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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.
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.
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 work of IDOP has resulted in:
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.
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.
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.
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.
New criteria for the diagnosis of diabetes in pregnancy have been developed by the International Association of Diabetes in Pregnancy Study Groups and adopted by the American Diabetes Association on the basis of the Hyperglycaemia and Pregnancy Outcomes (HAPO) study. These new criteria double the percentage of women diagnosed with diabetes in pregnancy from approximately 8.5% to 17%. Appropriate management improves outcomes for them and their new born children. The results, which proved valid for all ethnic groups and countries, have led to a worldwide re-appraisal of glycaemic risk in pregnancy and the introduction of new guidelines to manage this.
Research conducted at King's College London into the mechanisms underlying hypoglycaemia unawareness in type 1 diabetes mellitus (T1DM) and novel technology for reducing the risk of hypoglycaemia has led directly to innovative changes in the management of diabetes. These include UK and worldwide development and dissemination of the government-recommended `Dose Adjustment for Normal Eating' (DAFNE) programme and on-going development of continuous subcutaneous insulin infusion (pump) therapy, now used by over 18,500 people with T1DM in the UK.