King’s Health Partners Diabetes, Endocrinology & Obesity (KHP DEO) Clinical Academic Partnership brings together clinical, operational and academic teams from across Guy’s and St Thomas’ NHS Foundation Trust (NHS FT), King’s College Hospital NHS Foundation Trust (NHS FT), South London and Maudsley NHS Foundation Trust (NHS FT) and King’s College London with colleagues from across the south east London (SEL) system. We work together to improve the health, wellbeing and outcomes of people living with diabetes, obesity & endocrine disorders for our local population and beyond.
In this newsletter edition, we wish to raise awareness for World Obesity Day on Saturday 4 March 2023. Read more here and find out how you can get involved.
Dr Alastair Duncan Consultant Dietitian, Guy’s and St Thomas’ Hospital NHS FT Lecturer in Nutritional Sciences, King’s College London
Please can you tell us about how you got into dietetics and what motivated you to be a dietitian?
I have to admit that I didn’t know what dietitians did until I met one. This was back in 1993. Some friends were very unwell with HIV and in response I was volunteering with a wonderful charity called The Food Chain www.foodchain.org.uk who provide nutritional services for people living with HIV. I met Hazel Ross, who at the time was one of the only dietitians in the world specialising in HIV care, and I thought “I want to do that!”. I already had a degree in microbiology so completed the postgrad route into the profession. The first five years of working in HIV dietetics at Guy’s and St Thomas’ NHS FT focussed on dealing with the consequences of opportunistic infections and malnutrition – diarrhoea and wasting for example. Then with the advent of effective antiretroviral therapy my work changed to managing dyslipidaemia and excessive weight gain. Around 2010 I began to wonder why so many people living with HIV were developing diabetes. I was awarded an NIHR clinical doctoral research fellowship to investigate and tested a diet and exercise intervention to reduce diabetes risk. It worked, I’m delighted to say.
Can you tell us a little about your area of work?
In 2016 I was asked to develop a pilot Tier 3 weight management programme in Southwark, testing delivery to their diverse population. Outcomes proved to be positive, and as a result we were asked to expand the pilot across south east London. It is now fully commissioned, with 4,000 patients living with complex obesity being referred each year. I lead the most wonderful multidisciplinary team – physiotherapists, psychologists, doctors and dietitians, aided by clinical assistants and pathway coordinators. There are 34 of us delivering over 30,000 appointments annually. I also lead the dietetic service for metabolic surgery, and two Tier 2 weight management services – in Southwark and in Lewisham. The Lewisham service is called Up!Up! and was co-designed with Dr Louise Goff from King’s College London, stakeholders and representatives from Lewisham’s Black communities, in response to evidence that people of Black heritage experience poorer weight management outcomes compared to White people.
How does this benefit patients?
The Tier 3 weight management programme doesn’t work for everyone, and we do experience attrition from the programme to the same extent as similar programmes across the UK. However, it can be literally life changing for patients. I recall one patient who was approaching 200kg when referred, living with multiple comorbidities and polypharmacy, and using a rollator to move around. He did spectacularly well on the 800 kcal/day total meal replacement intervention we modelled from the DiRECT study. After 12 months with us he weighed 119kg, had ceased all prescribed medicines, and was beginning to enjoy running. Thinking about the Up!Up! programme in Lewisham, evaluation has been highly positive, with one participant telling us “I’ve been waiting for something like this all my life”.
How does being part of a Clinical Academic Partnership help your work?
I am surrounded by a network of highly talented people who are always willing to help solve problems and offer advice. I strongly believe that to achieve the highest quality of care for our patients we need to work in partnership, not just with each other but with our patients as well. KHP fosters this approach.
What would your advice be to someone starting out as a clinical academic?
As a Consultant Dietitian I am required to deliver on four pillars of practice at an advanced level: clinical, research and audit, innovation and education. I love working across all four pillars and find this very rewarding. If you are starting out as a clinical academic, then I advise you to identify strengths and areas for development within each pillar. Chat with the lovely people from Training and Development, devise a plan with your line manager, and find a mentor to bounce ideas off. Finding protected time for personal development will always be a challenge, but it’s your line manager’s job to help you with this – don’t let them off the hook!
