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Welcome to the NIHR CLAHRC Community e-newsletter 
 

Diabetes newsletter

 

Welcome to the community e-newsletter for the National Institute for Health Research (NIHR) Collaborations for Leadership in Applied Health Research and Care (CLAHRCs) bringing you the latest news and interesting developments from across the thirteen collaborations and the health service research community. The NIHR CLAHRCs are funded by the NIHR and form part of the NIHR infrastructure. This newsletter looks at the work NIHR CLAHRCs are doing in the area of diabetes and coincides with World Diabetes Day on 14 November.

 


 

 

Find out more about the CLAHRC Partnership Programme at www.clahrcpp.co.uk.
Working with opticians to detect nerve damage
The NIHR CLAHRC Greater Manchester and Heidelberg Engineering have been working with optometrists to give them practical experience of performing a new corneal confocal microscopy procedure, a quick, non-invasive eye test which can detect diabetic neuropathy (nerve damage) in its earliest stages. Over 440 patients have been recruited into the study and the mid-point data is extremely promising. Read more.
 
Walking away from gestational diabetes: a joint CLAHRC project
Women with gestational diabetes are seven times more likely to develop type 2 diabetes within ten years, and the number of cases is growing due to increasingly unhealthy lifestyles. Researchers from NIHR CLAHRC East Midlands and NIHR CLAHRC West Midlands are undertaking a joint project which aims to develop and implement lifestyle education programmes for women with a history of gestational diabetes. The project will identify women with a diagnosis of gestational diabetes between six and 36 months previously, and 250 participants will be randomly allocated to usual care or intervention groups for 12 months. The usual care group will receive usual care plus - an information leaflet about healthy lifestyle choices after childbirth; while the intervention group will receive usual care plus a referral to the face-to-face and online education programmes. Participants will wear a physical activity monitor for seven days before, during and after the study, and the education programmes will be deemed successful if physical activity increases by around 30 minutes per day. This level of activity is sufficient to reduce type 2 diabetes risk by 30-50 percent, as part of a healthy lifestyle. If successful, researchers will work with local stakeholders during the study to ensure it is widely implemented.
 
Improving diabetes care and outcomes for people with severe mental illness
People with severe mental illness (SMI) have a two-to-three fold increased risk of developing diabetes and experiencing poor health outcomes.  However, little is known about the barriers and facilitators to managing diabetes alongside SMI or about the care that these patients receive or need. The DIAMONDS study (Diabetes and Mental Illness – Improving Outcomes and Services) will increase understanding about the relationship between diabetes and SMI, with an aim to improve health services and outcomes. The DIAMONDS research group is an NIHR CLAHRC Yorkshire and Humber collaboration between Bradford District Care NHS Foundation Trust, the Universities of York and Leeds, and Leeds and York Partnership NHS Foundation Trust. A PPI panel of service users/carers has helped to identify research priorities. As well as reviewing evidence about what improves diabetes management in this population, we will examine patient-level data to investigate health outcomes and care pathways. This will inform the development of an intervention for people with co-morbid SMI and diabetes, which will be co-designed with service users, carers and staff before being evaluated to examine its effectiveness for improving diabetes management. Find out more at www.diamonds.nihr.ac.uk or follow us on Twitter @DIAMONDS_YH.
 
Co-designing community-based diabetic services for children and young people
National Institute for Health and Care Excellence (NICE) Guidelines (2015) call for more research into the impact of peer education in paediatric diabetes programmes.  An NIHR CLAHRC North Thames project, Co-designing Community based Diabetes Services Responsive to the Needs of Children and Young People addresses this. Over the last year, researchers from the University of East London’s Institute for Health and Human Development have been working with groups of young people as Co-Inquirers and Young Commissioners (CYP’s) aged 16-25, to define and understand the challenges experienced by disadvantaged groups of CYP’s living with diabetes in Newham.  In collaboration with Newham Clinical Commissioning Group, we used primary and secondary data to inform service transformation which will be online by April 2016. Peer educators are influencing the re-commissioning process and are its greatest ambassadors, while the research team including the co-inquirers are assessing the difference made by peer educators. Contact Dr Darren Sharpe for more information - D.Sharpe@uel.ac.uk
 
