Type 2 Diabetes (T2D) is one of the greatest challenges currently facing the NHS, with growing levels of obesity contributing to a large increase in the numbers of people with the condition. The disease can lead to serious long-term health problems – including heart attack, stroke, kidney failure and sight loss – which have an enormous impact on the lives of patients and their families. And it is these complications that account for most of the healthcare activity and cost associated with T2D.
In North West London (NWL), T2D makes up a large part of the total disease and cost burden of healthcare, costing approximately £600 million every year and accounting for over 40% of all hospital admissions.
In primary care (e.g. GP surgeries), which manages the health of 90% of people with T2D, care decisions are often made in time-constrained circumstances. Similarly, people make decisions every day that affect their risk of developing complications of T2D, such as choice of food and the daily dose of their medication. However, this is done with limited support from healthcare professionals, averaging just 1-3 hours of clinician support time each year.
Meanwhile, evidence has shown that understanding these risks and providing targeted interventions to those at highest risk can reduce hospital admissions and death from diabetes and its complications.
We aim to prevent complications by predicting the individual risk of people with diabetes
In our newly-launched research project, we will use risk prediction algorithms to understand individuals’ risk of developing serious complications from T2D. Funded by Health Data Research UK (HDR UK), we’re working in partnership with North West London Health and Care Partnership, AstraZeneca, Discover-NOW/Imperial College Health Partners and MyWay Digital Health.
These risk algorithms were developed in Scotland by MyWay Digital Health. So first, we’ll adapt these for the population in NWL, one of the most ethnically diverse in the UK. To do this we will access Discover-NOW – a health data research hub – which includes more than 10 years of anonymised data for millions of individuals in North West London and is supported by consent-to-contact technology. This means that people on the database can give their consent to be contacted about participating in research studies.
Understanding personalised risk of people with T2D will allow us to develop tools to support clinical decision-making for people with diabetes, focusing on early intervention. These computer-based tools will use the calculated risk to help patients and clinicians make better-informed decisions around self-management and treatment of their condition.
In turn this could also encourage patients to change certain behaviours, leading to positive outcomes like a healthier weight and better control of blood sugar levels, ultimately improving quality of life.
Piloting an intensive 12-week programme for those at highest risk
In addition to deploying the risk prediction tools, we will also be piloting a 12-week intensive digital support programme in NWL for those identified as being at highest risk of developing serious complications.
We’ll run the pilot in 2021 with participating GP practices in NWL. It will involve group consultations to drive behaviour change, medicine intensification (giving higher doses of medications), and diet and lifestyle coaching. On top of this, participants will measure and report important indicators for diabetes – such as weight, blood sugar, and blood pressure – using a smartphone app and monitoring devices, all without needing to visit their GP practice. This is particularly important as people with diabetes are at a higher risk from COVID-19, with many continuing to shield from the rest of the population.
If we’re successful with this pilot, our aim is to roll out this service programme to all GP practices in NWL. And ultimately, help more people with diabetes take control of their health.
Dr Jack Halligan is IGHI’s Health Innovation Policy Fellow.