DRWF Research Manager Dr Eleanor Kennedy reports from the Diabetes UK Professional Conference in Liverpool.
For diabetes researchers there are three main punctuation points in the year. There’s the European Association for the Study of Diabetes annual conference in the autumn. There’s the American Diabetes Association’s annual conference in the summer. And, in early spring, the Diabetes UK’s Professional Conference pops into our diaries.
Thousands of scientists, clinicians and other allied healthcare professionals have descended, this year, on Liverpool, home of The Beatles and the Cavern Club, a waterfront that is designated a World Heritage Site and, to those of us of a certain vintage, “The Liver Birds”.
The opening session of the conference revolves around the NHS National Diabetes Prevention Study and the Diabetes Remission Clinical Trial (DiRECT) study. This latter study is one that Diabetes UK has invested more money in than in any other piece of research and one that it continues to promote endlessly as being the best way to get people with type 2 diabetes into remission.
Professor Jonathan Valabhji, the National Clinical Director for Diabetes and Obesity at NHS England, kicks off proceedings with an update on the NHS’ flagship Healthier You: NHS Diabetes Prevention Programme study. Although it will be several more months before we know if diabetes can actually be prevented with this intervention, he was able to update a packed auditorium that, as of summer 2018, there is now universal coverage across England of this study and that there is encouraging preliminary data on participant retention as well as a weight loss of around 3kg and a drop in HbA1c levels. However, in order to reach more challenging groups, like those of working age, digital modes of delivery rather than the current face-to-face delivery will be introduced as will pay-for-performance incentives for more hard to reach people from black and minority ethnic groups, those of more deprived socioeconomic status and those who are obese.
Professor Roy Taylor from the University of Newcastle and one of the principal investigators on the DiRECT study was also on stage and he reported that the benefits to patients of being on an 800 calorie per day diet are that people report feeling ten years younger, that they spend less time in their doctors’ surgeries and that they lose the “diabetic” label all of which they appreciate.
However, Professor Taylor was upstaged by a patient who had been involved in this “Taylor Diet” as he referred to it. Mr David Paul held a large audience in rapturous laughter as he described the process as “hellish” and the pre-packaged soups and shakes that make up the 800 calorie a day diet as “ghastly”. But he did concede that, for him, it was well worth it as, now, he is an avid cyclist and has shed a lot of weight. He admitted though that keeping this weight off is still a challenge. Which, of course, begs the question that many of us are asking. How sustainable is all of this? The Diabetes Prevention Study costs about £2,800 per patient to implement; the DiRECT Study around £1,000. For an NHS buckling with the numbers of people presenting with type 2 diabetes, what are the opportunity costs of this expenditure? Could there be more cost-effective ways to prevent diabetes or to put the condition into remission? If Mr Paul, the poster boy for the DiRECT Study, admits difficulties, then what hope does this give to the rest of us who are probably a whole lot less motivated than he clearly is?
That debate will, I am sure, rumble on for some time.
Following this, Simon Heller, Professor of Clinical Diabetes at the University of Sheffield and arguably one of the world’s leading authorities on hypoglycaemia, addressed a packed lecture theatre here to listen to his Banting Memorial Lecture entitled The ongoing challenge of hypoglycaemia, a century after the discovery of insulin.
This was typical Professor Heller in barnstorming mode pacing the stage, energetically describing everything from the pathophysiology of hypoglycaemia and the effects that it can have on people with type 1 diabetes – cognitive dysfunction, seizures and comas, fear and diminished quality of life - to recent research linking hypoglycaemia with increased cardiovascular risk. Three large randomised controlled trials have certainly reported a link between severe hypoglycaemia and mortality but how can we square this circle and demonstrate what the actual cause of this increased mortality is? Is this at the root of the so-called “dead in bed” syndrome? Could further research elucidate whether the different heartbeats observed during periods of severe hypoglycaemia are what ultimately lead of death?
Cutting edge research to one side, one of the joys of a conference like this is the simple networking opportunities that arise – I meet DRWF-funded researchers as well as several members, both past and present, of our Research Advisory Board and I chat with Dr Amanda Adler from Addenbrooke’s Hospital and Professor Andrew Hattersley from the University of Exeter who has pioneered the genetic research into the so-called monogenic forms of diabetes. And he reminds me of a session tomorrow evening that I shouldn’t miss – he’ll be speaking which means that it’ll be good!