Obesity Awareness - Innovating Healthcare
Our colleague Prof Barbara McGowan, Consultant in diabetes and endocrinology at Guy’s and St Thomas’ NHS FT, joined thought leaders from the NHS, life sciences industry, and civil society to discuss obesity for National Obesity Awareness Week. The episode from Chamber UK highlights the challenges of obesity and potential solutions to improve population health.
Prof Barbara McGowan Consultant in Diabetes and Endocrinology Guy’s and St Thomas’ NHS FT
The video is part of Chamber UK’s Innovating Healthcare series which brings together leaders across government, the NHS, civil society, and industry to discuss specific healthcare issues.
Chamber UK’s social media channels are as follows:
Prof Francesco Rubino Chair Metabolic and Bariatric Surgery King’s College London and King’s College Hospital NHS FT
Prof Francesco Rubino, Chair Metabolic and Bariatric Surgery at King’s College London and King’s College Hospital NHS FT, outlines the rationale behind the consensus paper on weight stigma.
People with obesity face not only increased risk of serious medical complications but also a pervasive, resilient form of social stigma.
Perceived – without evidence – as lazy, gluttonous, lacking will power and self-discipline, individuals suffering from obesity are often discriminated against in the workplace, education, and even by healthcare professionals.Extensive research has shown that obesity stigma can cause significant harm to afflicted individuals, including both physical and psychological consequences, and people with obesity are less likely to seek and receive adequate care (Brewis et al., 2018; Flint et al., 2015; Puhl & Suh, 2015).
The damaging consequences of obesity stigma, however, extend beyond harm to individual victims. Despite scientific evidence to the contrary, the prevailing view in society is that obesity is a choice: a condition, rather than a disease, that can be reversed by voluntary decisions to eat less and exercise more. These assumptions mislead public health policies, confuse messages in popular media, undermine access to evidence-based treatments, and compromise advances in research.
For all of the reasons above, tackling stigma is not only a matter of human rights and social justice but also a way to advance prevention and treatment of obesity and associated metabolic diseases. To begin to address this issue, a large group of international experts and scientific organisations have issued a joint position statement and related pledge to eliminate weight stigma, published in Nature Medicine in March 2020 (Rubino et al., 2020). These statements called on academic institutions, professional organisations and the media to support educational initiatives aimed at eradicating weight bias through dissemination of current knowledge of obesity and body weight regulation.
Following up on this recommendation we are now launching an educational program on weight-stigma at KHP. The project is designed for a diverse group of stakeholders and aims to address misconceptions in the conventional narrative of obesity that contribute to fuel weight-based stigma.
L to R: Dr Kate (Katherine) Hunt, Consultant in Diabetes and General Medicine, King’s College Hospital NHS FT and Dr Dulmini Kariyawasam, Consultant in Diabetes, Endocrinology and General Internal Medicine, Guy’s and St Thomas’ NHS FT
Dr Kate Hunt, Consultant in Diabetes and General Medicine at King’s College Hospital NHS FT outlines the progress of two related projects to improve diabetes care for young adults in south east London. These projects are jointly led by Dr Hunt and Dr Dulmini Kariyawasam and are being carried out jointly between Guy’s and St Thomas’ NHS FT, King’s College Hospital NHS FT, and the Lambeth and Southwark Diabetes Intermediate Care teams.
NHS England Pilot:
Our clinical academic partnership is delighted to be supporting the Diabetes Transition and Young Adult Service Expansion pilot. The pilot is a joint project across Guy’s and St Thomas’ NHS FT, King’s College Hospital NHS FT, Southwark Community Diabetes service and Lambeth Intermediate Diabetes service to expand their services for young people (up to age 25) with diabetes.
The pilot has expanded the current provision of services for young adults with type 1 diabetes at both acute Trusts. The pilot has also launched the new service for patients with type 2 diabetes in Lambeth and will launch the service in Southwark in March 2023. The pilot is establishing patient and public involvement groups from both the type 1 and type 2 patient cohorts.
Once the new services are fully launched, the pilot will then use co-design techniques to tailor the services. The pilot is developing a risk stratification tool and pathways to align the King’s College Hospital NHS FT and Guy’s and St Thomas’ NHS FT Young Adult Diabetes services.
