Summary of the impact

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.

Summary of the impact

A health informatics platform supporting chronic disease management nationally and internationally creating impact upon:

• NHS: Implementation in all 1043 general practices, 38 hospitals, and 14 Health Boards in Scotland, continuously monitoring care of 271,000 people with diabetes, with evidence of improved clinical outcomes.
• Government Policy: Embedded in Government policy: Scottish Diabetes Framework, Scottish Diabetes Action Plan; highlighted as "best practice" in the 2009 House of Lords Report Genomic Medicine and UK Life Sciences Strategy 2012.
• Commercialisation: A start up informatics company, now with 82 employees and deployments internationally.
• Internationalisation: Implementation of the informatics network through the Kuwait-Scotland eHealth innovation network.

Summary of the impact

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.

Summary of the impact

The work of IDOP has resulted in:

• Improved awareness of challenges posed by diabetes in older people among NHS commissioners and service providers
• Greater recognition at national and international level of the importance of frailty in diabetes
• Developing the growing national community network for practice and learning (ODN)
• Publication of UK and European Guidelines for clinicians outlining better standards of diabetes care and best clinical practice
• Improved service commissioning by creation and dissemination of specific guidance
• Initiating major new national, European and global projects being initiated, attracting considerable funds, and providing the platform for enhanced diabetes care in older people (see www.instituteofdiabetes.org).

Summary of the impact

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.

Summary of the impact

Research undertaken at the Centre for Intellectual and Developmental Disabilities(CIDD), has significantly impacted upon:

1. The identification of health inequalities through improved health surveillance.
2. The development of a network of Health Facilitators linked to GP Practices to promote health screening/annual checks.
3. The development of accessible information to assist people with ID in making positive lifestyle choices and access healthcare services.
4. The development of health promotion interventions targeting secondary health conditions for people with ID.
5. The translation of this research into pre/post multi-disciplinary education.
6. The preparation of regional, national and international policy guidelines.

Summary of the impact

The University of Oxford's United Kingdom Prospective Diabetes Study (UKPDS) was a landmark 30-year clinical trial, reported in over 80 academic research papers between 1983 and 2008. It showed beyond doubt that diabetic complications, previously thought to be inevitable consequences of the condition, could be delayed or prevented by improved treatment from the time of diagnosis. These findings have had a profound influence on the management of type 2 diabetes, clinical guidelines, and standards of care, and have reduced diabetes-related complications worldwide, lowering the incidence of blindness, kidney failure, amputation, heart attack and stroke.

Summary of the impact

It is now widely recognised that the evaluation of treatments for chronic conditions needs to consider impacts on quality of life as well as quality of health. Research in the Health Psychology Research Unit since 2011, and for over 20 years previously in the Department of Psychology at Royal Holloway, has generated a series of Patient-Reported Outcome Measures (PROMs) validated in over 100 languages. These PROMs have been used by every major pharmaceutical company in the world to measure the impact of new treatments on quality of life and other patient reported outcomes, and have delivered major benefits to people with diabetes and other long-term medical conditions. These PROMs have also delivered substantial economic and commercial impacts through cost-saving in the NHS, licence fee income raised through the spin-off company Health Psychology Research (HPR) Ltd, and contributions to the development of best-selling drugs.

Summary of the impact

This case study describes two types of impact. First, awareness of a health benefit has been raised in the treatment of people with diabetes, second, people with diabetes' attitudes to the treatment of diabetes has changed. These impacts were achieved in collaboration with health professionals working for two NHS trusts (Western Sussex Hospitals NHS Trust and Sussex Community NHS Trust) through the development of new educational materials to increase people with diabetes' awareness of diabetes and diabetes self-care behaviour.

Summary of the impact

Pre-pregnancy care (PPC) significantly reduces the risk of poor pregnancy outcomes among women with diabetes. Yet, lack of awareness has resulted in poor participation, with two thirds of women receiving suboptimal PPC (CEMACH, 2007).

An innovative preconception counselling resource (DVD/website) to inform women about PPC and improve pregnancy outcomes is embedded in routine care in Northern Ireland and beyond since 2010. The UK's first widely distributed multimedia preconception counselling resource for women with diabetes is already having a significant impact on pregnancy planning. In early evaluation results 76% of all pregnant women with diabetes in Northern Ireland reported receiving PPC.