Research interests
I am a clinical researcher and am driven by the need to research clinical problems in the area of diabetes and endocrinology with the aim of translating these research findings into improved clinical care for my patients. Since I arrived in Southampton, I have attracted over £13 million in research funding.
My current research interests are broadly focussed around two main areas, the physical health problems of those with mental illness and growth hormone misuse in sport. I have also recently obtained a further NIHR grant as chief investigator in a new research area to develop and test a pre-admission intervention to improve the outcomes of people with diabetes listed for surgery.
I am a clinical researcher and am driven by the need to research clinical problems in the area of diabetes and endocrinology with the aim of translating these research findings into improved clinical care for my patients. Since I arrived in Southampton, I have attracted over £13 million in research funding.
My current research interests are broadly focussed around two main areas, the physical health problems of those with mental illness and growth hormone misuse in sport. I have also recently obtained a further NIHR grant as chief investigator in a new research area to develop and test a pre-admission intervention to improve the outcomes of people with diabetes listed for surgery.
Diabetes and Mental Illness
My first area of interest encompasses studies of the effects of severe mental illness on diabetes and cardiovascular disease. This area is in keeping with the research strategy for Human Development and Health but I have also formed successful collaborations with other divisions within the Faculty of Medicine and outside Southampton. I have become a world expert on the subject of severe mental illness and diabetes and have been asked to lecture internationally on this subject, at both major diabetes and psychiatric conferences. I have applied my research to the development of pragmatic guidelines for the management of diabetes risk in people with severe mental illness.
STEPWISE (Structured lifestyle Education for People With SchizophrEnia) trial
My biggest success in this area was the award of a NIHR HTA grant (£1.93 million) in 2013 to adapt the successful DESMOND programme for people with schizophrenia to help them address the problem of weight. I was the chief investigator of this multicentre study. It was hosted by the University of Sheffield Clinical Trials Unit and has involved monthly visits to Sheffield for trial management meetings. The trial recruited to target (414/396) in 12 months (15 months allowed in the original grant application) and maintained a retention rate of >80%. Unfortunately, the intervention was not successful in promoting weight loss. The results were presented at the World Psychiatric Conference in Berlin in September 2017 and the results paper is under review at the British Journal of Psychiatry.
Prediction and Management of cardiovascular risk for people with severe mental illness (PRIMROSE) study
The PRIMROSE project is a recently completed a five year programme of research funded by the NIHR Programme Grants for Applied Research (RP-PG-0609-10156). The aim of the project was to improve the detection and management of cardiovascular disease risk in people with severe mental illnesses in primary care. The project designed two new risk models to assess the risk of cardiovascular disease which outperform those used by the general population. We designed a primary care nurse-led intervention to identify and manage cardiovascular disease and tested this in a cluster randomised controlled trial. Although the primary outcome of total cholesterol did not differ between PRIMROSE and treatment-as-usual groups, the intervention was cost effective because it reduced the number of hospital admissions. The results were published in the Lancet Psychiatry
The programme was led by Professor David Osborn and researchers at University College London in partnership with Camden and Islington NHS Foundation Trust and Rethink Mental Illness. Co-investigators are also based at Kings College London, Imperial College London and the University of Southampton (Richard Holt and Rob Peveler).
Diabetes and mental illness: improving outcomes and services (DIAMONDS)
This programme of work is being led by Dr Najma Siddiqi at the University of York. (Dr Siddiqi is a co-investigator in the STEPWISE project). The aim is to improve the healthcare of people with severe mental illness and diabetes. The project has received initial funding from NIHR Programme Development Grant (NIHR PGfAR - RP-DG-1214-10002; £89,000) to undertake an in-depth analysis of people with SMI and diabetes, describing their health status and the care they receive. Following this initial grant, the project has received further funding from the NIHR Global Health Research programme, NIHR Health Services and Delivery Research Programme and Diabetes UK to continue this work (total funding awarded in 2017 = £5.3 million).
