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Five amazing health research breakthroughs in the last 12 months

As unprecedented times highlight the importance of health research, we’re looking back over some of the most incredible advances from the national institute for health and care research (nihr) in 2020-2021 so far..

Have you become more interested in health research over the last year? If so, you’re not alone. 

With the COVID-19 pandemic putting a spotlight on the nation’s wellbeing, more of us than ever are realising the importance of medical research – and coming to understand the vital role it plays in shaping our society and healthcare systems. 

Why is health research so important?

Health research is critical to making sure that we’re providing the best possible care for everyone – both today, and in the future. Whether our knowledge is gained through clinical trials, equipment testing, surveys, questionnaires or data analysis, the answers we find help us improve our processes, healthcare and make positive change. 

In fact, some of the most important medical discoveries over the past 80 years – including aspirin, penicillin and the contraceptive pill – would never have come about if it weren’t for the hard work of scientists, researchers and volunteers.  

As the nation’s largest funder of health and care research, the NIHR is dedicated to gathering the robust knowledge which makes such discoveries possible.

It’s thanks to health research that we’re able to:

• Improve diagnosis time and accuracy  
• Better understand how to prevent conditions from developing
• Fight new strains of viruses 
• Provide life-saving treatments and procedures
• Ease suffering and improve care 

Five amazing health research breakthroughs

1. The Oxford/AstraZeneca COVID-19 Vaccine

It was the discovery the world had been waiting for: in 2020, the Oxford/AstraZeneca vaccine was found to be effective at preventing COVID-19 and offering a high level of protection .

• The vaccine was developed by biopharmaceutical company AstraZeneca alongside the University of Oxford. Development of the vaccine was funded by the UK Research and Innovation (UKRI) and the Department of Health and Social Care through the NIHR.
• Clinical trials enrolled more than 24,000 participants from around the world – from the UK to South Africa.
• The vaccine was made from a weakened version of a common cold virus (adenovirus), genetically modified to be unable to grow in humans.
• Trials showed that the vaccine was 70.4% effective – or 90% effective when administered in a half dose followed by a full dose – and that it could also prevent transmission.
• Within just 5 months of being approved, around 17 million people in the UK and EU had received a dose of this life-saving vaccine.

2. The human liver repaired using lab-grown cells

In 2021, in the first procedure of its kind, researchers demonstrated a new technique to show that a damaged human liver could be repaired with mini bile-ducts grown in a lab .

• With a shortage of liver donors, researchers supported by the NIHR Cambridge Biomedical Research Centre aimed to develop an alternative to transplantations.
• Malfunctioning bile ducts, which act as the organ’s waste disposal system, are the cause of 70% of liver transplants in children, and a third in adults.
• The researchers used this technique to grow new ‘mini-bile ducts’ in the lab.
• Research showed that biliary cells from the human gallbladder could be converted into bile duct cells to replace and repair the damaged bile ducts.
• This is the first time a procedure of this kind has been used on human organs and this breakthrough could increase the number of suitable donor livers.
• This approach could also be applied to range of organs and diseases, to further accelerate cell-based therapy research.

3. The super effective single-dose breast cancer treatment 

Led by researchers at University College London in 2020, a pioneering breast cancer therapy was found to be as effective as conventional treatment – while taking just 30 minutes. 

• The study was funded by the NIHR’s Health Technology Assessment Programme and Cancer Research UK, and involved 32 hospitals in ten countries. Results confirmed the effectiveness of Target Intraoperative Radiotherapy (TARGIT-IORT) , a treatment which is delivered directly after tumour removal and which acts as both surgery and radiation treatment at once.
• TARGIT-IORT works via a small ball containing a single dose placed inside the breast.
• The conventional treatment for breast cancer – external beam radiotherapy (EBRT) – takes 3-6 weeks of daily treatment; TARGIT-IORT takes just 20-30 minutes.
• TARGIT-IORT also has fewer radiation-related side effects, a better cosmetic outcome and leads to a substantial reduction in deaths from causes other than breast cancer.

4. The steroids and arthritis drugs saving the lives of COVID-19 patients

Researchers on the NIHR-funded and supported RECOVERY study (Randomised Evaluation of COVID-19 therapy) which examined multiple drugs and their effects on COVID-19 recovery for hospitalised patients, discovered that the steroid dexamethasone and the arthritis treatment tocilizumab were able to dramatically reduce the risk of death for patients with severe COVID-19. 

• In 2020, the dexamethasone study compared the results of 2104 patients randomly selected to receive dexamethasone once per day for ten days, and 4321 patients randomly selected to receive usual care alone
• Dexamethasone was found to reduce the risk of 28-day mortality by 17% , with a significant trend showing greatest benefit among those on ventilators
• Dexamethasone has since been reported to have saved 22,000 lives in the UK and an estimated one million worldwide in the treatment of COVID-19
• In 2021, tocilizumab was found to reduce the length of hospital admission and the risk of patients requiring mechanical ventilation 
• 2022 patients were randomly allocated to receive tocilizumab by intravenous injection. Results were compared with 2094 patients randomly allocated to usual care alone.
• The study showed that for every 25 patients treated with tocilizumab, one additional life would be saved.

5. The oral antibiotic advancing cystic fibrosis treatment

The conclusion of a 10-year trial in 2020 revealed that oral antibiotics could successfully be used to treat a common cystic fibrosis complication at home .

The study was funded by NIHR, sponsored by University Hospitals Bristol and Weston NHS Foundation Trust, and developed with researchers from The University of Nottingham’s School of Medicine.

• 286 patients took part in the study, which was conducted over 70 cystic fibrosis centres across the UK and Italy.
• Patients with cystic fibrosis are prone to infection by a bacterium called Pseudomonas aeruginosa, which causes chronic destructive lung infections.
• The study found that traditional oral antibiotics are just as effective as intravenous antibiotics in tackling Pseudomonas aeruginosa.
• No longer requiring intravenous medication means that patients can be treated in the comfort of their own home, improving the quality of life for many people with cystic fibrosis.

Getting involved with health research

From the life-saving procedures to the discoveries that have improved treatment, none of these breakthroughs in health research would have been possible without the support of volunteers.

That’s why it’s so important to get as many people as possible interested in research – because only through working together will we keep advancing the field of medical care. 

There are many different types of health research and ways to get involved, and you don’t need to have a medical condition in order to help with research.  

Ready to see how you can make a difference in health research?  Find a study in your area today . 

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Our founding institutes

The crick began operating in april 2015 when the mrc's national institute for medical research and cruk's london research institute (at lincoln's inn fields and clare hall) merged. groups from the founding institutes began moving into the crick from 2016..

The Clare Hall laboratories, along with Lincoln's Inn Fields, were the principal research facilities of the former Imperial Cancer Research Fund (ICRF), prior to its amalgamation with the Cancer Research Campaign (CRC) to form Cancer Research UK in 2002.

Clay Hall, as it was originally called, was built around 1745 by Thomas Roberts, a linen draper of St Albans. It was renamed Clare Hall in 1750.

From 1886 to 1974 the building was used variously as a nunnery, a smallpox isolation hospital and then a treatment centre for treating tuberculosis and other thoracic cases, which closed in 1974.

