Des Johnston Imperial College, London

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Presentation transcript:

Des Johnston Imperial College, London The role of the diabetologist in fulfilling the research aspirations in the new NHS Des Johnston Imperial College, London

Why should we care? Funding of R&D

Clinical Research Networks NHS Infrastructure (e.g. research nurses) Currently 8 networks UK-wide Working with industry - Industry Roadmap Group Interfaces with funders

Background to creation of topic specific networks Designed to support optimal approaches to disease prevention, diagnosis and treatment (emphasis on clinical trials) Topic-specific networks in cancer, diabetes, stroke, neurodegenerative diseases, mental health, medicines for children Each has its own co-ordinating centre Primary Care Research Network Comprehensive Research Network

Professor David Cameron NIHR Topic Specific Research Networks Professor Paul Wallace Deputy Director for Primary Care Professors Janet Darbyshire & Peter Selby UKCRN CC and PCRN Professor Gary Ford Director, Stroke Research Network Professor David Cameron Director, National Cancer Research Network Professor Ros Smyth Director, Medicines for Children Research Network Professor Til Wykes Director, Mental Health Research Network Professors Martin Rossor and Ian McKeith Co-Directors, Dementias and Neurodegenerative Diseases Research Network Professor Des Johnston Director, Diabetes Research Network 35

Why diabetes? Affects ~5% of population of England Diagnosed diabetes increased from 1.4 to 2.6 million since 1996 Type 2 diabetes 92% of total Diabetes UK: March 2010

The importance of diabetic complications Life expectancy reduced by 15 years in type 1 and by 5-7 years in type 2 diabetes Mortality from coronary heart disease and stroke 2-4 times higher Diabetes is the most common cause of non-traumatic amputation (Fox & MacKinnon, 1999) Diabetes is leading cause of visual impairment (Evans, 1995) and of end-stage renal failure in the UK (Ansell et al, 1999)

Importance of diabetes Cost – diabetes care consumes 5-15% of health care budgets in the Western world Most of cost is due to complications and mostly circulatory problems Decision partly political

Local Research Networks SW Peninsula Thames Valley North West London North East London Eastern England South East Midlands North West North & East Cumbria

CLRN Areas with nominated Leads for diabetes CLRNs that have not identified any diabetes research Initial map shows DLRN areas superimposed on CLRN boundaries. Mouse click superimposes in blue CLRNs that have formally nominated diabetes as a specialty together with existing DLRN areas. The few missing CLRNs are either wholly or partially covered by an existing DLRN. The two gaps are where a CLRN not nominating diabetes are 50% or less coverage by existing DLRN: Trent is half in SEMidlands DLRN and Cheshire and Merseyside is partially coverage by NW England DLRN.

Local Research Network Resources primary and secondary care consultant and GP sessions research staff managerial, administrative support other costs (e.g. pharmacy)

The Network – Types of Research Clinical treatment trials Technology assessments in real world Prevention studies Epidemiology Population genetics Pharmacogenetics Health Care Delivery Health Economics

Impact of participation in clinical studies on outcome in ovarian cancer Du Bois et al, Int J Gynecol Cancer 2005, 15, 183.

Research Portfolio Non-commercial and commercial Non-commercial automatic adoption if: Government or AMRC funded Open national competitive process Peer review Database: WWW.UKCRN.org

The Network – Types of Research All types Difficult studies e.g. uncommon complications, unusual presentations, difficult to access groups, large numbers required, early intervention trials in type 1 diabetes

The Diabetes Research Network – Type 1 infrastructure project Therapeutic trials of agents aiming to reverse established disease (e.g. anti-CD3 antibodies, anti-CD20 antibodies, antigen-specific tolerance vaccination) Often need treatment to commence within 6-12 weeks

Natural History of Type 1 Diabetes GENETICALLY AT-RISK Immune Dysregulation Environmental Triggers and Regulators MULTIPLE ANTIBODY POSITIVE IAA GADA ICA512A ICA LOSS OF FIRST PHASE INSULIN RESPONSE Interactions Between Genes Imparting Susceptibility and Resistance  Cell Mass Loss of FPIR (IVGTT) Variable Insulitis Beta Cell Sensitivity to Injury Glucose Intolerance C-Peptide Absence Overt Diabetes Pre-Diabetes NEWLY DIAGNOSED DIABETES Time Lancet. 2001. 358: 221-29.

The Diabetes Research Network – Type 1 infrastructure project 200 adults and 300 children per year with incident type 1 diabetes (within 6-12 weeks) 300 siblings per year Clinical and demographic information on database Sample repository including DNA Potential for additional information and samples

Sample collection proposal Samples collected from DRN Sites Samples sent to Porton Down for preparation and storage European collection of cell cultures Porton Down 200 µl Serum aliquot sent to Bristol for autoantibody status measurements Bristol (Polly Bingley’s lab)

ADDRESS Database Patient Baseline form Demographic data Diabetes classification Medical and social history Pregnancy Medication Family History Clinical measurements Biochemistry

The Diabetes Research Network – Type 1 infrastructure project Ascertain the patients within 6 weeks of diagnosis and consent (different levels) Ascertain the siblings and obtain consent Create computerised database Create sample repository Infrastructure for access

Agents for prevention of type 1 diabetes - mechanisms Antigen-specific tolerance Immune mimicry Anti-inflammatory Monoclonal anti-CD3

The Diabetes Research Network – Type 1 infrastructure project Intervention and prevention trials Aetiopathogenesis studies Epidemiology Other studies/trials

Diabetes Research Network – the future Five year plan accepted Emphasis on value for money Ability to react to opportunities

The Diabetes Research Network – Success 279 studies adopted 136 studies recruiting 96,527 patients recruited 56

The Clinical Research Network Portfolio Recruitment Data Information The table below shows the latest UKCRN Portfolio recruitment figures Snapshot at 15 February 2010 TOPIC Current Total Number of Studies Open or in Set up Comprehensive 1254 Primary Care 111 Cancer 405 Dementias and Neurodegenerative Diseases 109 Diabetes 141 Medicines for Children 123 Mental Health 234 Stroke 93 TOTAL 2470 * Topic led only – Where a study relates to more than one Topic, the recruitment data is shown against the lead Topic.

Cumulative figures this financial year (1 April 2009 – 31 March 2010) at 15 February 2010 TOPIC Number of Studies Open to Recruitment during 2009/10 Total Number of Studies Reporting Recruitment during 2009/10 Total Recruitment 2009/10 Comprehensive 1308 1154 160141 Primary Care 144 133 58737 Cancer 402 378 31733 Dementias and Neurodegenerative Diseases 114 107 6009 Diabetes 137 121 29899 Medicines for Children 99 90 5421 Mental Health 209 186 23696 Stroke 88 74 6745 TOTAL 2501 2243 322,381 * Topic led only – Where a study relates to more than one Topic, the recruitment data is shown against the lead Topic.

Where to find more information www.UKDRN.org DRNinfo@imperial.ac.uk