About me:

I am a clinician scientist who combines research in diabetes with work as a consultant physician in the Royal Devon University Healthcare NHS Trust. My research interests are in precision approaches to the management of diabetes, with a focus on practical approaches that can impact clinical practice now or in the near future. This includes approaches to improving clinical classification of diabetes, both through optimising use of classification biomarkers such as C-peptide and islet autoantibodies, and through development of prediction models to combine clinical features and biomarkers to guide diabetes classification and treatment. This work has informed national and international guidance in this area. Additional interests include developing stratified approaches to treatment of type 2 diabetes and, as part of my work with the University of Exeter NIHR Global Health Group, approaches to effective diabetes diagnosis, monitoring and classification in low resource settings. My research combines new multi-centre clinical studies with analysis of data from healthcare records, trial and observational studies and I work closely with methodology, laboratory and clinical colleagues, alongside national and international collaborators.

Interests:

Practical C-peptide testing, and its clinical utility

I have worked with colleagues in Exeter to develop practical inexpensive approaches to measuring insulin secretion using a test called C-peptide, and show that these approaches can be used to assist classification and treatment of diabetes. Our work in this area, together with our related work demonstrating that misclassification of diabetes is common, has contributed to the widespread up-take of C-peptide testing in clinical care to confirm diabetes subtype and treatment requirements.

Accurate classification of diabetes

Our research has shown that misclassification of diabetes is common, and that simple cut offs, such as those suggested by current guidelines, perform poorly. To address we have developed clinical prediction models to allow clinicians to integrate different clinical features and biomarkers to accurately differentiate type 1 and 2 diabetes, validating them in multiple circumstances and populations, including leading ongoing prospective studies across 55 NHS Trusts. This work has contributed to recent guideline changes to recommend routine islet-autoantibody testing in suspected type 1 diabetes in adults, with reconsideration of the diagnosis and subsequent C-peptide testing where this test is negative. Related work has demonstrated that reported changes in type 1 diabetes with older age, including a milder overlapping form of diabetes termed ‘Latent Autoimmune Diabetes in Adults’, may be explained by issues related to classification and diagnostic test interpretation. We have shown that when these issues are addressed the characteristics of type 1 (autoimmune) diabetes in older adults remains remarkably similar to the young.

Optimising individual’s treatment response in type 2 diabetes

I lead and support work using existing electronic healthcare record and trial data, and new multicenter studies, to stratify treatment in type 2 diabetes. This has led to a number of important findings on targeting diabetes treatment, using simple clinical features, classification tests and genetic markers.

Diabetes in Sub-Saharan Africa

I am Director (jointly with Professor Moffat Nyirenda, MRC/UVRI/LSHTM Uganda Research Unit) of an NIHR Global Health Group studying diabetes in Sub-Saharan Africa, and was acting Co-Director of our previous group. In this role I work closely with investigators in Sub-Saharan Africa to understand the optimal approach to diagnosing, preventing and treating diabetes in the Sub-Saharan African setting.

Qualifications:

• 2000 BSc. Clinical and Biological Sciences (1st), University of London (Imperial)
• 2001 MBBS, University of London (St. Georges)
• 2004 MRCP
• 2005 DTM&H (Distinction), University of Liverpool
• 2008 Pg Cert Ed, Peninsula College of Medicine and Dentistry, Universities of Exeter and Plymouth
• 2014 PhD, Peninsula College of Medicine and Dentistry, Universities of Exeter and Plymouth
• 2014 MRCP Endocrinology and Diabetes
• 2016 CCT Endocrinology & General (Internal) Medicine