The pilot will continue to develop the services for young adults living in Lambeth and Southwark until it finishes in April 2025.
Development of an Education & Support programme for Young People with Type 2 Diabetes:
In a related project, the Diabetes, Endocrinology and Obesity team is also supporting a project to develop an education and support programme for young people with type 2 diabetes.
It is well-evidenced that people who develop type 2 diabetes at a young age are more likely to develop life-changing cardiovascular and diabetes complications. A recent King’s College London medical student project has shown that of young people aged 16-24 years living with type 2 diabetes in Southwark, 59% are of Black ethnicity and 11% are of Asian ethnicity, and 82% live in the two most deprived IMD quintiles.
Effective management of glucose, weight, blood pressure, cholesterol, smoking cessation, early detection and management of complications (the ‘nine annual care processes’) reduces the risk of life-changing complications. However, the National Young People with type 2 diabetes audit (2019-2020) showed people with type 2 diabetes at a young age (<40 years) are less likely to have all annual care processes and are less likely to have glucose levels at target.
Our student project has also shown high use of emergency hospital services by young people with type 2 diabetes in Southwark (59% had at least 1 A&E attendance and/or hospital admission in 2021, with 27% having at least one hospital admission).
Sustained exercise and dietary changes, alongside taking medications and attending clinics, are key in managing type 2 diabetes to reduce the risk of long-term complications. However, understanding the need for this and implementing and sustaining change is very difficult to achieve.
There are national education programmes for people with type 2 diabetes (such as DESMOND) but these focus on providing information and are designed with older age groups in mind (as the majority of people with type 2 diabetes are older). Whilst we also know that having access to information is important, motivation to make sustained changes to lifestyle and diabetes is what makes a difference in health outcomes. There are local programmes such as HEAL-D, which was designed to support people from Black ethnic backgrounds with type 2 diabetes, but again this was not designed specifically for young people. As such, these programmes are not suitable for young people, who have very different life experiences and needs.
To address this gap in provision, in October 2022, the young adult diabetes teams at King’s College Hospital NHS FT and Guy’s and St Thomas’ NHS FT acquired funding via Partnership Southwark from NHS England Targeted Investment in Health Inequalities scheme. We plan to use a co-design process with young people with type 2 diabetes to develop and then pilot an education and support programme specifically designed for young people with type 2 diabetes.
So far, we have recruited a specialist dietitian who will drive co-design and pilot implementation of the programme. We have recruited health and wellbeing practitioners who have expertise in working and engaging with young people. We have involved colleagues from King’s College London, King’s College Hospital NHS FT and Guy’s and St Thomas’ NHS FT with relevant expertise. Project management is being provided through KHP DEO Clinical Academic Partnership.
The health and wellbeing practitioners are currently working to engage young people with type 2 diabetes in Southwark and Lambeth in the co-design process.
At the end of the first 12 months, we aim to have produced a programme framework, which we will then pilot over the following six months. We do not expect clear identifiable changes in clinical outcomes within the 18 months. However, in the pilot phase we do expect:
Increased engagement with diabetes care services
Improved process outcomes (completion of the ‘nine annual care processes’)
Improved patient experience
It is hoped that, if successful, we will expand the programme more widely across SEL and beyond.
Vital 5 - Population Health & Healthy Weight Setting Workshop
Obesity is a complex condition influenced by where a person lives, their background and their wider personal circumstances. A broad approach is therefore needed to address its multiple drivers, including those focusing on the environment that shapes our behaviours. There is strong evidence outlining the importance of system-wide commitment and action in encouraging healthy weight across the population.
Consequently, KHP, Local Authority Public Health representatives and and south east London Integrated Care Board (SEL ICB), are seeking commitment from SEL senior leaders to develop healthy weight promoting settings in their organisations. To do this, we are delivering a virtual workshop on Wednesday 10 May 1-5pm.
The workshop will focus on the role of health and social care settings in obesity prevention and tackling health inequalities.
Through this workshop, we aim to co-develop healthy weight promoting actions with a range of settings, ensuring approaches are tailored to a variety of workplace settings, staff, and service users throughout SEL. Creating a network of healthy weight promoting settings throughout the SEL system forms part of the delivery of the Vital 5 factors that have a major impact on health at an individual and population level.