The LOSE weight study
I am the chief investigator of the LOSE weight study which is a new 3 year study research to investigate whether Liraglutide 3 mg can support weight loss in people with schizophrenia. This study is hosted by Southern Health NHS Foundation Trust and is funded by Novo Nordisk through an investigator led grant. The study is in set up at present and the day-to-day running will be undertaken by Dr Clare Whicher, SpR in diabetes, who has also registered for a PhD.
Diabetes Attitudes Wishes and Needs (DAWN2) study
In 2001, the Diabetes, Attitudes, Wishes and Needs (DAWN) study showed that self-management of diabetes was considered poor by people with diabetes and healthcare professionals. The resulting ‘DAWN Call to Action’ encouraged multiple stakeholders to implement person-centred diabetes care, and actively involve people with diabetes in self-management with support from an interdisciplinary team of healthcare professionals. The 2nd DAWN study explores how people with diabetes, their family members and healthcare professionals perceive diabetes care and investigates the value of a person-centred model of diabetes care that emphasizes the needs of the individual in the context of current chronic care, self-management education and psychosocial support.
I am a member of the International Publication Planning Committee for the second Diabetes Attitudes Wishes and Needs (DAWN2) study.
Diabetes, depression and employment
It is well recognised that people with diabetes have a higher rate of depression than the general population. Together with researchers at the Steno Diabetes Center in Copenhagen, we have been exploring Danish population registers to assess the risk of depression in people with diabetes of working age compared with the general population and to assess whether there is a social or employment gradient in any effect. To date, three publication have come from this study.
The misuse of growth hormone
The second area of my research builds on my previous work on the growth hormone - insulin-like growth factor axis and has attracted considerable attention from the World Anti-Doping Agency, US Anti-Doping Agency, UK Sport and the UK government, not least in the run-up to the 2012 London Olympic Games. We have received over $3 million funding to develop a test to detect athletes abusing GH or IGF-I. I have acted as an adviser to WADA, USADA and UK Anti-Doping (formerly part of UK Sport). In addition to speaking at in camera meetings, I have spoken on this subject at international sporting and endocrinology conferences.
GH is believed to be widely misused by professional sportsmen and women for its anabolic and lipolytic properties. The detection of exogenously administered GH, however, poses a formidable challenge, as it is identical to that which is produced naturally in the body. We have developed a method based on the measurement of GH-sensitive markers, which rise in response to rhGH in a dose dependent manner. IGF-I and P-III-NP have been identified as the best markers and selected to construct age adjusted formulae that gave good discrimination between those taking GH and those taking placebo. The test was introduced at the London Olympic Games and two powerlifters were subsequently disqualified at the Paralympic Games.
The research is funded by the non-governmental organisations, the World Anti-Doping Agency, the US Anti-Doping Agency and Partnership for Clean Competition. Our current work has been focussed on the implementation of the test by evaluating further assays, including non-radio-isotopic assays.
OCTOPuS Study
This is a new study funded by the NIHR HTA programme to evaluate whether a diabetes specialist nurse led intervention at the time of listing for cardiac surgery can reduce length of stay and operative complications. This study has three phases. The first phase is to develop the intervention based on an intervention currently running in Bournemouth. The intervention will then be piloted before being tested in a multicentre trial across the UK. I am the chief investigator of this study.
Department(s)
Human Development and Health
Affiliate Department(s)
Human Development and Physiology
Professor Richard HoltProfessor in Diabetes & Endocrinology Human Development and Health Academic Unit Faculty of Medicine University of Southampton The Institute of Developmental Sciences (IDS Building) MP887 University of Southampton Southampton General Hospital Tremona Road Southampton SO16 6YD UK
Room Number: SGH/DC015/MP887
Telephone:(023) 8120 4665
Facsimile:(023) 8120 5255
Email:R.I.G.Holt@soton.ac.uk