The buildings remained empty until 1980 when they were acquired by the ICRF for scientific laboratories and support services. 

The Clare Hall laboratories were officially opened in 1986. Under the direction of Dr Tomas Lindahl, Clare Hall became a leading centre for studies of DNA repair, recombination and replication, cell cycle control and transcription. In addition, the site provided scientific support services of increasing sophistication to scientists throughout the ICRF. 

Upon the creation of Cancer Research UK in 2002, Clare Hall laboratories combined with the former ICRF's central laboratories in Lincoln's Inn Fields to form the Cancer Research UK London Research Institute (LRI). In 2005  John Diffley became director of the Clare Hall laboratories until it became part of the Crick in April 2015.

Lincoln's Inn Fields

The Cancer Research Fund was the UK's first specialist cancer research organisation when it formed in 1902. Before its formation, cancer research was carried out exclusively at hospitals. In 1904, the fund was renamed the Imperial Cancer Research Fund (ICRF).

ICRF laboratories occupied various locations in London until moving to a specialist laboratory block located adjacent to the Royal College of Surgeons in Lincoln's Inn Fields in the 1950s. The new laboratories were opened by Her Majesty Queen Elizabeth II on 11 June 1963, under the directorship of Guy Mariann.

Michael Stoker took over as Director in 1968 and established the laboratories as a world-leading centre for DNA and RNA tumour virus biology. A new laboratory extension opened in 1973, doubling the size of the laboratories. 

Walter Bodmer took over as scientific director of the laboratories in 1979, presiding over a substantial expansion of research into human cancer genetics. Paul Nurse took the helm in 1994.

In addition to housing more than 40 independent research groups, the building supported sophisticated research services including electron and light microscopy, mass spectrometry, informatics and pathology. 

Clare Hall laboratories combined with the former ICRF's central laboratories in Lincoln's Inn Fields to form the Cancer Research UK London Research Institute (LRI) in 2002.  Richard Treisman  served as the director of the institute before it became part of the Crick in April 2015.

The Medical Research Council was established in 1913 as the Medical Research Committee, and one of its first decisions was to establish a central institute in London. In 1914, the MRC National Institute for Medical Research (NIMR) was founded.

Premises at Mount Vernon Hospital in Hampstead were acquired but the outbreak of war in 1914 postponed occupation of the building. They were occupied in 1920, and the institute subsequently moved to its location at Mill Hill in 1950.

The building at Mill Hill was designed by Maxwell Ayrton, also the architect of nearby Wembley Stadium, and construction began in 1937. It was not officially opened by the Queen until the 1950, due to the outbreak of the Second World War.

Members of the Mill Hill laboratories, including five Nobel Laureates, have contributed notably to many fields of biomedical science. NIMR became part of the Crick in April 2015.

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The Francis Crick Institute is a unique partnership between

National Institute for Health Research (NIHR)

The National Institute for Health Research (NIHR) is the nation’s largest funder of health and care research and provides the people, facilities and technology that enables research to thrive. Working in partnership with the NHS, universities, local government, other research funders, patients and the public, the NIHR delivers and enables world-class research that transforms people’s lives, promotes economic growth and advances science.

The NIHR are primarily funded by the Department of Health and Social Care, but also receive UK Aid funding to support research for people in low- and middle-income countries.

The NIHR invests significantly in people, centres of excellence, collaborations, services and facilities to support health and care research in England. Collectively these form the NIHR infrastructure.

One part of the NIHR infrastructure are the 20 funded Biomedical Research Centres (BRCs) – of which Newcastle is one. These are collaborations between world-leading universities and NHS organisations that bring together academics and clinicians to translate lab-based scientific breakthroughs into potential new treatments, diagnostics and medical technologies.

The centres receive substantial levels of sustained funding – £816 million over five years – to create an environment where experimental medicine can thrive. They attract the best scientists and produce world-leading research, contributing to the local and national economy.

BRC funding supports researchers of the highest calibre to develop innovative research ideas that can attract investment from other funders, furthering the nation’s economic growth.

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Newcastle has a significant and growing range of NIHR centres, facilities and awards.

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The  NIHR is the UK’s largest funder of health and care research. Its mission is to improve the health and wealth of the nation through research. It delivers this through five strategic workstreams:

• fund, support and deliver high quality research
• engage and involve patients, carers and the public
• attract, train and support the best researchers
• invest in world-class infrastructure and a skilled delivery workforce
• partner with other public funders, charities and industry

The NIHR’s scope is very broad. It encompasses early translational research, clinical trials and applied health and care research.

It is primarily funded by the Department of Health and Social Care. It works in partnership with the NHS, universities, local government, other research funders, patients and the public. It enables world-class research transforming lives, promoting economic growth and advancing science.

NIHR in Newcastle

Newcastle is one of only eight Academic Health Science Centres in the UK. These are partnerships between top universities and NHS organisations. Together, they combine excellence in research, health education and patient care.

Newcastle Health Innovation Partners  brings the region’s world-class research, NHS and city partners together. They address the health inequalities and medical needs of people in the North East and North Cumbria.

Newcastle hosts a NIHR Biomedical Research Centre , one of 20 in England. It's the only Biomedical Research Centre which targets:

• long-term conditions
• multimorbidity across the life course

Such Centres bring together university academics and NHS-based clinicians. The aim is to translate scientific breakthroughs and innovative use of health data into new approaches to diagnosis and treatment.

Newcastle is also host to or involved in the following NIHR initiatives:

• Academic Health Science Centre: Newcastle Health Innovation Partners
• Academic Health Science Network North East and North Cumbria  
• Applied Research Collaboration, North East and North Cumbria  
• Blood and Transplant Research Unit in Organ Donation and Transplantation   
• Clinical Education Incubator
• Clinical Research Network North East and North Cumbria  
• Innovation Observatory  
• Methodology Incubator 
• Newcastle Clinical Research Facility 
• Newcastle Clinical Trials Unit  
• Newcastle In Vitro Diagnostics Co-operative  
• Older People and Frailty Policy Research Unit 
• Patient Safety Research Collaboration
• Policy Research Unit in Behavioural Science  
• Public Health Intervention Responsive Studies Teams (PHIRST)
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• Research Support Service Specialist Centre for Public Health
• School for Public Health Research  
• School for Primary Care Research  

Training clinical researchers of the future

Newcastle’s  Professor Dave Jones OBE  is Dean for the NIHR Academy. He assists the NIHR and universities in the leadership training and career management of all NIHR trainees.

We are also home to many NIHR Senior Investigators. They:

• provide research leadership to the NIHR
• promote clinical and applied research in health and social care
• constitute a network of experts who advise the Department of Health and Social Care

International Leprosy Association - History of Leprosy

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National Institute for Medical Research (NIMR), Mill Hill (later Francis Crick Institute)

On 1 April 2015, the Medical Research Council's National Institute for Medical Research (NIMR) became part of the new Francis Crick Institute.

The Crick is a consortium of six of the UK's most successful scientific and academic organisations - the Medical Research Council, Cancer Research UK, the Wellcome Trust, UCL (University College London), Imperial College London and King's College London.