The session will provide space for staff to reflect on how their organisations currently encourage healthy weight promotion, through healthy eating, physical activity, optimum sleep and stress reduction. It will then support staff to identify new ways to improve the health and wellbeing of themselves, their colleagues and service users, without perpetuating existing obesity and weight stigma.
We will shortly be sending an overview of the workshop to Chief Executives and Directors of HR/OD in healthcare organisations throughout south east London and asking them to nominate representatives from their organisations to attend. We encourage attendance from a range of frontline and back-office health and social care professionals of different levels within each organisation, including those able to commit to taking this work forward, and ensuring bottom-up ownership of meaningful actions.
Through this, we hope to achieve a collective commitment to promoting healthy weight across our settings and ultimately improving the health and wellbeing of our population and reducing prominent disparities in obesity.
If you or your organisation are interested in attending, please contact DEO@kcl.ac.uk.
Lancet Commission
The Lancet Commission on Diagnostic Criteria of Clinical Obesity aims to define criteria that discriminate between the condition of obesity (a risk factor for other diseases) and clinical obesity - intended as a disease state. This would be associated with distinct pathophysiology and specific signs and symptoms that reflect ongoing illness.
This Commission is organised as a partnership between the medical journal The Lancet Diabetes & Endocrinology and King’s Health Partners (KHP) Diabetes, Endocrinology and Obesity.
Thank you to Dr Louise Goff & Michelle Martin; Welcome back Hayley Ormandy
Thank you to Dr Louise Goff
Dr Louise Goff Reader in Nutritional Sciences King’s College London
We would like to take this opportunity to thank our friend and colleague Dr Louise Goff, Reader in Nutritional Sciences at King’s College London, who will be taking up a new position as a Professor in Nutritional Science at the University of Leicester, Diabetes Research Centre.
Louise has been a valued member of the team with many initiatives being led by her during her time at King’s Health Partners. Louise secured a large National Institute for Health and Care Research (NIHR) fund for her HEAL-D project which will continue to be progressed by King’s College London and Guy’s and St Thomas’ NHS FT, by participating as research sites i.e., participant recruitment and intervention delivery in south London.
The Up!Up! programme that Louise developed with Guy’s and St Thomas’ NHS FT Dietetics department will also continue to be delivered in Lewisham and may expand to new Boroughs in south London.
We wish Louise the very best in her next and exciting chapter.
Thank you to Michelle Martin; Welcome back Hayley Ormandy
Michelle Martin Interim Programme Director KHP Diabetes, Endocrinology and Obesity Clinical Academic Partnership
This month we are bidding farewell to Michelle Martin, Interim Programme Director for the KHP DEO Clinical Academic Partnership. In addition to spearheading a range of transformative projects within the clinical academic partnership Michelle has been invaluable for developing our relationships with commercial and international partners, including Novo Nordisk, Aarhus, and Dresden, all of which are influential in aiding the achievement of our clinical academic partnership mission. We thank her for her passion, leadership, and unwavering commitment to the programme over the last year - she will be sorely missed.
Welcome back to Hayley Ormandy who returns from maternity leave into this role in April.
Education & Training Updates
At KHP, we believe that education and training is essential for providing high quality care and ultimately improving the health and wellbeing of people living with diabetes, obesity, and endocrine disorders. Over the last few months, the programme team have been working to expand our education offer in a variety of ways.
Youth Empowerment Skills (YES) Programme
Since 2015, Guy’s and St Thomas’s NHS FT has been running a highly commended Youth Empowerment Skills (YES) programme across South London. Originally a pilot, the programme is co-designed and co-delivered by young people and focuses on all aspects of life as a young person, not just their diabetes. The programme also touches on topics such as drugs, alcohol, and sexual health, as well as supporting social connectivity and skills development. We are supporting the expansion of this programme outside of London, with events in the Midlands scheduled throughout 2023.
