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Research founded on population-based cohort studies has directly informed NICE Public Health guidance on the prevention of diabetes. In prospective studies Wareham and Griffin demonstrated that diabetes can be predicted by a simple risk score using routinely available information and by HbA1c levels. Although people with a high HbA1c account for 36% of incidence, the majority of future cases emerge from the larger population of people with moderately elevated levels, justifying a more population-wide perspective on the prevention of diabetes. The research also showed that the same behaviour targets that are effective in high risk individuals are strongly associated with diabetes in the wider population.
The University of Liverpool (UoL) has provided pivotal evidence for the introduction and development of national screening programmes for diabetic retinopathy (DR). Technician based screening, which has been introduced since 2008, is now covering over 1.9 million UK people at risk and employing over 1,000 technicians across 96 programmes. Sweden and Scotland have introduced 2 and 3 year screening for patients with no DR based on UoL work on extended screen intervals. The UoL led the revision of the St. Vincent Declaration, the principal policy statement of the WHO on the management of diabetes, and has continued to develop pan European policy and influence national policies in several European countries (including Italy, Germany, Spain).
Dr Lloyd's research examines the relationship between diabetes and mental health, particularly in under-served or marginalised communities. Through extensive international collaborations research findings have been disseminated to a wide audience. Locally, service users have been involved in the development of alternative ways of obtaining informed consent, to allow greater research inclusivity. Culturally appropriate tools, for identifying depressive symptoms as well as knowledge deficits in diabetes self-care, have been designed and tested. As a result, a psychotherapy service for people with co-morbid diabetes and psychological problems has been successfully established in a diabetes centre attended by more than 6,000 individuals.
We are facing a diabetes epidemic: the number of people affected worldwide is estimated to rise from 366 million in 2011 to 552 million by 2030, representing a huge financial burden on society. Using data from the United Kingdom Prospective Diabetes Study (UKPDS), the University of Oxford's Diabetes Trials Unit developed two assessment tools - the UKPDS Risk Engine (a diabetes-specific heart attack and stroke risk calculator) and the UKPDS Outcomes Model (a lifetime simulator for people with diabetes) to better understand and plan for diabetes risk and its outcomes on both individuals and society as a whole. Patients, clinicians and policymakers globally are now using these tools to assist in planning for future health economic needs, and for predicting health risks for people with diabetes.
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.
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.
Diabetic retinopathy is a leading cause of blindness in people of working age. Screening programmes for its early detection are therefore crucial. Following the introduction of screening programmes for diabetic eye disease, research carried out at the University of Aberdeen enabled the resulting images to be analysed by computer rather than manually, a technique that has now been adopted by Scotland's national screening programme. This has achieved a significant impact on patient health, as well as economic impacts for the taxpayer, through cost savings, and for the company that developed the screening software commercially.
Therefore this research has had impact in health and welfare by influencing decisions and care practices by a health service.
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 work of IDOP has resulted in:
A series of projects focusing on the medical, social, and emotional experience of pre-pregnancy, pregnancy, and early motherhood have been undertaken since 2006 at Plymouth University. The impact of these projects is wide ranging covering both policy and practice. The research has: changed the physical environment of the antenatal clinic specifically to suit the needs of pregnant women with pre-existing diabetes; developed an online leaflet for women with Polycystic Ovary Syndrome (PCOS); developed training programmes for health and social care professionals; provided baseline information to inform practitioners and patients involved in UK screening programmes; and, informed screening strategies for Downs Syndrome.