Researchers from NIMR transferred to the Crick on 1 April 2015, but will be based at their existing location in Mill Hill, London, until they transfer to the new institute in early 2016.

As part of the National Institute for Medical Research, the Leprosy Committee of the Tropical Medicine Research Board emerged from the Leprosy Subcommittee of Colonial Medical Research Committee (CMRC). The origins of leprosy work at the National Institute for Medical Research can be traced to Robert Cochrane’s 1949 proposal for a Leprosy Subcommittee of the Colonial Medical Research Council. This proposal was titled "Memorandum on the Organisation of a Basic Research Unit in Leprosy with the Department of Tropical Medicine at the London School of Hygiene and Tropical Medicine Oct 1951 and Proposal for Field Research Units." In 1963, the Council was advised in the field of leprosy research by its Leprosy Committee (formerly a sub-committee of the Colonial Medical Research Committee) under the chairmanship of Sir John Boyd.

In 1963, Dr Dick Rees reported on the difficulties of leprosy research at the Medical Research Council: Tropical Medicine Research Board that "The continuing failure to culture the human leprosy bacillus in vitro or to transmit the infection to experimental animals as a routine procedure has seriously restricted the scope of both fundamental and applied research in leprosy. Even the simplest, though basically essential, laboratory techniques for studying an infectious disease cannot be used in leprosy. For example, it is impossible to prepare a specific vaccine against leprosy or to test in vitro for chemotherapeutically active drugs. Unfortunately, progress of research in leprosy has been limited, particularly because work in this field has been undertaken by personnel with inadequate training in research methods."

In October 1981, the Laboratory for Leprosy and Mycobacterial Research described the work they did in the following way:

"The majority of work in the laboratory deals with the pathogenesis, immunology, chemotherapy and biochemistry of leprosy. Much of this work is done in our role as a WHO Collaborative Centre of Reference and Research on M leprae, with great involvement in WHO programmes on immunology (IMMLEP) and therapy (THELEP) of leprosy. Although leprosy was one of the first human diseases shown to be caused by a bacterium it is still impossible to grow the organism in vitro, unlike almost all other known disease-causing agents. Unfortunately, as with many bacterial infections, drug resistant strains are emerging and trials are in progress to determine the drug/drugs to treat these. This necessitates the use of animal models to study the efficacy of drug treatments on some of the millions of leprosy sufferers in the world.

"However, biochemical studies aimed at determining the metabolism of the bacteria are being pursued and may lead to a method of in vitro culture, while some of the immunological studies being undertaken could lead to methods of early detection (and hence treatment before too much damage is done) or prevention (a vaccine)."

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New NIHR HRC launched for cardiovascular and respiratory medicine

by Jen Brogan | 22nd Apr 2024 | News

Guy’s and St Thomas’ and King’s College London (KCL) have launched a new HealthTech Research Centre (HRC) for cardiovascular and respiratory medicine.

The new centre is one of 14 new HRCs across England that received a total of £42m from the National Institute of Health and Care Research (NIHR).

Based within St Thomas’ hospital campus, the HRC will work with industry and academic partners to develop new technologies, medical devices and digital solutions for cardiovascular and respiratory medicine.

Designed as a ‘one stop shop’, the newly-launched HRC will specifically focus on four themes: cardiovascular disease in adults, technologies for children with congenital heart disease, cardiovascular interventions and respiratory medicine.

In addition, the HRC will develop technologies to support and promote the use of health- technology at home, as well as develop training for the next generation of health-technology innovators and researchers.

Rachel Clough, consultant vascular surgeon and clinical senior lecturer, surgical and interventional engineering, KCL and HRC co-director, commented: “Building on the extensive expertise in the management of cardiovascular diseases, respiratory conditions, biomedical and clinical engineering,…[the] centre…will foster and accelerate the translation to bedside of new promising technologies for the benefit of patients, the NHS and the British economy.”

In November 2023, the NIHR announced funding for new NIHR HRCs to work with businesses to support the development of medical devices, diagnostics and digital technologies to enable people to better monitor their health, diagnose ill health sooner, and improve the management of conditions including cancer, dementia, cardiovascular and respiratory disease.

In February, Cambridge University Hospitals NHS Foundation Trust announced that an innovative brain and spinal injury health technology research centre is set to open this April at Addenbrooke’s Hospital.

With £3m of the total NIHR funding, the Cambridge HRC will bring together NHS partners, businesses and patients from across the UK to develop technologies that improve care while patients are in hospital.

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• Published: 20 April 2024

“I am in favour of organ donation, but I feel you should opt-in”—qualitative analysis of the #options 2020 survey free-text responses from NHS staff toward opt-out organ donation legislation in England

• Natalie L. Clark 1 ,
• Dorothy Coe 2 ,
• Natasha Newell 3 ,
• Mark N. A. Jones 4 ,
• Matthew Robb 4 ,
• David Reaich 1 &
• Caroline Wroe 2  

BMC Medical Ethics volume  25 , Article number:  47 ( 2024 ) Cite this article

39 Accesses

Metrics details

In May 2020, England moved to an opt-out organ donation system, meaning adults are presumed to be an organ donor unless within an excluded group or have opted-out. This change aims to improve organ donation rates following brain or circulatory death. Healthcare staff in the UK are supportive of organ donation, however, both healthcare staff and the public have raised concerns and ethical issues regarding the change. The #options survey was completed by NHS organisations with the aim of understanding awareness and support of the change. This paper analyses the free-text responses from the survey.

The #options survey was registered as a National Institute of Health Research (NIHR) portfolio trial [IRAS 275992] 14 February 2020, and was completed between July and December 2020 across NHS organisations in the North-East and North Cumbria, and North Thames. The survey contained 16 questions of which three were free-text, covering reasons against, additional information required and family discussions. The responses to these questions were thematically analysed.

The #options survey received 5789 responses from NHS staff with 1404 individuals leaving 1657 free-text responses for analysis. The family discussion question elicited the largest number of responses (66%), followed by those against the legislation (19%), and those requiring more information (15%). Analysis revealed six main themes with 22 sub-themes.

Conclusions

The overall #options survey indicated NHS staff are supportive of the legislative change. Analysis of the free-text responses indicates that the views of the NHS staff who are against the change reflect the reasons, misconceptions, and misunderstandings of the public. Additional concerns included the rationale for the change, informed decision making, easy access to information and information regarding organ donation processes. Educational materials and interventions need to be developed for NHS staff to address the concepts of autonomy and consent, organ donation processes, and promote family conversations. Wider public awareness campaigns should continue to promote the positives and refute the negatives thus reducing misconceptions and misunderstandings.

Trial registration

National Institute of Health Research (NIHR) [IRAS 275992].

