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Research Priorities

July 2008

Studies to establish cost-effectiveness and best approach to screening for Type 2 diabetes
Studies to establish the effectiveness and methodology for mass screening of Type 2 diabetic patients to identify risk of future lower limb complications.
Studies to establish cost-effectiveness and best approach to screening for diabetic retinopathy
Studies to establish the best screening interval for diabetic retinopathy

Strong in basic mechanisms/ research needed in mechanisms being affected by genetic variations
Weak in public health research, both in terms of measurement and interventions
Major challenge is to change behaviour, research desperately needed around this area
More research needs to be focused at the very young and in family dynamics

Major opportunity to study mechanisms, issues of screening and prevention, interventions to prevent cardiovascular disease and delivery of effective health care across different cultures

Major variation in UK in quality and delivery of care
Major health gains to be obtained from successfully applying what we know now
Little existing care or training of health care professionals is evidence based
Currently a major shift in axis of care from secondary to primary care sectors, an urgent need to find more effective models of care in adolescence, pre-conception, Type 2 diabetes
Practical ways of measuring quality of life and psychological distress routinely

Essential to effective treatment of both types of diabetes but educational interventions may provide less and more short lived improvement in metabolic control in the UK compared to other European countries
Challenge in Type 2 diabetes is to alter behaviour in people who have made ‘wrong’ choices throughout their life, urgent need to understand reasons for patients’ decisions around behaviour change and the essential components of structured educational interventions
To assess the efficacy of educational programmes to encourage patient self-management for the prevention of the late sequelae of chronic complications, including a foot ulceration, lower limb amputation and end stage renal disease

Piloting and developing therapeutic interventions that appear to preserve or restore impaired physiological responses to hypoglycaemia in animal models

Trials to assess cost-effectiveness and clinical benefit of new technologies, particularly CSII and continuous glucose monitoring

Trials to assessthe role of metformin in gestational diabetes and type 2 diabetes
Prevention studies of type 2 diabetes in women with previous GDM show that the onset of type 2 diabetes can be delayed or prevented by interventions including lifestyle, metformin, acarbose and thiazolidinediones. There is an urgent clinical need for translational studies examining the ability of various approaches to lifestyle modification to reduce metabolic risk, including health economic analysis.
RCTs are needed to examine the relative roles of structured education, continuous subcutaneous insulin infusion (CSII) and insulin analogues in type 1 diabetic pregnancy.

Functional genomic studies to understand the mechanistic implications of the genetic predisposition to complications and role in therapeutic modulation of risk of complications
Cardiovascular and microvascular complications usually considered as discrete yet underlying mechanisms maybe similar. Research examining total vascular complication load, identification of early risk markers in prediabetes and/or genetic variation leading to increased risk, effects of early interventions
Research to understand interaction of genetic variation with environment.
Nephropathy – studies in primary secondary and tertiary prevention. Possible questions:
1. Is microalbuminuria reduction enough?
2. Can we influence the gradual decline in GFR by interventions such as glycaemic control, lipid control, and aspirin use - blood pressure reduction is probably well established here.
3. Can we reduce the toll of cardiovascular disease in diabetic kidney disease?
4. Diabetic kidney disease v. chronic kidney disease in patients with diabetes - can we distinguish the two and does it matter?
Diabetic Foot Studies of the role of antibiotics in foot infection and good randomised control trials in Charcot arthropathy.
Retinopathy Studies of diabetic retinopathy in children and adolescents. There is still much debate on the effects of puberty on diabetic retinopathy and very little work on adolescents except for studies with small numbers of patients.