Dose Adjustment for Normal Eating (DAFNE) Refresher
A pilot Dose Adjustment for Normal Eating (DAFNE) Refresher session, joint between Guy’s and St Thomas’ NHS FT and King’s College Hospital NHS FT, launched on 8 December 2022. This interactive session recapped the content and self-management skills covered in the main DAFNE course and included updates on the latest diabetes research and technology. Attendees also received advice from a diabetes psychologist on emotional health and wellbeing. The pilot received positive feedback from attendees and is something both clinical teams are keen to pursue as a regular joint offering for their services.
In other DAFNE news, we are happy to share that Dr Yee Cheah, Consultant Diabetologist at King’s College Hospital NHS FT has been appointed to the DAFNE Executive Board. Internal Education & Training
We offer a number of online modules covering diabetes, nutrition, collaborative care planning, diabetes and mental health and how to address obesity sensitively during a consultation on our E-Learning Hub.
We are supporting our clinical colleagues develop how they train their staff to care for inpatients with diabetes and developing training for diabetes technology usage. We are also working closely with ICB and primary care colleagues to standardise the approach to diabetes education in primary care settings across SEL. Through this, we hope to improve the equity of diabetes services for our local population.
Education Prospectus
We have developed a Diabetes Education prospectus detailing how we can support the delivery of high-quality diabetes education and training in the Voluntary Sector, Local Authorities, Primary Care, Acute Settings (outside of our local area) and industry partners. The document outlines courses, events and CPD activity on a multitude of important topics relating to diabetes, such as technology, that our partners can choose from, allowing them to develop their own bespoke educational event or package. We are socialising this document with our partners at present and will put this out for commercial review in the coming weeks. Want to know about more about KHP Diabetes, Endocrinology and Obesity Education & Training? Please email DEO@kcl.ac.uk.
Research, Publications & International Collaborations
International Collaboration: KHP & Aarhus Team Brief event
As part of an ever-growing relationship with Central Denmark, the KHP DEO Clinical Academic Partnership hosted a virtual International Team Brief Event with colleagues at Steno Diabetes Centre Aarhus, Aarhus University andAarhus University Hospital on 24 February 2023. This builds on a visit to the Steno Diabetes Centre by four of our six clinical academic co-leaders in November of last year and will pave the way for a series of theme-based research seminar events, clinical visits and knowledge exchange sessions being planned for 2023.
L to R: Prof Troels Krarup Hansen (Steno Diabetes Centre), Dr Gavin Bewick (King’s College London), Prof Annelli Sandbæk (Aarhus University), Dr Sophie Harris (King’s College Hospital NHS FT), Dr Stephen Thomas (Guy’s and St Thomas’ Hospital NHS FT), Prof Emma Duncan (King’s College London)
The event allowed for an opportunity to introduce teams to each other, build momentum and engagement across the teams and allowed them to be clearly sighted on the history of this collaboration, why we are keen to collaborate and what is coming in the future. More than 50 attendees included students, PHDs, clinicians (including Allied Health Professionals) and academics from across Danish and English services.
This event builds on ever strengthening relationships of KHP with the Central Denmark region amongst other through:
Our collaboration with Human First, an Academic Health Science Centre (AHSC) equivalent in Central Denmark;
Our collaboration academically via KCL and Aarhus University in Circle U;
Our relationship with the European University Hospital Alliance (EUHA), and Aarhus University Hospital being the most recent University Hospital to join nine other leading institutions;
And also, Aarhus University Hospital joining the H20 Health Outcomes Observatory Consortium for Patient Reported Outcomes, of which KCL is leading the academic delivery of work package three around Diabetes PROMS.
Trends and predictions of malnutrition and obesity in 204 countries and territories: an analysis of the Global Burden of Disease Study 2019. Bryan Chong, Jayanth Jayabaskaran, Gwyneth Kong, Yiong Huak Chan, Yip Han Chin, Rachel Goh, Shankar Kannan, Cheng Han Ng, Shaun Loong, Martin Tze Wah Kueh, Chaoxing Lin, Vickram Vijay Anand, Ethan Cheng Zhe Lee, H. S. Jocelyn Chew, Darren Jun Hao Tan, Kai En Chan, Jiong-Wei Wang, Mark Muthiah, Georgios K. Dimitriadis, Derek J. Hausenloy, Anurag J. Mehta, Roger Foo, Gregory Lip, Mark Y. Chan, Mamas A. Mamas, Carel W. le Roux, and Nicholas W. S. Chew. Lancet - eClinicalMedicine 2023;57: 101850
Grant Opportunities
Programme Grants – British Heart foundation
Renewable funding for up to five years to address significant research challenges. This is intended to support researchers to undertake a variety of activities focusing on one strategic research theme. Reviewed at three-monthly Chairs and Programme Grants Committee.