Peer Review reports

In England May 2020, Max and Kiera’s Law, also known as the Organ Donation (Deemed Consent) Bill, came into effect [ 1 , 2 ]. This means adults in England are now presumed to have agreed to deceased organ donation unless they are within an excluded group, have actively recorded their decision to opt-out of organ donation on the organ donor register (ODR), or nominated an individual to make the decision on their behalf [ 1 , 2 ]. The rationale for the legislative change is to improve the organ donation rates and reduce the shortage of organs available to donate following brain or circulatory death within the UK [ 2 , 3 , 4 ]. This is particularly important considering the growing number of patients awaiting a transplant. Almost 7000 patients were waiting in the UK at the end of March 2023 [ 5 ]. Wales was the first to make the legislative change in December 2015, followed by Scotland in March 2021 and lastly Northern Ireland in June 2023 [ 2 ]. Following the change in Wales, consent rates had increased from 58% in 2015/16 to 77% in 2018/19 [ 6 ], suggesting the opt-out system can significantly increase consent, though it further suggests that it might take a few years to fully appreciate the impact [ 7 , 8 ]. Spain, for example, has had an opt-out legislation since 1979 with increases in organ donation seen 10 years later [ 9 ].

Research, however, has raised concerns from both the public and healthcare staff regarding the move to an opt-out system. These concerns predominantly relate to a loss of freedom and individual choice [ 9 , 10 ], as well as an increased perception of state ownership of organs [ 10 , 11 , 12 ] after death. Healthcare staff additionally fear of a loss of trust and a damaged relationship with their patients [ 9 , 11 ]. These concerns are frequently linked to emotional and attitudinal barriers towards organ donation, understanding and acceptance [ 9 ]. Four often referenced barriers include (1) jinx factor: superstitious beliefs [ 13 , 14 , 15 ]; (2) ick factor: feelings of disgust related to donating [ 13 , 14 , 15 ]; (3) bodily integrity: body must remain intact [ 13 , 14 , 15 ]; (4) medical mistrust: believing doctors will not save the life of someone on the ODR [ 13 , 14 , 15 ]. The latter barrier is mostly reported by the general public in countries with opt-out systems [ 13 , 14 , 16 ] although medical mistrust does feature as a barrier across all organ donation systems. In addition, it is a reported barrier healthcare staff believe will occur in the UK under an opt-out system [ 9 , 16 ].

Deceased donation from ethnic minority groups is low in the UK, with family consent being a predominant barrier in these groups. Consent rates are 35% for ethnic minority eligible donors compared to 65% for white eligible donors [ 5 ]. The reasons for declining commonly relate to being uncertain of the person’s wishes and believing it was against their religious/cultural beliefs. Healthcare staff, particularly in the intensive care setting, have expressed a lack of confidence in communication and supporting ethnic minority groups because of language barriers and differing religious/cultural beliefs to their own [ 17 ]. However, one study has highlighted that generally all religious groups are in favour of organ donation with respect to certain rules and processes. Therefore, increasing knowledge amongst healthcare staff of differing religious beliefs would improve communication and help to sensitively support families during this difficult time [ 18 , 19 ]. However, individually and combined, the attitudinal barriers, concerns towards an opt-out system, and lack of understanding about ethnic minority groups, can have a significant impact within a soft opt-out system whereby the family are still approached about donation and can veto if they wish [ 11 , 12 , 20 ].

The #options survey [ 21 ] was completed online by healthcare staff from National Health Service (NHS) organisations in North-East and North Cumbria (NENC) and North Thames. The aim was to gain an understanding of the awareness and support to the change in legislation. The findings of the survey suggested that NHS staff are more aware, supportive, and proactive about organ donation than the general public, including NHS staff from religious and ethnic minority groups. However, there were still a number who express direct opposition to the change in legislation due to personal choice, views surrounding autonomy, misconceptions or lack of information. This paper will focus on the qualitative analysis of free-text responses to three questions included in the #options survey. It aims to explore the reasons for being against the legislation, what additional information they require to make a decision, and why had they not discussed their organ donation decision with their family. It will further explore a subset analysis of place of work, ethnicity, and misconceptions. The findings will aid suggestions for future educational and engagement work.

Design, sample and setting

The #options survey was approved as a clinical research study through the integrated research application system (IRAS) and registered as a National Institute of Health Research (NIHR) portfolio trial [IRAS 275992]. The survey was based on a previously used public survey [ 22 ] and peer reviewed by NHS Blood and Transplant (NHSBT). The free-text responses used in #options were an addition to the closed questions used in both the #options and the public survey. Due to the COVID-19 pandemic, the start of the survey was delayed by 4 months, opening for responses between July to December 2020. All NHS organisations in the NENC and North Thames were invited to take part. Those that accepted invitations were supplied with a communication package to distribute to their staff. All respondents voluntarily confirmed their agreement to participate in the survey at the beginning. The COnsolidated criteria for REporting Qualitative research (COREQ) checklist was used to guide analysis and reporting of findings [ 23 ], see Supplementary material 1 .

Data collection and analysis

The survey contained 16 questions, including a brief description of the change in legislation. The questions consisted of demographic details (age, sex, ethnicity, religion), place of work, and if the respondent had contact with or worked in an area offering support to donors and recipients. Three of the questions filtered to a free-text response, see Supplementary material 2 . These responses were transferred to Microsoft Excel to be cleaned and thematically analysed by DC. Thematic analysis was chosen to facilitate identification of groups and patterns within large datasets [ 24 ]. Each response was read multiple times to promote familiarity and initially coded. Following coding, they were reviewed to allow areas of interest to form and derive themes and sub-themes. Additional subsets were identified and analysed to better reflect and contrast views. This included, at the request of NHSBT, the theme of ‘misconceptions’. The themes were reviewed within the team (DC, CW, NK, NC, MJ) and shared with NHSBT. Any disagreements were discussed and agreed within the team.

Overall, the #options survey received 5789 responses from NHS staff. The COVID-19 pandemic further impacted on NHS organisations from North Thames to participate, resulting in respondents predominantly being from NENC (86%). Of the respondents, 1404 individuals (24%) left 1657 free-text responses for analysis. The family discussion question elicited the largest number of responses, accounting for 66% of the responses ( n  = 1088), followed by against the legislation at 19% ( n  = 316) and more information needed at 15% ( n  = 253). The responses to the against legislation question provided the richest data as they contained the most information. Across the three questions, there were six main themes and 22 sub-themes, see Table  1 . The large number of free-text responses illustrate the multifaceted nature of individuals views with many quotes containing overlap between themes and sub-themes.

Respondent characteristics

In comparison to the whole #options survey respondents, the free-text response group contained proportionally more males (21% vs 27%), less females (78% vs 72%), and marginally more 18–24year-olds (7% vs 8%), respectively. There were 5% more 55 + year olds in the free-text group, however all other age groups were between 2–3% lower when compared to the whole group. Additionally, the free-text group were more ethnically diverse than the whole group (6.9% vs 15.4%), with all named religions also having a higher representation (3.9% vs 7.3%), respectively.

Question one: I am against the legislation – Can you help us understand why you are against this legislation?

Of the three questions, this elicited the largest number of responses from males ( n  = 94, 30%), those aged over 55 years ( n  = 103, 33%), and ethnic minority responders ( n  = 79, 25%). Subset analysis of place of employment indicates 27% were from the transplant centre ( n  = 84), 8% were from the mental health trust ( n  = 26), and 4% from the ambulance trust ( n  = 14). Thematic analysis uncovered four main themes and 12 sub-themes from the responses, with the predominant theme being a perceived loss of autonomy.

