Tackling the prevalence of diabetes
Leading research linking diabetes and mental health
University of Southampton research is instrumental in preventing Type 2 diabetes and is leading research into the links between this disease and mental health.
The alarming rate in the rise of diabetes is placing unprecedented demand on NHS resources. The NHS diabetes spend is £1.6m an hour, which is ten per cent of the annual NHS budget. Around 80 per cent of that spend is on managing the complications arising from diabetes, such as kidney dialysis, amputation of limbs, and going blind.
Of the two types of diabetes, the greatest rise is in the prevalence of Type 2 diabetes. Type 1 diabetes is a currently non-preventable autoimmune disease where the body’s immune system attacks and destroys the cells that produce insulin. 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 largely explains why there are 700 new cases of Type 2 diabetes in the UK a day, worryingly, also now in children.
“Given its prevalence, (there are 12,000 people with diabetes in Southampton) there is a danger that it 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,” says Dr Mayank Patel, Consultant Physician in diabetes and acute medicine at Southampton.
On any given day 15 per cent of our inpatients have diabetes. The majority are here because of an unrelated health problem, but can spend up to an additional five days in hospital if their condition is neglected.
As part of the drive to improve education, Mayank and his multidisciplnary diabetes team have been instrumental in devising a local diabetes prevention programme, in which localities are invited to make the case for resources to support people at risk of developing diabetes. He conducts talks to patient groups and contributes to GP tutorials. Together with Dr Partha Kar, Associate National Clinical Director for Diabetes for NHS England, he has released the first ever Type 1 diabetes comic book, which explains more about the disease in a user-friendly fashion.
Mayank has created an eLearning resource that hospital staff can use to be educated on diabetes. “On any given day 15 per cent of our inpatients have diabetes. The majority are here because of an unrelated health problem, but can spend up to an additional five days in hospital if their condition is neglected,” he says. The resource covers the common themes staff may encounter for a ward patient with diabetes. He has also co-developed a smartphone app called Microguide, inside which is DiAppBetes. “This support app provides concise guidance notes for clinicians, which has proved “invaluable”.
Mayank and his clinical team also teach on the University’s newly created MSc Diabetes Best Practice programme. Now in its second year, the course equips healthcare professionals with skills in the diagnosis, treatment, psychology and management of diabetes, and is generating interest from applicants both in the UK and internationally.
Addressing psychosocial barriers
Richard Holt, Professor in Diabetes and Endocrinology within Medicine at Southampton, sits on the international steering committee of a multinational study called Diabetes Attitudes, Wishes and Needs (DAWN2). The aim of the study, which involved 17 countries and 15,500 people, is to identify some of the psychological and social barriers to people with diabetes getting good glycaemic control.
Despite advances in treatments and increasingly sophisticated guidelines, sub-optimal diabetes control remains common, adversely affecting those with diabetes and with cost implications for the wider health economy. An increasing understanding of the non-medical factors contributing to poor diabetes management has led to calls for greater emphasis on the psychosocial aspects of diabetes, hence the study.
The headlines that come out of the study are that diabetes represents a major psychological burden. There are high rates of distress and depressive symptoms among those with diabetes, but also their families. There was also clear recognition that we need to support people with diabetes better in order that they can control their diabetes themselves. “Most people with diabetes will only see their healthcare professional for a few hours a year, but then have to manage their diabetes for the other 8,700 hours themselves. There is no point in giving ever more sophisticated treatments unless we educate people in how to use those treatments effectively. There is also the issue of stigma and discrimination, and how those societal factors mitigate against good diabetes care.”
People with schizophrenia have a two-fold increased risk of developing diabetes compared with the rest of the population
Diabetes and mental health
Richard is also leading research into the link between diabetes and mental health problems, particularly schizophrenia. He has received a £2m grant from the NIHR HTA programme for the STEPWISE study, a four-year project involving clinical trials of 414 people with schizophrenia.
“We have developed a lifestyle intervention programme for people with schizophrenia to help them manage the problem of weight gain and obesity, which will hopefully translate into reductions in long term physical health problems such as diabetes and cardio-vascular disease. 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 10–15 years earlier than the general population, and most of this is being driven by physical health rather than mental health problems, with diabetes being one of the biggest contributors,” says Richard.
In tandem with research into education programmes, work continues into improving existing treatments. Mayank is involved in an international study, Sustain 7, looking at compounds other than insulin given by injection once a week for Type 2 diabetes. The aim is to see their efficacy on blood glucose control and weight.
Meanwhile, Richard is involved with ongoing research into Type 1 diabetes.
“In collaboration with Stephan Gadola, formerly Professor of Immunology at Southampton, and Annie Tocheva, Research Fellow, we have been looking at why the immune system attacks the pancreas and its own insulin producing cells. That is crucial if we are to develop a cure for Type 1 diabetes. Our project, funded by Diabetes UK, looked at the role of one particular immune cell, the INKT cell. We have shown that although there are the same number of these cells, there are differences in the way they work in people with Type 1 diabetes. There are two clinical implications. It means that we should be able to predict better who is likely to develop diabetes. And also if we can manipulate these cells, maybe we can prevent diabetes – although that is quite a long way into the future.”
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