World Diabetes Day – diabetes prevention and treatment in the future

In 2015, 415 million people worldwide had diabetes. By 2040 that figure is set to rise to 642 million, according to the International Diabetes Federation1. Considering that one in two adults with diabetes could be undiagnosed, the actual scale of the diabetes pandemic that we currently face could be much greater than we realise. Diabetes causes raised blood sugar levels, which on the face of it may not seem so severe, but diabetes is a chronic disease that can have many nasty complications. Just a few of these include nerve damage, sometimes resulting in limb amputations, and a two- to three-fold increase in the risk of heart attacks and strokes2. It’s important to raise awareness of diabetes, and given that November 14th is World Diabetes Day3, we decided to speak to Professor Martin Gibson, CEO of North West EHealth (NWEH), to learn about how NWEH could help with diabetes treatments in the future.

What’s your connection with diabetes?

In addition to my role at NWEH, I’m a clinician at Salford Royal Hospital, where I have been looking after people with diabetes for 18 years. Much of the work we’ve done at NWEH with electronic healthcare records (EHRs) actually grew from diabetes work we did at Salford Royal Hospital. People with diabetes touch many parts of the healthcare system. They see doctors in the hospital, their GPs and, because of the complications diabetes brings, they might also see foot specialists, dieticians, opticians, kidney doctors and more. No one has any idea what’s going on with each patient unless they have full sight of all their healthcare records. So we started building systems to bring together EHRs from primary and secondary care for diabetes patients in Salford. Having done that we realised we could use it for improving the quality and safety of care as well as running clinical trials such as the Salford Lung Study.

Is the NHS burdened by the current diabetes epidemic in the UK?

It’s claimed that we spend 10% of the NHS budget looking after people with diabetes, but I suspect it might actually be more than that. Diabetes can adversely affect just about every system in our body, contributing to so many other conditions, that it’s very costly for the NHS.  Furthermore, diabetes incidence is still increasing. Over the last 25 years, the number of people with diabetes patients in Salford has almost quadrupled, rising from 4,000 to around 15,000, even though the overall population of Salford hasn’t changed. Similar trends have been seen across the UK, and if it continues at the same rate over the next ten years, there will be twice as many people again with diabetes in the UK.

Where do you think we should focus our resources - looking for drug therapies or preventing diabetes?

It has to be a combination of everything. You can’t ignore the people who already have diabetes; we have to find better treatments for them or they will suffer. Equally important is preventing more people from developing diabetes. One way to combat the rise of diabetes is through legislation, by making sure we can’t drive our cars into town or by introducing a sugar tax. However, these are all really difficult to implement because nobody wants these changes.

There are also other elements that we don’t yet understand that pre-dispose some people to develop diabetes. If we had tests that could detect those high-risk people before they develop diabetes, we could focus the NHS budget on those who need it most and give them the treatments they need much sooner.

Is NWEH currently working to combat diabetes?

Salford is participating as a pilot site for the national diabetes prevention programme. We are using a contact centre-based platform that we developed for emerging diabetes some years ago. We thought it could be used to change people’s behaviour so that they eat better, do more exercise and so are less likely to develop diabetes. We focused on finding people with impaired glucose regulation using our FARSITE software. These people’s glucose levels are slightly abnormal but not quite at the diabetes end of the spectrum – you can think of them as having ‘pre-diabetes’. At this stage we have a chance to do something about stopping things progressing to full blown diabetes. Our initial results show that we can reduce the rate of people developing diabetes to levels similar to those seen in larger prevention studies which reduced progression by about 50% over a five year period. We think that’s pretty impressive considering we are doing this remotely over the phone.

Can NWEH’s Linked Database System technology be used for finding treatments for diabetes in the future?

Absolutely, we can gather a lot of information from consenting patients with diabetes so it’s a great place to start looking for ways in which we can improve care. Just like the Salford Lung Study, you could allocate people to different types of diabetes treatment and follow their progress over time to see if there are better outcomes for different treatment combinations. With our LDS, we can collect and analyse the information in real time and see which patients respond best to different treatments. You can then start to refine each person’s treatment to suit them, leading to personalised or precision medicine, and our technology is highly suited to this approach. Tailoring the right treatment to the right patient at the right time is where we all want to be and our technology can really support that process.

References

1. Diabetes Facts & Figures (2015). Int Diabetes Federation, http://www.idf.org/about-diabetes/facts-figures

2. Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease (2010). Lancet 375: 2215-2222

3. World Diabetes Day (2016). Diabetes UK - https://www.diabetes.org.uk/Get_involved/World-Diabetes-Day/