Theme one: loss of autonomy

Respondents’ reasons for a loss of autonomy were categorised into four sub-themes. Firstly, calling into question the nature of informed consent and secondly, peoples’ awareness of the legislative change. One respondent stated individuals need to be “fully aware and informed” [R2943] in order to have consented to organ donation. However, one respondent stated that they believe individuals have “not [been] informed well” [R930] and thus “if people are not aware of it, how are they making a choice on what happens to their organs” [R1166] . It was suggested that awareness of the change may have “been overshadowed by COVID” [R4119] .

Furthermore, there was concerns regarding the means to record an opt-out decision, specifically to those that are “not tech savvy” [R167] , “homeless” [R5721] , “vulnerable” [R4553] , and “elderly” [R2155] . Therefore, removing that individual’s right to record their decision due to being at a disadvantage.

Finally, respondents expressed concerns of a move to an authoritarian model of State ownership of organs. This elicited strong, negative reactions from individuals under the belief the State would own and “harvest” a person’s organs under a deemed consent approach, with some removing themselves as a donor consequently, “I am furious that the Government has decided that my organs are theirs to assign. It is MY gift to give, not theirs. I have now removed myself as a long-standing organ donor.” [R593] .

Theme two: consequences

Following respondents stating their reason for being against the legislative change, they discussed further what they believed to be the consequences of an opt-out legislation, with a focus on trust. Respondents cited a lack of trust towards the system, “I have no Trust in the UK government” [R5374] , with some surprisingly citing a lack of trust towards healthcare professionals, “Don’t trust doctors in regard to organ donation” [R3010], as well as a fear of eroding trust with the general public, “This brings the NHS Organ Donation directly into dispute with the public.” [R1237]. Respondents additionally believed the legislative change would lead to an increase in mistakes i.e., organ’s being removed against a person’s wishes by presuming, “not convinced that errors won't be made in my notifying my objection and that this won't be dealt with or handed over correctly” [R3018]. Finally, it is believed this change would also lead to, “additional upset” [R587], for already grieving families.

Theme three: legislation

Respondents were additionally against the legislation itself as they believed it lacked an evidence-base to prove it is successful at increasing the numbers of organs donated. As well as this, respondents perceived the legislation as one that removed the donor’s choice as to which organs they want to donate, some with a religious attribute “I don't mind donating but would like choice of what I like to i.e., not my cornea as for after life I want to see where I am going.” [R5274].

Theme four: religion and culture

Religion and culture was another common theme with sub-themes relating to maintaining bodily integrity following death and the lack of clarity around the definition of brain death. Many others stated that organ donation is against their religion or, were “unsure whether organ donation is permissible” [R1067].

Question two: I need more information to decide—What information would you like to help you decide?

This question elicited the most responses from females ( n  = 188, 74%), those aged over 55 years ( n  = 80, 32%), with 19% being from ethnic minority groups ( n  = 49). Subset analysis of place of employment indicates 18% were from the transplant centre ( n  = 46), 8% were from the mental health trust ( n  = 18), and 9% from the ambulance trust ( n  = 23). Thematic analysis uncovered a main theme of “everything” . There were many responses that did not specify what information was required, but indicated that more general information on organ donation was required, within this there were five sub-themes.

Sub-themes:

The first sub-theme identified a request for information around the influence a family has on the decision to donate and the information that will be provided to families. This included providing “emotional wellbeing” [R162] support, and information on whether families can “appeal against the decision” [R539] or “be consulted” [R923] following their loved one’s death. This was mainly requested by those employed by transplant centres.

The second request was for information on the “process involved after death for organ retrieval” [R171] , predominantly by ethnic minority groups and those employed by the mental health trusts, with specific requests on confirming eligibility. Other examples of requested information on the process and pathway included “how the organs will be used” [R1086] , “what will be donated” [R1629] , and “who benefits from them” [R3730] .

The third request was information regarding the publicity strategy to raise awareness of the legislative change. Many of the respondents stated they did not think there was enough “coverage in the media” [R3668]. Additional considerations of public dissemination were to ensure it was an “ easy read update” [R137 3 ] , specifically for “the elderly or those with poor understanding of English who may struggled with the process” [R1676] .

The fourth request was information around the systems in place to record a decision. There were additional requests for the opt-out processes if someone was within the excluded group and “what safeguards are in place” [R3777], as well as what if individuals change their mind and the ease of recording this new decision.

Finally, and similarly to the first question, the fifth request was information for an evidence-base. Respondents stated that they, “would like to know the reasons behind this change” [R3965] , believing that if they had a greater understanding then this might increase their support towards the legislative change.

Question three: Have you discussed your decision with a family member? If no, can you help us understand what has stopped you discussing this with your family?

The free-text responses to analyse were from those who responded “No” to, “Have you discussed your decision with a family member?”. This received 1430 responses with females ( n  = 1025, 27%) predominantly answering “No”. However, not everyone left a free-text response, leaving 1088 comments for analysis. These were predominantly made by those aged over 55 years ( n  = 268, 24%), with 5% being from ethnic minority groups ( n  = 49). Subset analysis of the 1088 responses regarding place of employment indicated 14% were from the transplant centre ( n  = 147), 7% were from the mental health trust ( n  = 78), and 9% from the ambulance trust ( n  = 96). The analysis uncovered a main theme of priority and relevance made up of five sub-themes.

The first sub-theme identified one reason to be that it was their “individual decision” [R3] and there would be “nothing to be gained” [R248] from a discussion. Some respondents stated that despite a lack of discussion, their family members would assume their wishes in relation to organ donation and support these, “I imagine they are all of the same mindset” [R4470]. However, some stated their reasons to be because they “don’t have a family” [R1127] to discuss this with or have “young ones whose understanding is limited about organ donation” [R356] . Positively, there were several respondents who suggested the question had acted as a prompt to speak to their family.

Another reason stated by respondents was that they found the topic to be too difficult to discuss due to “recent bereavements” [R444], “current environment” [R441] , and “a reluctance to address death” [R4486] . As evident in the latter quote, many respondents viewed discussions around death and dying as a “taboo subject” [R3285] , increasing the avoidance of having such conversations.

Finally, the fifth reason was that several respondents “had not made any decision yet” [R2478] . One respondent wanted to ensure they had reviewed all available information before deciding and having a well-informed discussion with them.

Misconceptions

A further subset analysis of responses coded as misconceptions was reviewed at the request of NHSBT, with interest in whether these occurred from healthcare staff working with donors and recipients. Misconceptions were identified across the three questions, with misconceptions accounting for 24% of the responses to the against the legislation question. Responses used emotive, powerful words with suggestions of State ownership of organs, abuse of the system to procure organs, change in treatment of donors to hasten death, religious and cultural objections, and recipient worthiness.

I worked in organ retrieval theatre during my career and I was uncomfortable with the way the operations were performed during this period. Although the 'brain dead' tests had been completed prior to the operation the vital signs of the patient often reflected that the patient was responding to painful stimuli. Sometimes the patient was not given the usual analgesia that is often given during routine operations. This made me rethink organ donation therefore I am uncomfortable with this. I always carried a donation card prior to my experience but subsequently would not wish to donate. This may be a personal feeling but that is my experience. [R660].

