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The work of IDOP has resulted in:
Elevated blood glucose levels — the hallmark of diabetes — is estimated by the World Health Organization to be the third leading cause of premature death globally. Around 4 million people in the UK have been diagnosed with diabetes; their treatment accounts for 10% (£10 billion) of NHS expenditure. Self-management strategies and the promotion of a healthy lifestyle are fundamental to the treatment and prevention of type 2 diabetes (T2DM). Since 2008, Leicester's Diabetes Research Centre has developed, evaluated, disseminated and implemented a range of programmes based on a technique called structured education. The flagship DESMOND programme is run in over half of all clinical commissioning groups (CCGs), affecting thousands of people with newly diagnosed T2DM. The Walking Away prevention programme has been widely implemented in the UK, Ireland and Australia. These programmes are the only nationally available evidence-based structured education programmes for the prevention and management of T2DM.
Around 2.5 million people in the UK have Type 2 diabetes, with many more in a pre-diabetic state, Both conditions are hard to detect and frequently remain undiagnosed and untreated for years. The cost burden to the NHS of eventual treatment is estimated at £10 billion; 80% of which is spent on complications that are, with good care, avoidable. Targeted diabetes prevention programmes could aid in prevalence reduction and associated costs. Leicester's Diabetes Research Centre has developed two risk scores, both suitable for use with an ethnically diverse UK population, to detect these conditions: a self-assessment questionnaire and a general practice database tool. Recommended by NICE, they have been used successfully in varied settings. Since July 2011, around 260,000 people have completed the self-assessment score online and more than 40,000 through other means.
Metformin is now the most prescribed medication for type 2 diabetes worldwide. Pre - 1990 it received trivial use and was on the verge of withdrawal. Research at Aston (1993 - 1996) generated a new appreciation of its mechanisms of action and therapeutic potential. Aston research was reinforced with a concerted education programme for healthcare professionals, including high-profile reviews and treatment guidelines. We claim impact on health & welfare and health practitioners as Aston research has provided a foundation for improved care of type 2 diabetes patients on a global scale.
Researchers at King's College London have developed the largest UK programme of research in diabetes and mental health. Their main findings are that depression is associated with worse outcomes, in particular increased mortality in diabetes, and that training diabetes nurses in psychological skills can help patients improve adherence. This research has been translated into award winning service innovations that integrate the treatment of psychiatric comorbidities with diabetes care. It has also been developed into a nurse-led clinic to optimize glycaemic control in those struggling the most with adherence and been used to deliver a series of local and national educational programmes to increase access to psychological skills training for diabetes professionals.
The Collaborative Atorvastatin Diabetes Study (2004), led by researchers at the University of Manchester (UoM), established the efficacy of statin therapy in the prevention of atherosclerotic cardiovascular disease (CVD) among patients with diabetes. The research challenged the previously held view that, since CVD risk is markedly raised in people with diabetes even when blood cholesterol levels are normal, statins were unlikely to be beneficial for this group. These key findings have informed clinical guidelines governing the use of statin therapy in the UK (NICE, SIGN) and internationally (American Heart Association and the American Diabetes Association, ESC, EAS), ensuring that statins are now considered for all diabetic patients.
Poor treatment adherence and self-management are universally recognised as major problems across all illnesses. Research at Kings College London (KCL) has resulted in new ways of assessing, investigating and improving these problems. These are now achieving widespread impact through the highly successful commercial organisation Atlantic Healthcare, which provides medication adherence and patient support programmes on a global scale. These programmes, which are now reaching patients with over 50 major medical conditions in a large number of countries, are very solidly based on the findings from KCL research.
Work led by Professor Nick Barber at the UCL School of Pharmacy showed that a majority of patients have problems soon after starting a new medicine for a chronic condition, and this led to the development of a post-consultation intervention by pharmacists that was shown to be more effective and cheaper than normal care. This entered Department of Health policy for pharmacy in 2008 and Barber helped design the New Medicines Service that was launched in October 2011. This service is offered by community pharmacists in England and by the end of May 2013 over a million patients had received the service. The intervention increases patient adherence to medication, thus improving quality of care, and reducing cost to the NHS from wastage. It also improves patient safety through better identification and resolution of adverse effects.
Research led by Pardhan has enhanced the healthcare offered to diabetic patients of South Asian origin in the UK and overseas (Pakistan, East Africa). Prevalence of diabetes within this ethnic group is six times higher than in Caucasians. Our research into this group, which demonstrated an increased risk of sight-threatening eye disease and poor engagement with screening/treatment regimes, has impacted upon both patients and healthcare practitioners. Ophthalmologists, general practitioners and other clinicians have used our findings to target various physiological and cultural factors that influence diabetic control and eye health in the South Asian population.
Our research also provided the underpinning data that informed reports commissioned by the Royal National Institute of Blind People (RNIB). These reports demonstrate the increased prevalence of eye problems in patients of South Asian origin, and highlight the barriers that affect patients' access to primary and secondary eye-care across the UK. The reports evaluate the effectiveness of current management, and suggest strategies to improve the eye health of this group of patients.
These reports have led directly to the creation of dedicated community-based eye-care programmes. Funded by the Royal National Institute of Blind People (£400,000) and Innovation, Excellence and Strategic Development Fund (Department of Health), the programmes are designed to reduce diabetic-related complications through improved self care by patients in Bradford and Glasgow, regions that have significant Asian diabetic populations.
Our research has led to major changes in the management of people with severe mental illness (SMI) in general practice. Our findings that people with schizophrenia are at greater risk of cardiovascular diseases informed NICE guidance in the UK and international guidelines. The Department of Health's strategy on Mental Health was influenced by our work on the interface between physical and mental health. Recommendations in the NICE guidance have now been taken up by the NHS Quality Outcomes Framework (QoF) in England and Scotland. General practitioners are specifically required to monitor BMI (Body Mass Index), blood pressure, and glucose and serum lipids levels in all registered patients with SMI.