Validating a new way to test for diabetes in pregnancy
Women who are at high risk of developing gestational diabetes are given a 'gold standard' oral glucose tolerance test (OGTT) – this involves a blood test in a clinic after an overnight fast. Women then have a sugary drink and wait for two hours before giving another blood sample. NIHR CLAHRC South London researchers are testing a new home-use electronic OGTT kit to see if its results are as accurate as the gold standard method when used in pregnancy. The home-use test kit has been developed as a test for diabetes and it analyses finger pricks of blood. The kit has already been validated outside of pregnancy. If the electronic test is accurate in pregnancy, and cost-effective, it would free up NHS staff time and women would no longer have to wait for two hours within a clinic or hospital. Read more
 
Supporting the NHS to better spread good practice in diabetes care
Diabetes is the fastest growing health threat of our times and an urgent public health issue. In April 2015, Ben Ellis from Diabetes UK was awarded an NIHR CLAHRC North West London Improvement Leader Fellowship to explore how Diabetes UK can support the NHS to better spread good practice in diabetes care. Ben has worked with commissioners and healthcare professionals across the country to coproduce and test different methods for spreading good practice, including in-depth case studies and practical ‘how to’ guides. Research suggests there is no simple answer to the question of which methods are most effective. Using a participatory action research approach, two important lessons were learned. The first is that disseminating good practice through online content and presentations is only half the battle – social influence and communication, achieved through methods such as networks, are essential for successfully diffusing good practice. The second is that many charities have well established channels that commissioners and healthcare professionals can tap into to. Find out more. 
 
Diabetes patients and clinical consultations
Diabetes is largely managed by patients themselves, and around one third believed that they had not ‘completely’ discussed their self-management with the clinicians who care for them. A study supported by NIHR South West Peninsula (PenCLAHRC) and initiated by diabetes patients and a diabetes nurse in the South West of England and which addresses this issue, is underway. It aims to investigate whether an established computer based tool designed to help identify issues for discussion between a cancer patient and their consultant before an outpatient appointment, can be adapted for diabetes patients. It also aims to identify any potential for improved communication, enablement, self-management, use of medication, glycaemic control and quality of life. The study is carried out by the University of Exeter Medical School and Plymouth University Peninsula Schools of Medicine and Dentistry in diabetes outpatient clinics at the Royal Devon and Exeter NHS Foundation Trust and Plymouth Hospitals NHS Trust. Find out more.
 
Moves to prevent diabetes in the East Midlands
A new diabetes prevention drive targeting 3,000 people in two Leicestershire towns has been launched by NIHR CLAHRC East Midlands. Loughborough and Shepshed are the first in the country to benefit from a new group education programme called Let’s Prevent Diabetes. People found to have pre-diabetes – where blood sugar levels are higher than normal – during their NHS Health Check are being invited to attend the new programme at the nine GP surgeries in the area. The programme is six hours long, attended by eight to 10 people and led by two trained educators. Discussions cover the risks and implications of developing Type 2 diabetes as well as how to make lifestyle changes to prevent its development. Let’s Prevent Diabetes was developed and tested in a large research study at the Leicester Diabetes Centre. Delivery of the programme is part of a three-year project funded by NIHR CLAHRC East Midlands. Find out more.
 
Preventing diabetes nationally
As part of the national diabetes prevention programme (NDPP), Public Health England has commissioned seven demonstrator sites to explore the local implementation of lifestyle interventions to prevent diabetes among people at risk of developing the disease. The NIHR CLAHRC Greater Manchester is carrying out an independent evaluation of the work at a site in Salford, which includes a telephone support service, an exercise programme and a new community-based service to improve the identification and referral of people at risk of diabetes from hard to reach groups. Read more.
 
Evaluation of an educational programme for young people with type 1 diabetes
Working with Insulin, Carbohydrate, Ketones and Exercise to manage Diabetes (WICKED) is a week-long educational programme for young people (16-24 years old) with type 1 diabetes developed in Sheffield’s diabetes Centre. The WICKED course has been designed with an aim to meet specific needs of young people with type 1 diabetes, who are often at high risk of poor diabetes control and adverse impacts on well-being. In addition to key sessions on diabetes control (for example carbohydrate counting and preventing hypoglycaemia), WICKED also includes topics which have been identified as particularly relevant for young people (such as relationships and alcohol). Learning is based on participants’ previous experiences and around peer-support, resulting in a different level of engagement from participants - ‘I thought it was really good… it didn’t feel like you were at school’ (Harrogate WICKED programme participant). WICKED has successfully been implemented as part of diabetes care in Sheffield and now further implementation is being evaluated in two more centres in Leeds and Harrogate by the Translating Knowledge into Action theme of the NIHR CLAHRC Yorkshire and Humber.  For further information please contact Daniel.wolstenholme@sth.nhs.uk.
 