I think that this is a choice that should be left to individuals and families to make. After many years in nursing lots of it spent with transplant patients not all recipients embrace a 'healthy lifestyle' post-transplant with many going back to old lifestyle choices which made a transplant necessary in the first place. [R867].

Additional comments suggested certain medical conditions and advancing age precludes donation and that the ability to choose which organs to donate had been removed.

Most of them will be of no use as I have had a heart attack, I smoke and have Type 2 diabetes. [R595]

Further analysis indicated that 27% ( n  = 24) of these comments were made by individuals who worked with or in an area that supported donors and recipients.

In summary, this qualitative paper has evidenced that the ability to make an autonomous informed decision is foremost in the respondent’s thoughts regarding an opt-out system. This has been commonly cited as a reason throughout the literature by those against an opt-out system [ 9 , 10 , 25 , 26 ]. The loss of that ability was the primary reason for respondents being against the change in legislation with the notion that the decision is a personal choice cited as a reason for lack of discussion with family members. Respondents stated that the ability to make autonomous decisions needs to be adequately supported by evidence-based information that is accessible to all. If the latter is unavailable, they expressed concern for negative consequences. This includes an increase in the perceived belief of the potential for mistakes and abuse of the system, as well as family distress and loss of trust in the donation system and the staff who work in it, as supported by previous literature [ 9 , 11 ].

Our findings further coincide with that of previous literature, highlighting views suggesting that the opt-out system is a move towards an authoritarian system, illustrating the commercialisation of organs, and a system that is open to abuse and mistakes [ 10 , 11 , 12 , 27 , 28 , 29 ]. Healthcare staff require reassurance that the population, specifically the hard-to-reach groups like the elderly and homeless, have access to information and systems in order to be able to make an informed decision [ 30 , 31 ]. Whilst the findings from the overall #options survey demonstrated awareness is higher in NHS staff, there was a significant narrative in the free-text response regarding a lack of awareness and a concern the general public must also lack the same awareness of the system change. Some responses also reflected medical mistrust concerns of the general public [ 13 , 14 , 16 ] as well as expressing a fear of losing trust with the public [ 9 , 11 , 16 ], as found within previous work. Additional research articles raising awareness of the opt-out system in England suggest that despite publicising the change with carefully crafted positive messaging, negative views and attitudes are likely to influence interpretation leading to an increase in misinformation [ 28 ]. Targeted, evidence-based interventions and campaigns that address misinformation, particularly in sub-groups like ethnic minorities, is likely to provide reassurance to NHS staff and the general public, as well as providing reliable resources of information [ 28 ].

Respondents also requested more detailed information about the process of organ donation. The disparity of information and the knowledge of the processes of donation includes eligibility criteria, perceived religious and cultural exclusions, practical processes of brain and circulatory death, and subsequent organ retrieval. As well as, most importantly, more information on the care provided to the donor before and after the donation procedure. The gap of available factual knowledge is instead filled by misconceptions and misunderstandings which is perpetuated until new information and knowledge is acquired. It may also be attributed to the increased awareness of ethical and regulatory processes. These attitudes and views illustrate the complexity of opinions associated with religion, culture, medical mistrust, and ignorance of the donation processes [ 11 , 15 , 32 ]. There is evidently a need for healthcare staff to display openness and transparency about the processes of organ donation and how this is completed, particularly with the donor’s family. It further reinforces the need to increase the knowledge of differing religious and cultural beliefs to support conversations with families [ 18 , 19 ].

Both healthcare staff and the public would benefit from educational materials and interventions to address attitudes towards organ donation [ 19 , 28 , 33 ]. This would assist in correcting misconceptions and misunderstandings held by NHS staff, specifically those who support and work with organ donors and recipients. Previous work illustrates support for donation being higher in intensivists, recommending educational programmes to increase awareness across all healthcare staff [ 34 ]. The quantitative and qualitative findings of the #options survey would support this recommendation, adding that interventions need to be delivered by those working within organ donation and transplantation. This would build on the community work being conducted by NHSBT, hopefully leading NHS staff to become transplant ambassadors within their local communities.

A further finding was that of confusion and misunderstanding surrounding the role of the family, a finding also supported by the literature [ 11 ]. It was suggested that family distress would be heightened, and families would override the premise of opt-out. Literature also supports this could be further impacted if the family holds negative attitudes towards organ donation [ 20 ]. The uncertainty of the donors’ wishes was the most common reason for refusing from ethnic minority groups [ 35 ], further highlighting the need for family discussions. Without this, families feel they are left with no prior indication so they opt-out as a precaution. Making an opt-in decision known can aid the grieving process as the family takes comfort in knowing they are fulfilling the donors wishes [ 26 ] and reduces the likelihood of refusal due to uncertainty about their wishes [ 36 ]. The ambiguity around the role of the family, coupled with not explicitly stating a choice via the organ donor register or discussions with family can make it problematic for next of kin and NHS staff.

Limitations

It is acknowledged that the findings of this study could have been influenced by the COVID-19 pandemic beyond the changes to the research delivery plan including a shift in critical care priorities, initial increase of false information circulating social media, delayed specialist nurse training, and removal of planned public campaigns [ 37 , 38 ]. The degree of the impact is unknown and supports the view that ongoing research into healthcare staff attitudes is required. Additionally, the survey did not collect job titles and is therefore limited to combining all healthcare staff responses. It is understood not all staff, such as those working in mental health, would know in depth details of organ donation and legislation, but it is expected that their level of knowledge would be greater than that of the general public.

The quantitative analysis [ 21 ] of the #options survey showed that overall NHS staff are well informed and more supportive of the change in legislation when compared to the general public. This qualitative analysis of the free-text responses provides a greater insight into the views of the healthcare staff who against the change. The reasons given reflect the known misconceptions and misunderstandings held by the general public and evidenced within the literature [ 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 ]. There are further concerns about the rationale for the change, the nature of the informed decision making, ease of access to information including information regarding organ donation processes. We therefore propose that educational materials and interventions for NHS staff are developed to address the concepts of autonomy and consent, are transparent about organ donation processes, and address the need for conversations with family. Regarding the wider public awareness campaigns, there is a continued need to promote the positives and refute the negatives to fill the knowledge gap with evidence-based information [ 39 ] and reduce misconceptions and misunderstandings.

Availability of data and materials

The datasets analysed during the current study are available from the corresponding author on reasonable request.

Abbreviations

Coronavirus Disease 2019

Integrated research application system

North-East and North Cumbria

• National Health Service

National Health Service Blood and Transplant

National Institute of Health Research

Organ donor register

United Kingdom

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UK Parliament, House of Lords, Lords Chamber, Volume 803: debated 18 May 2020. Draft Human Tissue (Permitted Material: Exceptions) (England) Regulations 2020. https://hansard.parliament.uk/lords/2020-05-18/debates/1a7747af-1951-4289-b8d5-639493c85bb1/LordsChamber . 18 May 2020. Accessed 05 Dec 2023.

Miller J, McGregor L, Currie S, O’Carroll RE. Investigating the effects of threatening language, message framing, and reactance in opt-out organ donation campaigns. Ann Behav Med. 2022. https://doi.org/10.1093/abm/kaab017 .

