The Big Interview – Professor Melanie Davies CBE

Professor Melanie Davies CBE is Professor of Diabetes Medicine at the University of Leicester and co-founder of the Leicester Diabetes Centre, an international centre of excellence in diabetes research, education and innovation.

She is a National Institute of Health Research (NIHR) Senior Investigator, one of only a handful in diabetes in the UK, Director of the NIHR Leicester-Loughborough Diet, Lifestyle and Physical Activity Biomedical Research Unit and principal investigator on a number of large global studies in the field of diabetes, obesity and cardiovascular disease.

Here she talks to us about the power and importance of structured education, ways to improve care and her work to help prevent type 2 diabetes, including developing an evidence base for exercise based on precision.

How is the NHS going to cope with the rise in type 2 diabetes?

It’s really a more radical version of what they have started to do with the Healthier You: the NHS Diabetes Prevention Programme (NDPP), which is a fantastic opportunity to invest in prevention.

But we really need to invest a lot more in the prevention of type 2 diabetes to stem the tide. I think it’s about individualising patient self-management to support people because it is a long-term condition. We also need to ensure people are on the right therapies.

As is already happening, we need to further invest and really support primary care to take on the care of patients and let the specialists concentrate on more complex interventions.

We also need to be sure that younger type 2 patients have access to specialist care as the outcomes are appalling, they are being failed at present.

You have often compared education to being as powerful as a drug, explain?

Diabetes drugs are really important and I wouldn’t say education is better but it’s also a really important part of diabetes care and we need to recognise this – the two work well together.

When based on robust evidence, diabetes structured education provides a means to maximise the precious contact time between healthcare professionals and people with diabetes – supporting individuals to engage in behaviour change by setting personal goals based on their biomedical results to address issues of importance around their life with diabetes. It’s been proven to approve outcomes and is cost-effective – yet is often not offered to patients. If people are empowered in their own care we will get better adherence and see less complications.

Professor Melanie Davies CBE

With only 14 per cent of healthcare professionals offering structured diabetes education and only 10 per cent of people with diabetes having attended a structured education programme, what can be done to address this?

I think the whole culture needs to change with commissioners, the wider medical community and healthcare professionals needing to recognise that education is a pivotal part of people’s care. I think healthcare professionals need to be challenged so they actually understand what we are talking about.

People with diabetes have a demanding condition to manage, yet on average they see a healthcare professional for one hour a year only. One hour of support out of a total of 8,760 to help them manage a condition, which, if neglected, could lead to blindness, a lost limb or an increased risk of a stroke or heart attack.

We need more awareness at grassroots level, making sure people are aware about structured diabetes self-management support or structured education and have access to it. There’s also something about the words we use, what does education as a term mean? It is structured self-management, which is really about supporting people. For some people using the word ‘education’ is a real turn off.

How does the diabetes community continue to persuade commissioners to commission evidenced-based diabetes structured educations amid financials pressures?

That’s where we need a culture change because if you think of a drug or device there are clear processes that companies have to go through to get a CE mark or a licence for a drug. In many ways education is the same, it’s an intervention offered by the NHS. In America they have a process where they get accreditation for their programmes. That’s starting in the UK but it’s not something commissioners understand yet. I think there are now people who are exploiting a gap in the understanding and a lack of an accreditation process.

Is diet and exercise often ignored as a first port of call in the treatment of type 2 diabetes?

I think on a superficial level probably, but often advice has been given for a long time and often when people are diagnosed they often do need medication. But also it’s often because there isn’t the evidence, when people talk about exercise what do they mean? It can mean walking, it can mean high-intensity interval training but actually there’s a whole lot of experimental evidence that suggests that just standing for five minutes every 30 minutes can reduce your glucose levels by 30 per cent. We are working to develop an evidence base for exercise based on precision.

We should in all aspects of interventions, whether it be drugs, nutrition and diet or activity and exercise, be sure we follow a precision medicine approach and develop the right treatment for the right patients. This is far more likely to be value for money and work better for patients.

What is the Leicester Diabetes Centre doing to help prevent type 2 diabetes and help people successfully manage the condition?

We are becoming more patient facing. We are also part of the National Diabetes Prevention Programme, which is rolling out our work to more people at regional levels. We have got a pipeline of research looking at providing evidence for specific precision advice regarding exercise and lifestyle more generally in the prevention and management of type 2 diabetes and other chronic conditions rather than general advice. This will result in quality information for patients that can be individualised. We know general advice doesn’t work, so we need to give specific advice around what will work for the individual.

What do you think to the new the CCG Improvement and Assessment Framework and what will it mean for diabetes?

This is a real opportunity to improve quality of care for aspects of diabetes particularly around structured self-management. I think it’s an opportunity to raise the importance of diabetes self-management formally in the care pathway. We don’t get these opportunities very often so it’s important we take them.

What are your research priorities?

The Healthier You: The NHS Diabetes Prevention Programme – a national drive to prevent type 2 diabetes by identifying those at high risk and referring them onto a behavior-change programme – is great but in reality everyone gets the same lifestyle advice. We want to extend the research evidence for the whole spectrum, physical activities, sitting down, sleep patterns etc. Also, with diet and nutrition interventions, there’s a huge amount we don’t know about the specifics of what does and doesn’t work and there is lots of controversy in this area.

We also want to continue to do the work we do with pharmaceutical companies looking at new therapies, we like doing that work because it gives people in Leicestershire access to the latest in cutting-edge treatments years before they become generally available. Evidence shows that if patients get involved in research their outcomes are better.

What’s been your biggest achievement?

Being awarded a CBE, being recognised for all the work we have done and working with Professor Kamlesh Khunti and the team. Personally the CBE was great for me because I was able to share that with my family and parents, it was a nice day out and it was a very public recognition of what I’ve been fortunate enough to achieve in my professional life.

What is the future of diabetes care in the UK?

I think it’s really very positive. There are uncertain times at the moment with Brexit and with what’s happening in the NHS, but I still think that our primary care, hospitals and integrated care are amongst the best in the world. There is room for improvement, plus an opportunity to do more work internationally. There are also exciting new therapies and technology coming through which could make a huge impact on the lives of people with diabetes.

We need to do the straightforward things well and implement the things we know work well. We also need to ensure more and more people have access to structured self-management and effective therapies.