Helping patients at risk of type 2 diabetes
The NIHR CLAHRC Greater Manchester is working with Hitachi Europe Ltd and Salford Royal NHS Foundation Trust on a trial comparing an enhanced lifestyle intervention service against an existing telephone-based service. The trial will investigate whether a web-enabled telephone health coaching intervention is an acceptable, efficient and effective means of encouraging lifestyle change among people with impaired glucose regulation (IGR), also known as prediabetes. Read more.
 
Savings to be made in diabetic retinopathy screening
Research supported by NIHR PenCLAHRC has concluded that it would be a safe and cost-effective strategy to screen people with type 2 diabetes who have not yet developed diabetic retinopathy, for the disease once every two years instead of annually. For just one hospital, the Royal Devon and Exeter Hospital, there would be an estimated reduction in costs from £1.83m a year to £1.36m. Savings of around 25 percent are predicted. Find out more.
 
Leicester Self-Assessment
NIHR CLAHRC East Midlands has developed a number of projects focusing on the identification of those at- risk from diabetes, as well as prevention programmes to try to prevent the onset of full type 2 diabetes. The Leicester Self-Assessment (LSA) is a short questionnaire which provides a quick and easy way for people to see how at-risk they are of developing Type 2 diabetes, taking into account factors like family background and ethnicity. The LSA was developed with support from NIHR CLAHRC East Midlands, in partnership with Diabetes UK. Thanks to the LSA, an estimated 50,000 people have been identified as having type 2 diabetes and have commenced treatment, which will save the NHS money and improve their health. The questionnaire is available on the Diabetes UK website, where it has been taken by more than 900,000 people. It is also widely used by Boots and Tesco chemists and has formed part of the biggest diabetes awareness campaign to date, run by Diabetes UK.
 
Walking Away from Diabetes
The Walking Away from Diabetes study was developed from the Leicester Self-Assessment study (see the above Leicester Self-Assessment newsletter story) by NIHR CLAHRC East Midlands. Walking Away from Diabetes is a structured education programme encouraging and supporting physical activity in those at-risk from diabetes. The Walking Away programme is recommended for use in the National Institute for Health and Care Excellence (NICE) Guidelines for Early Intervention and Prevention of Diabetes. It has been commissioned by 16 Clinical Commissioning Groups (CCGs) in England, and is used in health services in Ireland, Gibraltar and Western Australia. Find out more.
 
Unique EarlyBird study follows children through to adulthood for the first time
The EarlyBird study is led by an academic from Plymouth University Peninsula Schools of Medicine and Dentistry who is supported by NIHR PenCLAHRC. The study is following 300 young people who were age five when recruited in 2000. Originally conceived to scope diabetes and endocrine diseases it is the first study of its kind in the world to track the same group from childhood to adulthood. Established in 2000 the study has weighed, measured and investigated children in the Plymouth area to see how their lifestyles, diet and exercise patterns affect health – especially diabetes. Results so far have linked lifestyle and/or genetics to ‘western’ conditions such as diabetes, obesity, heart disease and stroke. Recently the data allowed researchers to show a link between childhood obesity and the early onset of puberty. The study now aims to test whether patterns of pancreatic function detected in childhood persist into adulthood and may be responsible not only for adult health conditions, but also for the shape and fat content of the body. Find out more.
 
Further information
Further information on the NIHR can be found at www.nihr.ac.uk. Further information on the CLAHRCs, including links to their own web resources, is available at www.clahrcpp.co.uk. This newsletter is produced by the CLAHRC Partnership Programme based at Universities UK on behalf of the CLAHRC community. If you have any ideas or suggestions for the newsletter please contact Christina.heap@universitiesuk.ac.uk. For past issues of this newsletter and to join the mailing list please visit the CPP website.