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Acknowledgements

With thanks to the NHSBT legislation implementation team for peer review of the questionnaire and the Kantar population survey data.

Funding for the project was gained from the Northern Counties Kidney Research Fund. Grant number 16.01.

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Dorothy Coe & Caroline Wroe

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NC, DC, and CW were responsible for the drafting and revising of the manuscript. NN, MJ, MR, DR, and CW were responsible for the design of the study. DC completed the qualitative analysis. NC, DC, NN, MJ, MR, DR, and CW read and approved the final manuscript.

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The research was carried out in accordance with the Declaration of Helsinki. The study was reviewed and approved by a Health Research Authority (HRA) and Health and Care Research Wales (HCRW) [REC reference: 20/HRA/0150] via the integrated research application system (IRAS) and registered as a National Institute of Health Research (NIHR) portfolio trial [IRAS 275992]. Informed Consent was obtained from all the participants and/or their legal guardians.

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Clark, N.L., Coe, D., Newell, N. et al. “I am in favour of organ donation, but I feel you should opt-in”—qualitative analysis of the #options 2020 survey free-text responses from NHS staff toward opt-out organ donation legislation in England. BMC Med Ethics 25 , 47 (2024). https://doi.org/10.1186/s12910-024-01048-6

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Received : 19 September 2023

Accepted : 17 April 2024

Published : 20 April 2024

DOI : https://doi.org/10.1186/s12910-024-01048-6

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How can I plan what to eat or drink when I have diabetes?

How can physical activity help manage my diabetes, what can i do to reach or maintain a healthy weight, should i quit smoking, how can i take care of my mental health, clinical trials for healthy living with diabetes.

Healthy living is a way to manage diabetes . To have a healthy lifestyle, take steps now to plan healthy meals and snacks, do physical activities, get enough sleep, and quit smoking or using tobacco products.

Healthy living may help keep your body’s blood pressure , cholesterol , and blood glucose level, also called blood sugar level, in the range your primary health care professional recommends. Your primary health care professional may be a doctor, a physician assistant, or a nurse practitioner. Healthy living may also help prevent or delay health problems  from diabetes that can affect your heart, kidneys, eyes, brain, and other parts of your body.

Making lifestyle changes can be hard, but starting with small changes and building from there may benefit your health. You may want to get help from family, loved ones, friends, and other trusted people in your community. You can also get information from your health care professionals.

What you choose to eat, how much you eat, and when you eat are parts of a meal plan. Having healthy foods and drinks can help keep your blood glucose, blood pressure, and cholesterol levels in the ranges your health care professional recommends. If you have overweight or obesity, a healthy meal plan—along with regular physical activity, getting enough sleep, and other healthy behaviors—may help you reach and maintain a healthy weight. In some cases, health care professionals may also recommend diabetes medicines that may help you lose weight, or weight-loss surgery, also called metabolic and bariatric surgery.

Choose healthy foods and drinks

There is no right or wrong way to choose healthy foods and drinks that may help manage your diabetes. Healthy meal plans for people who have diabetes may include

• dairy or plant-based dairy products
• nonstarchy vegetables
• protein foods
• whole grains

Try to choose foods that include nutrients such as vitamins, calcium , fiber , and healthy fats . Also try to choose drinks with little or no added sugar , such as tap or bottled water, low-fat or non-fat milk, and unsweetened tea, coffee, or sparkling water.

Try to plan meals and snacks that have fewer

• foods high in saturated fat
• foods high in sodium, a mineral found in salt
• sugary foods , such as cookies and cakes, and sweet drinks, such as soda, juice, flavored coffee, and sports drinks

Your body turns carbohydrates , or carbs, from food into glucose, which can raise your blood glucose level. Some fruits, beans, and starchy vegetables—such as potatoes and corn—have more carbs than other foods. Keep carbs in mind when planning your meals.

You should also limit how much alcohol you drink. If you take insulin  or certain diabetes medicines , drinking alcohol can make your blood glucose level drop too low, which is called hypoglycemia . If you do drink alcohol, be sure to eat food when you drink and remember to check your blood glucose level after drinking. Talk with your health care team about your alcohol-drinking habits.

Find the best times to eat or drink

Talk with your health care professional or health care team about when you should eat or drink. The best time to have meals and snacks may depend on

• what medicines you take for diabetes
• what your level of physical activity or your work schedule is
• whether you have other health conditions or diseases

Ask your health care team if you should eat before, during, or after physical activity. Some diabetes medicines, such as sulfonylureas  or insulin, may make your blood glucose level drop too low during exercise or if you skip or delay a meal.

Plan how much to eat or drink

You may worry that having diabetes means giving up foods and drinks you enjoy. The good news is you can still have your favorite foods and drinks, but you might need to have them in smaller portions  or enjoy them less often.

For people who have diabetes, carb counting and the plate method are two common ways to plan how much to eat or drink. Talk with your health care professional or health care team to find a method that works for you.

Carb counting

Carbohydrate counting , or carb counting, means planning and keeping track of the amount of carbs you eat and drink in each meal or snack. Not all people with diabetes need to count carbs. However, if you take insulin, counting carbs can help you know how much insulin to take.

Plate method

The plate method helps you control portion sizes  without counting and measuring. This method divides a 9-inch plate into the following three sections to help you choose the types and amounts of foods to eat for each meal.

• Nonstarchy vegetables—such as leafy greens, peppers, carrots, or green beans—should make up half of your plate.
• Carb foods that are high in fiber—such as brown rice, whole grains, beans, or fruits—should make up one-quarter of your plate.
• Protein foods—such as lean meats, fish, dairy, or tofu or other soy products—should make up one quarter of your plate.

If you are not taking insulin, you may not need to count carbs when using the plate method.

Work with your health care team to create a meal plan that works for you. You may want to have a diabetes educator  or a registered dietitian  on your team. A registered dietitian can provide medical nutrition therapy , which includes counseling to help you create and follow a meal plan. Your health care team may be able to recommend other resources, such as a healthy lifestyle coach, to help you with making changes. Ask your health care team or your insurance company if your benefits include medical nutrition therapy or other diabetes care resources.

Talk with your health care professional before taking dietary supplements

There is no clear proof that specific foods, herbs, spices, or dietary supplements —such as vitamins or minerals—can help manage diabetes. Your health care professional may ask you to take vitamins or minerals if you can’t get enough from foods. Talk with your health care professional before you take any supplements, because some may cause side effects or affect how well your diabetes medicines work.

Research shows that regular physical activity helps people manage their diabetes and stay healthy. Benefits of physical activity may include

• lower blood glucose, blood pressure, and cholesterol levels
• better heart health
• healthier weight
• better mood and sleep
• better balance and memory

Talk with your health care professional before starting a new physical activity or changing how much physical activity you do. They may suggest types of activities based on your ability, schedule, meal plan, interests, and diabetes medicines. Your health care professional may also tell you the best times of day to be active or what to do if your blood glucose level goes out of the range recommended for you.

Do different types of physical activity

People with diabetes can be active, even if they take insulin or use technology such as insulin pumps .

