Preventing Complications

Projects Underway

	Retinopathy Creating a database with South West Retina to describe the epidemiology of diabetic retinopathy In the next 5 years the plan is to develop different interventions and create a follow up cohort (in Liverpool)
	Nephropathy Over the next 5 years, the plan is to test further interventions for improving diabetes management in patients with diabetic nephropathy RCT of a novel agent to delay nephropathy progression (funded by the Baker Institute) RCT of saxagliptin and dapagliflozin in CKD 3 (DELIGHT: Astra Zeneca-completed)
	Heart and cardiovascular disease Impact of improving glycaemic control (Liverpool) on cardiac function Impact of exercise on cardiac function (Campbelltown PhD student application underway) Impact of bariatric surgery (sleeve gastrectomy) on diabetic cardiomyopathy (Liverpool) Impact of aldosterone antagonist on diabetic cardiomyopathy (Liverpool) Over the next 5 years, the Liverpool team will continue to collaborate with the Department of Cardiology in studies of diabetic cardiomyopathy (e.g. effects of the new classes of diabetes therapy, e.g. GLP-1 agonists, SGLT-2 inhibitors on left ventricular function amongst our patients with type 2 diabetes)
	Diabetic foot Creation of a standardised national Diabetic Foot registry (Liverpool) Patient pathways-mapping study of whether patients admitted with foot disease received the right care and if not why not. (Liverpool study underway) Pharmacological treatments for Charcot Foot (Liverpool study underway) Management of diabetic foot ulcers/infections - Diagnostic techniques -Trialling the use of a 3D wound imaging camera (Liverpool study underway) - Microbiological techniques- using advanced molecular and microscopy techniques to determine which bacteria reside in diabetic foot ulcers (Liverpool study underway) - Pharmacological treatments for diabetic foot ulcers-monitoring study of outpatient intravenous antibiotics (Liverpool study underway) Management of co-morbidities-prospective audit of cardio-metabolic risk management among patients attending high-risk foot services (Liverpool- underway) Establishment and evaluation of a diabetes complications screening/step down foot clinic at Western on e.g. re-ulceration rates (2017-2020-Western Campbelltown Campus). Pathogenesis of ulceration and re-ulceration in relation to 'fidget', increased sedentary pressures, wound deformation, weight bearing and inflammation (2017-2019 Campbelltown/Camden). Effect of hyperbaric oxygen therapy on vascular disease, blood flow and neuropathy in patients with foot disease (2019-2020 Campbelltown/Camden/Mascot/POW) Health economics of the diabetic foot

Future Projects

	Diabetic foot New projects being planned include to examine neuro-psychological aspects of people with complex diabetic foot disease, continue research into the microbiome of the diabetic foot including exploring methods of adjusting the microbiome for both prevention and treatment of infections and develop new projects comparing treatment differing paradigms for diabetic foot infection.
	Massive obesity and diabetes The Camden and Concord Metabolic Rehabilitation Programs have a unique cohort of patients with massive obesity and the obesity related co-morbidities of Type 2 Diabetes, Fatty Liver Disease & Obesity Hypoventilation Syndrome. Approximately 50% of participants in the Fatty Liver and Obesity Hypoventilation programs also have diabetes. Participants undergo an intensive rehabilitation programme with a large interdisciplinary team comprised of medical, nursing, dietetics, psychology, physiotherapy and exercise physiology, as well as supervised on-site exercise classes. If insufficient weight loss, publically funded bariatric surgery is considered and offered to suitable participants after 12 months in the programs. Work is underway to evaluate the Metabolic Rehabilitation Programs more formally. Integration between the obesity services, gastroenterology, primary care and public/private lifestyle providers is being evaluated as part of the work. The first joint funding application for investigating the genetics of severe obesity has been made with the molecular biology group at the Garvan Institute and the epigenetics group at Western. Over the next 5 years, we intend to have: (i) completed a case control study comparing survival and service utilisation among participants and waiting list controls; ii) commenced a RCT comparing the Metabolic Rehabilitation Diabetes Programs to an enhanced diabetes clinic model of care; and (iii) increased the number of family studies to identify possible genetic causes for severe obesity
	Diabetes inpatients Over the next 5 years, we intend to: (i) extend the ongoing quality improvement program among diabetes inpatients at Campbelltown to other sites; (ii) undertake a cluster RCT of inpatient staff education assessing the impact upon e.g. length of stay; (iii) undertake a RCT of glucose control among different groups of inpatients (e.g. during labour); (iv) investigate different approaches to managing/charting insulin among inpatients; and (v) investigate glycaemic patterns among inpatients.
	Type 1 diabetes Campbelltown is currently a TRIALNET site looking at the natural history of type 1 diabetes (and its prevention). Over the next 5 years, we plan to: (i) commence Oz-DAFNE (structured type 1 diabetes education) locally and then join the Oz-DAFNE research collaborative; (ii) test a new model of care in transition care (ages 18-25) currently under development; and (iii) participate in trials of new technology (CGMS, CSII as they become available.
	Type 2 diabetes Campbelltown is already a DELIGHT site for Astra Zeneca and over the next 5 years, all sites intend to increase participation in pharmaceutical trials as they arise. Management of type 2 diabetes (besides before/in pregnancy, with severe complications or with management difficulties) largely in primary care with whom we intend to work closely in an increasingly integrated fashion (vide infra) over the next 5 years.

Our Projects