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joined 9 years, 10 months ago

Rajiv Dhir

Deputy Chief Pharmacist, Wandsworth Clinical Commissioning Group; Clinical Champion, Diabetes UK

Rajiv Dhir is a pharmacist who works as Deputy Chief Pharmacist at Wandsworth Clinical Commissioning Group (CCG), London. He is also a Clinical Champion for Diabetes UK.

Since graduation from University of Brighton in 1993, he has held a variety of positions mainly in Primary Care. After completion of his pre-registration training at Boots the Chemists, he continued working there gaining more experience in different roles (relief pharmacist, store manager and Professional Development Pharmacist). In 1999, he completed his post-graduate diploma in Clininal Pharmacy and was awarded a distinction.

Rajiv has been a pharmacist for over 24 years. He started his career working in community pharmacy before working in various roles in primary care, before taking on a role as Deputy Chief Pharmacist at Wandsworth Clinical Commissioning Group. The main focus of this role is to maximise benefit and minimise risk associated with medicines, as well as making the best use of resources allocated for prescribing.

Rajiv has a specific interest in diabetes and has completed diploma level modules on diabetes in primary care at Kings College London. Being a member of the various local diabetes committees allows him to develop and shape policies to help patients and clinicians manage Type 2 diabetes. Recently he has been involved with working with GPs and nurses to overcome barriers to optimising treatment in patients with poorly controlled diabetes. The role involves engaging with healthcare professionals across all sectors, as well as with patients, to make a positive impact on patient care.

In his role as one of Diabetes UK Clinical Champions, Rajiv looks at prescribing in the frail and elderly population with Type 2 diabetes. The aim of the project is to reduce the risk of hypoglycaemia and treatment-related harm, for example fall-related fractures, and improve the quality of life for people with moderate or severe frailty.


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joined 9 years, 10 months ago

Roni Sharvanu Saha

Consultant in Acute Medicine, Diabetes and Endocrinology

Dr Roni Sharvanu Saha is a consultant in acute medicine, diabetes and endocrinology in the Acute Medical Unit at St George's Hospital, London.


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joined 9 years, 10 months ago

Sachin Patel

General Practitioner

Dr Patel is a GP Principal in West Wandsworth. He looks after a large and diverse diabetic population in Putney & Roehampton and is the lead GP for diabetes at Mayfield Surgery.

He has completed post graduate training in diabetes and is the Clinical Diabetic lead for West Wandsworth on the clinical reference group for Wandsworth CCG.


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joined 9 years, 10 months ago

Neil Bamford

GP Principal and Diabetes Clinical Lead, Wandsworth Clinical Commissioning Group

Neil Bamford was born in Wandsworth and still works there as a GP, joining his father’s practice after a period researching eye disease at the Institute of Eye Health.

He has a MSc in Public Health and a Diploma in Primary Care Diabetes.

He has been diabetes clinical lead in Wandsworth since 2002, seeing diabetes care transformed by the implementation of the National Service Framework, the Quality and Outcomes Framework and the Health Care for London report. During this time the management of diabetes has stopped being a hospital speciality practised by an elite few and has become an area of primary care which, with adequate support from specialist clinicians, is available throughout general practice and integrated with local communities.


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Richard Lane, former President of DUK, and a patient diagnosed with T2DM suggest that the biggest challenge for diabetes care is actually engaging people who are either at risk of the condition or living with diabetes. Only once people are engaged do you stand a chance to raise their awareness of the disease, and encourage them to change their diets and lifestyles in order to slow the progression of the condition and even prevent it.

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Structured educational courses to help people living with diabetes manage their condition are not working.
 
A few closed service providers dominate diabetes education in the UK, and according to the last National Diabetes Audit, less than 2% of the 3.8 million diagnosed with diabetes attend any form of structured education.
 
The non-dramatic, insidious and chronic nature of diabetes masks the fact that it has become a global epidemic with the potential to overwhelm national health systems, if education can't halt its progress. 
 
Although advances in diabetes research are significant, the horizon for a cure is still distant. At this moment in time, the best option to halt the progression of diabetes is convenient, fast and effective education.
 
 
Diabetes education and outcomes
Current providers of diabetes education fail to demonstrate how their offerings affect outcomes, and people are not interested in educational courses if they're not linked to outcomes. A 2012 London School of Economics study concludes that there's a lack of diabetes outcome data in the UK, and, "No one really knows the true impact of diabetes, and its associated complications."