Maximum Value: N/A
Deadline: N/A
Travel & Training Grant
To help endocrine nurses and midwives in the UK to cover conference/training expenses, including travel costs.
Maximum Value: £500
Deadline: N/A
Research Grant - British Dietetic Association
For research that advance the science and practice of dietetics (past grants £5,000 - £40,000).
Maximum Value: N/A
Deadline: 03/04/2023
Translational Award – British Heart Foundation
To progress the development of novel, innovative technologies towards benefits to human cardiovascular health.
Maximum Value: £750,000
Deadline: 21/06/2023
Upcoming Events
The Heart and Mind in Diabetes - The Heart and Mind health care practitioners in south London are invited to this half-day event on 30 March 2023 run by the KHP Diabetes, Endocrinology and Obesity team.
Cardiometabolic Medicine in the 21st Century: Challenges and Opportunities - taking place on 14 March 2023 at The Royal Society of Medicine (RSM), attend this event to learn about the pathophysiology, evidence-based management and state-of-the-art prevention strategies for non-communicable cardiometabolic diseases. The speakers will explore how obesity, diabetes, dyslipidaemia, hypertension, renal disease and metabolic liver disease increase the risk of vascular disease with associated morbidity and premature mortality.
Adipose Biology: Metabolic Buffering in an Obesogenic World - the 46th meeting of the pose Tissue Group co-hosted by the Danish Diabetes and Endocrine Academy, the Society for Endocrinology, and the British Heart Foundation. This two-day symposium from 23-24 March in Edinburgh brings together basic and clinical researchers to discuss central aspects of adipose biology and its relation to disease.
MatchPoints Conference: Global Health Challenges and Solutions – taking place from 11-12 May 2023, this conference is hosted by Aarhus University and will explore topics central to global health today, such as pandemic preparedness, health inequality, climate change and sustainability, chronic disease and mental health – all from a global. perspective.
North Europe Young Diabetologists (NEYD) Annual Meeting 2023 - this three-day annual meeting from 24-26 May 2023 is for young researchers from the United Kingdom, Netherlands, Belgium, and Denmark and allows for discussion of research in an intimate and stimulating setting for young researchers.
ARC South London Knowledge Exchange Event – taking place on 7 March 2023, the aim of this event is to bring together researchers, health and social care practitioners, service users, patients and the public to discuss and exchange ideas, evidence and expertise.
Diabetes UK Professional Conference 2023 – this three-day conference from 26-29 April 2023 has something for everyone each day, spanning disciplines from primary to specialist care, podiatry, paediatrics and dietetics.
Opportunities & Resources
MSc Diabetes: Clinical Care and Management at King’s College London – this course is now open for applications to start in October 2023. The aim of this three-year programme is to equip health professionals with advanced skills in formulating diabetes care to improve patient outcomes.
Obesity Prize for Excellence – the European Association for the Study of Obesity (EASO) and the Novo Nordisk Foundation have announced four new Investigator Awards in Basic Science, Clinical Research, Childhood Obesity, and Public Health. The deadline for receipt of nominations is Friday 10 March.
We hope these quarterly newsletters help keep you informed about news, updates, and opportunities across our partnership. If you would be interested in contributing to future editions or have a publication you would like to share with our readers, please get in touch with us via email at DEO@kcl.ac.uk.
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A pilot Dose Adjustment for Normal Eating (DAFNE) Refresher session, joint between Guy’s and St Thomas’ NHS FT and King’s College Hospital NHS FT, launched on 8 December 2022. This interactive session recapped the content and self-management skills covered in the main DAFNE course and included updates on the latest diabetes research and technology. Attendees also received advice from a diabetes psychologist on emotional health and wellbeing. The pilot received positive feedback from attendees and is something both clinical teams are keen to pursue as a regular joint offering for their services.
