MRC APBI STratification and Extreme Response Mechanism IN Diabetes - MASTERMIND

Lead Research Organisation: University of Exeter
Department Name: Peninsula Medical School

Abstract

Context

The present clinical guidelines for the treatment of type 2 diabetes propose that treatment given to patients is primarily determined by the cost of the therapy and assumes that all patients respond similarly to treatment. This ignores the fact that for many therapies there is enormous variation in response between individuals with type 2 diabetes. If it was possible to understand the reasons why patients responded differently to therapy then it would be possible to choose the therapy most likely to be effective for an individual patient thus maximising the benefit and minimising the risk of a particular treatment.

Aims and Objectives

The aim of this research is to develop a scientific framework which will be used to develop the stratification of treatment in Type 2 Diabetes; that is individualising treatment for a patient or subgroups of patients with the aim of giving the right drug to the right patient at the right time.
In Strand 1, the main aim is to define the biological mechanisms involved in patients' extreme response to second and third line treatment in type 2 diabetes. The objectives are to define exactly why some patients respond very differently to the same drug. We will define the clinical characteristics which relate to whether patients are more or less likely to respond to a drug, including whether the patients who do not respond are just those that do not take their tablets. We will also define those characteristics related to rapid deterioration of the blood glucose. We will determine whether if a person does not respond to one type of drug they are likely to not respond to other drugs or whether that person simply does not respond to all diabetes treatment. We will determine how consistent someone's response is by asking patients to stop their drug treatment briefly; someone who is a consistent good responder to the drug will have a rapid in rise in blood sugar when the drug treatment is stopped. Finally, we will set up a resource to enable future genetic and non genetic markers of drug response to be developed.
In Strand 2 we will develop critical information that is required before an approach using stratification can come into clinical practice. We will develop a model which allows us to predict a patient's likely response to a particular therapy. We will then work out in theory when it would be both effective and cost effective to use treatment stratification in type 2 diabetes.

Potential applications and benefits

There are enormous potential benefits to giving drugs to patients who are likely to respond to them and not to patients who are unlikely to respond. This would have considerable benefits in improving the patient's blood sugar control and hence reducing their risk of complications, cutting down on the number of tablets that they need to take (hence saving money on unnecessary therapy) and reducing the risk of side effects to therapies that were ineffective. For the pharmaceutical industry it would enable targeted drug development for patients where other therapy was ineffective and also to define patient subgroups that were most likely to benefit from new drug development. In addition this new understanding about why patients responded very well to drugs already developed would aid in the future modification of therapy to give improved patient outcome.

Technical Summary

The work in Strand 1 is to assess the mechanisms explaining differences in response to hypoglycaemic therapy and in Strand 2, to develop the appropriate tools to apply stratification in clinical practice and the theoretical models to assess when this would be effective and cost effective.
In Strand 1 the principal approach will be to study the extreme responders to both drug therapy and rate of glycaemic deterioration. In a large cross-sectional study, clinical characteristics, DNA, and serum and plasma (for the biomarkers studied) will be collected from 6000 subjects. The pathophysiology associated with the extreme response to therapy will be assessed by in depth studies of groups of 80 responders and non responders for each drug class. Further studies will assess what the 'best' drug is for an individual i.e. in someone who has an extremely good or poor response to one drug, is an alternative drug that works via a different mechanism similarly effective, better or worse. Finally, the fundamental question of durability of response will be addressed by assessing if the extreme initial response to a therapy wears off over time, as this will guide whether drugs should be continued as new drugs (e.g. insulin) are added or stopped.

In Strand 2, large amounts of individual and group patient data will be used to develop a model allowing prediction of response to specific therapy types. This will be based on existing trial data and then validated in longitudinal observational patient data. We will develop theoretical models to assess when and to what extent stratification results in a more effective use of treatment. We will go on to create further models, which will look at the cost effectiveness of this approach including taking into account the impact on morbidity and mortality of improved glycaemic control in such an approach. We will develop a theoretical framework dealing with the issues of implementing the stratified approach in the treatment of type 2 diabetes.

Planned Impact

This grant offers the possibility of defining the mechanism, effectiveness and cost effectiveness of stratification for 2nd and 3rd line treatment in type 2 diabetes. It will also answer fundamental questions about whether therapy should be discontinued when glycaemic targets are no longer met, whether patients who do not respond to one drug are unlikely to respond to another and whether the response to therapy changes over time. These are fundamental pieces of information required in the treatment in type 2 diabetes which have considerable potential and wide ranging impact.