The 2013 Annual Report of Diabetes UK (DUK) states that 50,000 people with diabetes used the Charity's blood glucose tracker app, 500,000 took its diabetes risk test, and DUK distributed 250,000 foot-guides, but the Report fails to mention what impact these important activities had on patient outcomes. 
 
Shift of power
Traditional providers of diabetes education have yet to appreciate that the information age has shifted the balance of power from health providers to patients.
 
Mobile devices are ubiquitous and personal. By 2018 smartphone penetration in the UK is expected to be 100%. The over 55s are projected to experience the fastest year-on-year smartphone penetration, and the difference of smartphone penetration by age is expected to disappear by 2020. Further, competition will continue to drive down prices of mobile devices, and increase their functionality. 
 
Over 70% of people living with diabetes regularly use their mobiles to search the Internet for healthcare information, and use social-media to share information about health providers, and educational courses.  This is carried out 24-7, 365 days a year.
 
Traditional providers of diabetes educational courses should be minded that 35% of all patients who use social-media say negative things about health providers, 40% of people who receive such negative information believe it, and 41% say it affects their choices. Social-media is the new frontier of reputation risk for providers of diabetes education.
 
Takeaways
Traditional providers of diabetes education must become more open to independent service providers, and enhance their digital strategies to make their education offerings smarter, faster, and better. 
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In October 2014 Harvard professor Douglas Melton announced a breakthrough in the treatment of type-1 diabetes by creating stem cells that produce insulin.

Melton demonstrated that mice treated with transplanted pancreatic cells are still producing insulin months after being injected. Testing in primates is now underway at the University of Chicago, and clinical studies in humans should begin in just a few years.

"Most patients are sick of hearing that something's just around the corner," says Melton, but he's convinced that his research represents a significant turning point in the fight against diabetes.

Type-1
Type-1 diabetes, which usually occurs in children, is an autoimmune disease in which the body attacks its own beta cells of the pancreas and destroys their ability to make insulin. It's a devastating lifelong chronic condition, which affects some three million Americans and 400,000 English people. Treatment is daily insulin doses, a healthy diet and regular physical activity.
 
Increasing incidence
For reasons not completely understood, the incidence of type-1 diabetes has been increasing throughout the world at about three to five per cent a year, and is most prevalent in Europe. This is troubling, because type-1 diabetes has the potential to disable or kill people early in their lives.

The search to discover why type-1 diabetes is increasing resembles the penultimate chapter of an Agatha Christie mystery, where there are many suspects, but no prime candidate. The last chapter to explain the increasing incidence of type-1 diabetes is yet to be written.  
 
Parents unaware of symptoms
A 2012 UK report suggests that parents are unaware of the warning signs of type-1 diabetes: thirstiness, tiredness, weight loss and frequently passing urine. As a consequence 25% of children with the condition are diagnosed once they are already seriously ill with diabetic ketoacidosis (DKA). DKA occurs because a severe lack of insulin upsets the body's normal chemical balance, and leads to the production of poisonous chemicals called ketones. This build-up can be life threatening, and needs immediate specialist treatment in hospital.
The challenge of cell production
Making industrial quantities of the insulin-producing cells of the pancreas has been a Holy Grail of diabetes research. All previous attempts have failed to achieve scalable quantities of the mature beta cells that could be of practical benefit to people living with diabetes.

Just over 20 years ago when Professor Melton's son Sam was diagnosed with type-1 diabetes Melton promised that he would find a cure. He was further inspired when his daughter at 14 was also diagnosed with type-1 diabetes.

According to Melton, it should be possible to produce 'scalable' quantities of beta pancreatic cells from stem cells in industrial-sized bioreactors, and then transplant them into a patient to protect them from immune attack. This would result in an effective cure.

"The biggest hurdle has been to get glucose-sensing, insulin-secreting beta cells, and that's what our group has done," says Melton.

In addition to offering a new form of treatment, and possibly a 'cure' for type-1 diabetes, Melton believes his discovery could also offer hope for the 10% of people living with type-2 diabetes who have to rely on regular insulin injections.

Takeaway
If Professor Melton is successful, not only will his discovery honour a promise to his children, but also it'll be a medical game-changer on a par with antibiotics and bacterial infections.
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