Diabetes

Cardiovascular Risk

Predictors of cardiovascular disease and of Type 2 Diabetes are being studied using a database collected prospectively on a large group of employees of a major industrial company. Detailed risk factors information was obtained sequentially in these subjects over a period of more than 20 years. This database has permitted the investigation of predictors of heart disease and Diabetes, and has enabled the importance of longitudinal changes in risk factors to be assessed.

A research programme has investigated the long-term consequences of hypopituitarism. Epidemiological evidence has shown premature death from cardiovascular disease in hypopituitarism and investigations in vivo have demonstrated evidence of excess cardiovascular disease during life. The mechanisms underlying this premature vascular disease have been the subject of investigation. Patients show multiple risk factors. The role of growth hormone deficiency, and replacement therapy with growth hormone, together with the role of glucocorticoids, have been studied. Optimal treatment regimens are under investigation.

Complications of Pregnancy

There is increasing evidence that growth in utero has implications for the health of the infant in later life. The role of the placenta in fetal nutrition is being investigated in normal pregnancy, intrauterine growth restriction and gestational Diabetes. Specifically, the role of the placenta as a source of glucose is being investigated using tracer studies employing stable isotopes.

Type 2 Diabetes

The aetiopathogenesis of Type 2 Diabetes is a major research area. Gestational Diabetes has been studied as a model of early Type 2 Diabetes, permitting the investigation of predisposed subjects before the onset of Diabetes. The role of insulin resistance in the causation of fatty liver, which frequently accompanies Type 2 Diabetes, is being investigated in collaborative studies. The genetic basis of Type 2 Diabetes has been investigated using family-based and other approaches. A population study of screening for Diabetes is under way and will ascertain patients with Diabetes, lesser degrees of glucose intolerance and other CHD risk factors. This screening study will provide a framework for genetic epidemiology studies in Diabetes and CHD, integrating genetic, conventional physiology and metabonomic approaches. The ethnic mix of this population provides an opportunity to explore the basis for ethnic differences in Diabetes and CHD risk.

Diabetes Technology

The diabetes team at Imperial have strong links with the Faculty of Engineering and an extensive research portfolio of diabetes technology, including awards from the Wellcome Trust and Biomedical Research Councils. Research interests include closed loop insulin delivery and dose advisory tools for type 1 diabetes, novel continuous metabolic sensors and remote care interventions for risk management in populations.

Selected Publications:

    1. Oliver NS, Georgiou P, Johnston D, Toumazou C. A Benchtop Closed Loop System Controlled by a Bio-Inspired Silicon Implementation of the Pancreatic Beta Cell. Journal of Diabetes Science and Technology 2009;3:1419–1424

    2. Mehdi S, Hatfield E, Dornhorst A, Oliver NS. Assessment of glycemic variability in continuous subcutaneous insulin infusion therapy in Type 1 Diabetes related to anthropometry and complication status. J Diabetes Science and Technology 2009;3:1227-1228

    3. Alasaarela E, Oliver NS. Wireless Solutions for Managing Diabetes. Technology and Healthcare 2009;17:353-367

    4. Alasaarela E, Nemana R, DeMello S, Oliver NS, Miyazaki M. Wireless for managing Healthcare. International Journal of Healthcare Delivery Reform Initiatives 2009;1:52-73

    5. Oliver NS, Toumazou C, Cass AEG, Johnston DG. Glucose Sensors: A Review of Current and Emerging Technology. Diabetic Medicine 2009;26:197-210

Diabetes Research Network

The Diabetes, Endocrinology and Metabolism Section at St Mary's also works as the coordinating centre for the UK Diabetes Research Network (DRN). Professor Desmond Johnston serves as the Director of the DRN which is coordinated by Imperial College in conjunction with the Oxford Centre for Diabetes, Endocrinology and Metabolism at the University of Oxford.

The DRN has eight branches, Local Research Networks (LRNs), which are spread countrywide. The North West London branch is based at St Mary's Hospital, with Professor Robert Elkeles as the Clinical Head. http://www.ukdrn.org/index.html