Try to do different kinds of activities . While being more active may have more health benefits, any physical activity is better than none. Start slowly with activities you enjoy. You may be able to change your level of effort and try other activities over time. Having a friend or family member join you may help you stick to your routine.

The physical activities you do may need to be different if you are age 65 or older , are pregnant , or have a disability or health condition . Physical activities may also need to be different for children and teens . Ask your health care professional or health care team about activities that are safe for you.

Aerobic activities

Aerobic activities make you breathe harder and make your heart beat faster. You can try walking, dancing, wheelchair rolling, or swimming. Most adults should try to get at least 150 minutes of moderate-intensity physical activity each week. Aim to do 30 minutes a day on most days of the week. You don’t have to do all 30 minutes at one time. You can break up physical activity into small amounts during your day and still get the benefit. 1

Strength training or resistance training

Strength training or resistance training may make your muscles and bones stronger. You can try lifting weights or doing other exercises such as wall pushups or arm raises. Try to do this kind of training two times a week. 1

Balance and stretching activities

Balance and stretching activities may help you move better and have stronger muscles and bones. You may want to try standing on one leg or stretching your legs when sitting on the floor. Try to do these kinds of activities two or three times a week. 1

Some activities that need balance may be unsafe for people with nerve damage or vision problems caused by diabetes. Ask your health care professional or health care team about activities that are safe for you.

Stay safe during physical activity

Staying safe during physical activity is important. Here are some tips to keep in mind.

Drink liquids

Drinking liquids helps prevent dehydration , or the loss of too much water in your body. Drinking water is a way to stay hydrated. Sports drinks often have a lot of sugar and calories , and you don’t need them for most moderate physical activities.

Avoid low blood glucose

Check your blood glucose level before, during, and right after physical activity. Physical activity often lowers the level of glucose in your blood. Low blood glucose levels may last for hours or days after physical activity. You are most likely to have low blood glucose if you take insulin or some other diabetes medicines, such as sulfonylureas.

Ask your health care professional if you should take less insulin or eat carbs before, during, or after physical activity. Low blood glucose can be a serious medical emergency that must be treated right away. Take steps to protect yourself. You can learn how to treat low blood glucose , let other people know what to do if you need help, and use a medical alert bracelet.

Avoid high blood glucose and ketoacidosis

Taking less insulin before physical activity may help prevent low blood glucose, but it may also make you more likely to have high blood glucose. If your body does not have enough insulin, it can’t use glucose as a source of energy and will use fat instead. When your body uses fat for energy, your body makes chemicals called ketones .

High levels of ketones in your blood can lead to a condition called diabetic ketoacidosis (DKA) . DKA is a medical emergency that should be treated right away. DKA is most common in people with type 1 diabetes . Occasionally, DKA may affect people with type 2 diabetes  who have lost their ability to produce insulin. Ask your health care professional how much insulin you should take before physical activity, whether you need to test your urine for ketones, and what level of ketones is dangerous for you.

Take care of your feet

People with diabetes may have problems with their feet because high blood glucose levels can damage blood vessels and nerves. To help prevent foot problems, wear comfortable and supportive shoes and take care of your feet  before, during, and after physical activity.

If you have diabetes, managing your weight  may bring you several health benefits. Ask your health care professional or health care team if you are at a healthy weight  or if you should try to lose weight.

If you are an adult with overweight or obesity, work with your health care team to create a weight-loss plan. Losing 5% to 7% of your current weight may help you prevent or improve some health problems  and manage your blood glucose, cholesterol, and blood pressure levels. 2 If you are worried about your child’s weight  and they have diabetes, talk with their health care professional before your child starts a new weight-loss plan.

You may be able to reach and maintain a healthy weight by

• following a healthy meal plan
• consuming fewer calories
• being physically active
• getting 7 to 8 hours of sleep each night 3

If you have type 2 diabetes, your health care professional may recommend diabetes medicines that may help you lose weight.

Online tools such as the Body Weight Planner  may help you create eating and physical activity plans. You may want to talk with your health care professional about other options for managing your weight, including joining a weight-loss program  that can provide helpful information, support, and behavioral or lifestyle counseling. These options may have a cost, so make sure to check the details of the programs.

Your health care professional may recommend weight-loss surgery  if you aren’t able to reach a healthy weight with meal planning, physical activity, and taking diabetes medicines that help with weight loss.

If you are pregnant , trying to lose weight may not be healthy. However, you should ask your health care professional whether it makes sense to monitor or limit your weight gain during pregnancy.

Both diabetes and smoking —including using tobacco products and e-cigarettes—cause your blood vessels to narrow. Both diabetes and smoking increase your risk of having a heart attack or stroke , nerve damage , kidney disease , eye disease , or amputation . Secondhand smoke can also affect the health of your family or others who live with you.

If you smoke or use other tobacco products, stop. Ask for help . You don’t have to do it alone.

Feeling stressed, sad, or angry can be common for people with diabetes. Managing diabetes or learning to cope with new information about your health can be hard. People with chronic illnesses such as diabetes may develop anxiety or other mental health conditions .

Learn healthy ways to lower your stress , and ask for help from your health care team or a mental health professional. While it may be uncomfortable to talk about your feelings, finding a health care professional whom you trust and want to talk with may help you

• lower your feelings of stress, depression, or anxiety
• manage problems sleeping or remembering things
• see how diabetes affects your family, school, work, or financial situation

Ask your health care team for mental health resources for people with diabetes.

Sleeping too much or too little may raise your blood glucose levels. Your sleep habits may also affect your mental health and vice versa. People with diabetes and overweight or obesity can also have other health conditions that affect sleep, such as sleep apnea , which can raise your blood pressure and risk of heart disease.

NIDDK conducts and supports clinical trials in many diseases and conditions, including diabetes. The trials look to find new ways to prevent, detect, or treat disease and improve quality of life.

What are clinical trials for healthy living with diabetes?

Clinical trials—and other types of clinical studies —are part of medical research and involve people like you. When you volunteer to take part in a clinical study, you help health care professionals and researchers learn more about disease and improve health care for people in the future.

Researchers are studying many aspects of healthy living for people with diabetes, such as

• how changing when you eat may affect body weight and metabolism
• how less access to healthy foods may affect diabetes management, other health problems, and risk of dying
• whether low-carbohydrate meal plans can help lower blood glucose levels
• which diabetes medicines are more likely to help people lose weight

Find out if clinical trials are right for you .

Watch a video of NIDDK Director Dr. Griffin P. Rodgers explaining the importance of participating in clinical trials.

What clinical trials for healthy living with diabetes are looking for participants?

You can view a filtered list of clinical studies on healthy living with diabetes that are federally funded, open, and recruiting at www.ClinicalTrials.gov . You can expand or narrow the list to include clinical studies from industry, universities, and individuals; however, the National Institutes of Health does not review these studies and cannot ensure they are safe for you. Always talk with your primary health care professional before you participate in a clinical study.

This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health. NIDDK translates and disseminates research findings to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by NIDDK is carefully reviewed by NIDDK scientists and other experts.

NIDDK would like to thank: Elizabeth M. Venditti, Ph.D., University of Pittsburgh School of Medicine.

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