01 August 2014, [Many patients are not ready to self-manage early in their illness, but become motivated later, often as a result of a change in medication or development of a complication. The intervention is low cost, and as most costs are fixed, irrespective of number of users, is likely to be cost-effective, particularly if widely used.]

45. Low cigarette consumption and risk of coronary heart disease and stroke: meta-analysis of 141 cohort studies in 55 study reports, BMJ 2018; 360 doi:, 24 January 2018. [Smoking only about one cigarette per day carries a risk of developing coronary heart disease and stroke much greater than expected: around half that for people who smoke 20 per day. No safe level of smoking exists for cardiovascular disease.]

46.  Consumers Are Ready to Adopt Mobile Health Faster than the Health Industry is Prepared to Adapt, PwC Study on Global mHealth Adoption, 2012. [Widespread adoption of mobile technology in healthcare is inevitable in both developed and emerging markets; the pace of adoption will be led by emerging markets and lag consumer demand. Consumers have high expectations for mHealth, particularly in developing economies as mobile cellular subscriptions become ubiquitous. Barriers are not technology but rather systemic to healthcare and inherent resistance to change. The use of mHealth will be determined in each country by stakeholders’ response to mHealth as a disruptive innovation to overcome structural impediments and align interests around patients’ needs and expectations]. Research by Maastricht University came to similar  conclusions.

47. Deleterious Effects of Bed Rest Among Older Persons, Thomas M. Gill et al., Yale University School of Medicine, Department of Internal Medicine, Journal of Gerontology: The Gerontological Society of America 2004, Vol. 59A, No. 7, 755–761. [Episodes of bed rest among community-living older persons are associated with decline in several activities of daily living, mobility, physical activity, and social activity.]

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

48. Alexander Mok, Nick Wareham, et al. Physical activity trajectories and mortality: population based cohort study. BMJ, 2019; l2323 DOI: 10.1136/ [people who met criteria for all five lifestyle habits enjoyed significantly longer lives than those who had none: 14 years for women and 12 years for men (if they had these habits at age 50). People who had none of these habits were far more likely to die prematurely from cancer or cardiovascular disease].

49. Impact of Healthy Lifestyle Factors on Life Expectancies in the US Population, Yanping Li et al. Originally published 30 Apr 2018, Circulation. 2018; 138:345–355. [Adopting a healthy lifestyle could substantially reduce premature mortality and prolong life expectancy in US adults.]

50. Prediction of ischaemic and haemorrhagic stroke by self-measured blood pressure at home: the Ohasama study, Ohkubo T. et al., Blood Press Monit. 2004 Dec;9(6):315-20. [shows a linear relationship between home blood pressure and risk of stroke and subtypes. On average, each 10/5 mmHg elevation in home blood pressure respectively, was associated with an approximately 30/20% respectively, higher risk of total stroke. A similar relationship was observed for the risk of haemorrhagic stroke, and the risk of ischaemic stroke.]

51. Health profile for England: 2021, [annual profile combining data and knowledge from several sources to give a broad picture], 15 September 2021, UK Government.

52. Treatment of Diabetes in Older Adults: An USA Endocrine Society Clinical Practice Guideline, Derek LeRoith, M Hassan Murad et al.. The Journal of Clinical Endocrinology & Metabolism, Volume 104, Issue 5, May 2019, Pages 1520–1574, 23, March 2019. [Formulation of clinical practice guidelines for the treatment of diabetes in older adults, by a group of USA experts drawing on latest research results. Aging effects interact with diabetes to accelerate the progression of many common diabetes complications. This guideline covers all aspects of the etiology and available evidence, primarily from controlled trials, to give guidance to HCPs that will benefit patients with diabetes (both type 1 and type 2), and avoid unnecessary and/or harmful adverse effects.]

53. Health state life expectancies by national deprivation deciles, England: 2016 to 2018, Life expectancy and years expected to live in “Good” health using national indices of deprivation to measure socioeconomic inequalities in England, Office for National Statistics, 27 March 2020 . [A girl born in one of the most deprived areas of England is expected to live 19 fewer years in “good” health than one born in one of the least deprived areas].

54. Accelerometer measured physical activity and the incidence of cardiovascular disease: Evidence from the UK Biobank cohort study, Rema Ramakrishnan et al., Published: January 12, 2021, [“In this study of 90,000 people in the UK Biobank cohort study, we found no evidence of a threshold for the inverse association between objectively measured moderate, vigorous, and total physical activity (PA) with CVDs. Our findings suggest that PA is not only associated with lower risk of CVDs, but the greatest benefit is seen for those who are active at the highest level”.]

55. Goon S, Kim H and Giovannucci EL. Population attributable risk for colorectal and breast cancer in England, Wales, Scotland, Northern Ireland, and the United Kingdom [version 1; peer review: awaiting peer review]. AMRC Open Res March 2021, 3:11. 

56. Joint association of physical activity and body mass index with cardiovascular risk: a nationwide population-based cross-sectional study, Pedro L Valenzuela et al, European Journal of Preventive Cardiology, 26 January 2021 [ ‘Fat but fit’ people DO have worse heart health than normal weight people who don’t exercise, Researchers in Spain analysed data on the health of 527,662 working adults].

57. Gondek, D., Bann, D., Brown, M. et al. Prevalence and early-life determinants of mid-life multimorbidity: evidence from the 1970 British birth cohort. BMC Public Health 21, 1319 (2021). [1 in 3 British adults suffer from two or more long-term diseases in middle age, such as back problems, mental ill-health, high blood pressure, diabetes, and high-risk drinking, according to UCL researchers.]

58. Global burden of cancer in 2020 attributable to alcohol consumption: a population-based study, Harriet Rumgay, BSc , et al. Lancet Oncology, Open Access:July 13, 2021, DOI: [Although the main take-away message was that 4% of new cancer cases worldwide in 2020 were attributable to alcohol, it was also noteworthy that moderate drinking accounted for 103,100 out of 741,300 of these projected annual cases. The risk of cancer increases even with low or moderate levels of drinking. Drinking less means you’ll have a lower risk of cancer than if you drink heavily, but there is no safe limit of alcohol consumption. The study linked alcohol consumption with an increased risk of at least seven different cancer types, including cancers of the oral cavity, pharynx, larynx, esophagus, colon, rectum, liver, and breast.]

Note: We are not responsible for the content of the above linked external documents and websites.

page updated 06 January 2022.

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