southampton

Published:: 5 February 2019

Diabetes is rising at an alarming rate: every day around 700 people in the UK are diagnosed with type 2 diabetes, and 30 people a day with type 1 diabetes. The NHS spends a staggering £1.6m an hour on diabetes, the vast majority on managing complications such as kidney dialysis, limb amputation and blindness.

University of Southampton researchers are at the forefront of this issue. Our researchers are creating educational resources to improve understanding of diabetes. They are also investigating links between diabetes and mental health problems, and looking at how cardiac surgery recovery can be improved in people with diabetes.

Type 2 diabetes results from the body not producing enough insulin and the body’s cells not reacting properly to insulin. Although type 2 diabetes often runs in families, the rise in obesity due to poor eating habits and lack of exercise is the main cause of this increase. Type 1 diabetes is currently a non-preventable autoimmune disease where the body attacks and destroys the cells that produce insulin.

There are approximately 13,000 people with type 2 diabetes in Southampton. Given its prevalence, there is a danger that diabetes is becoming the norm and just background noise. People feel they are fated to develop the disease. That is not the case and we need to dispel these myths.

Ongoing education

As part of the drive to improve education, Mayank delivers talks to medical students, junior doctors, nursing staff and patient groups with diabetes, and contributes to local face-to-face GP education. He has also produced online diabetes resources as part of a local GP tutorials online resource.

Together with Dr Partha Kar, Associate National Clinical Director for Diabetes for NHS England, he has worked with people with type 1 diabetes to release the first ever free-to-download type 1 diabetes comic book, which explains more about the disease in a user-friendly fashion aimed at a younger audience. The comic won the 2017 Quality in Care Diabetes Award for Diabetes Collaboration Initiative of the Year.

Mayank has created a diabetes e-learning resource for hospital staff. “On any given day, 15 per cent of our inpatients have diabetes. The majority are here because of an unrelated health problem, but they can spend up two to three extra days in hospital if their condition is neglected,” he says.

He has also co-developed a smartphone app called, DiAppBetes, which provides concise guidance notes for clinicians. To access the app, clinicians need to download the MicroGuide app and then select DiAppBetes from the University Hospital Southampton NHS Foundation Trust section.

With his clinical team, Mayank teaches on the University’s MSc Diabetes Best Practice programme . Now in its third year, the course equips healthcare professionals with skills in the diagnosis, treatment, psychology and management of diabetes. It is generating interest from applicants both in the UK and internationally.

Diabetes and mental health

Richard Holt , Professor in Diabetes and Endocrinology within Medicine at Southampton is leading research into the link between diabetes and mental health problems, particularly schizophrenia.

With a £2m grant from the National Institute for Health Research (NIHR) Health Technology Assessment (HTA) programme, he has recently completed a four-year project that aims to address the problem of obesity in people with schizophrenia, schizo-affective disorder and first-episode psychosis. Richard and his team developed a structured lifestyle education programme, known as STEPWISE, and tested this in a clinical trial involving 414 people with schizophrenia.

Although the intervention did not significantly improve the ability of people with schizophrenia to control their weight gain, the trial has provided a number of important lessons for undertaking clinical trials in this group of people.

We successfully delivered the largest trial of a lifestyle intervention in people with schizophrenia to date. We managed to recruit more people than we anticipated and more quickly, with most staying in the trial to its conclusion. This shows the level of interest in the problem of obesity among this group of people and their healthcare professionals.

“People with schizophrenia have a two-fold increased risk of developing diabetes compared with the rest of the population. On average, people with schizophrenia die around 10 to 15 years earlier than the general population, and this is mainly due to physical health rather than mental health problems, with diabetes being one of the biggest contributors,” he adds.

Richard is now leading a further trial in people with severe mental illness. In collaboration with Southern Health NHS Foundation Trust, the research team will be examining the effect of liraglutide, an injectable treatment licensed to treat obesity, in people with schizophrenia. Liraglutide works by helping the pancreas release the correct amount of insulin when blood sugar levels are high and by telling the brain when it is time to stop eating.

The research team is also working to improve existing treatments. Mayank is involved in an international study, Sustain 7, which is looking at compounds other than insulin given by injection once a week for type 2 diabetes. The aim is to see how effectively these compounds can control blood glucose levels and body weight.

Improving cardiac surgery outcomes in people with diabetes

Richard and Mayank have recently embarked on a four-year project funded by the NIHR HTA to evaluate whether an assessment and follow-up by a specialist diabetes team, at the point someone with diabetes is added to the waiting list for cardiac surgery, can improve surgical outcomes.

This project will involve adapting an intervention that has been used in Bournemouth hospital for several years so that it is suitable for a broader UK population. The team will then test this across the UK in 10 to 15 cardiothoracic centres.

“People with diabetes tend to make a slower recovery after surgery and many of the reasons behind this could be addressed before they have their surgery. We hope that by introducing people with diabetes who are awaiting cardiac surgery to a specialist diabetes team, we can help them prepare better for surgery,” says Richard.

“If our trial confirms this, we will be able to make the inpatient stay of people with diabetes easier and safer.”