Who will benefit from this research?
The people who will benefit the most are patients with diabetes. The answers provided by this project will directly influence the choice of what treatment they should take. We hope that this will mean that they are taking the right treatment at the right time and importantly also avoiding treatments which are ineffective for them. It will also be of clear benefit to doctors in primary and secondary care who treat patients with type 2 diabetes. For providers of healthcare it will be enormously important to ensure that patients are treated with appropriate drugs with the more expensive newer agents being used in those who will gain the most benefit. A major beneficiary will be the pharmaceutical industry who will get early information on a new approach to the treatment of type 2 diabetes. The definition of people that will clearly not benefit from generic medication or alternatively will clearly benefit from recently introduced novel therapies will give a clear target of where pharmaceutical companies should be aiming their therapy. In addition the establishment, even if for only 1 drug, that strata can occur and it can be beneficial to be selective in who receives the drug will open new opportunities for drugs which do not show efficacy across a broad range of patients but might be very effective for a smaller subgroup. The development by a very strong academic team of the theoretical basis of stratification is likely to be very resonant with organisations advising on prescribing such as NICE and hence be very relevant to companies. In addition the information on what determines the mechanism of response will be important to inform the development of new therapies with less response heterogeneity and increased effectiveness.

There will also be a clear benefit for people working in other fields as this could develop a blueprint for how to investigate stratification for conditions where the tissue is not available for detailed study. It is not over stating the case to say that defining that stratification is clearly beneficial in a single sub group of type 2 diabetes medication could change thinking for many common conditions such as hypertension.
At a national level given the very large number of patients with type 2 diabetes there will be improvement in the health of the nation by achieving better glucose control and hence preventing the development of complications. There would also be an advantage in the wealth of the nation by reducing healthcare costs in not prescribing unnecessary medication and also in providing a clear focus to the appropriate use of current medication and directions for the development of future medication for type 2 diabetes.

Publications

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Eibich P (2017) Costs and Treatment Pathways for Type 2 Diabetes in the UK: A Mastermind Cohort Study. in Diabetes therapy : research, treatment and education of diabetes and related disorders

 
Description MRC Stratified Medicine
Amount £2,897,589 (GBP)
Organisation Medical Research Council (MRC) 
Sector Academic/University
Country United Kingdom
Start 04/2012 
End 06/2016
 
Description MASTERMIND Clinical investigation 
Organisation King's College London
Department Faculty of Life Sciences and Medicine
Country United Kingdom 
Sector Academic/University 
PI Contribution Design and carrying out of clinical studies to define predictors of drug response and identifying extreme responders and progressors to glucose lowering drugs in diabetes.
Collaborator Contribution Design and carrying out of clinical studies to define predictors of drug response and identifying extreme responders and progressors to glucose lowering drugs in diabetes.
Impact Grant application to MRC
Start Year 2012
 
Description MASTERMIND Clinical investigation 
Organisation University of Dundee
Department School of Medicine
Country United Kingdom 
Sector Academic/University 
PI Contribution Design and carrying out of clinical studies to define predictors of drug response and identifying extreme responders and progressors to glucose lowering drugs in diabetes.
Collaborator Contribution Design and carrying out of clinical studies to define predictors of drug response and identifying extreme responders and progressors to glucose lowering drugs in diabetes.
Impact Grant application to MRC
Start Year 2012
 
Description MASTERMIND Clinical investigation 
Organisation University of Glasgow
Department School of Medicine Glasgow
Country United Kingdom 
Sector Academic/University 
PI Contribution Design and carrying out of clinical studies to define predictors of drug response and identifying extreme responders and progressors to glucose lowering drugs in diabetes.
Collaborator Contribution Design and carrying out of clinical studies to define predictors of drug response and identifying extreme responders and progressors to glucose lowering drugs in diabetes.
Impact Grant application to MRC
Start Year 2012
 
Description MASTERMIND Clinical investigation 
Organisation University of Newcastle
Department Faculty of Health and Medicine
Country United Kingdom 
Sector Academic/University 
PI Contribution Design and carrying out of clinical studies to define predictors of drug response and identifying extreme responders and progressors to glucose lowering drugs in diabetes.
Collaborator Contribution Design and carrying out of clinical studies to define predictors of drug response and identifying extreme responders and progressors to glucose lowering drugs in diabetes.
Impact Grant application to MRC
Start Year 2012
 
Description MASTERMIND Clinical investigation 
Organisation University of Oxford
Department School of Medicine
Country United Kingdom 
Sector Academic/University 
PI Contribution Design and carrying out of clinical studies to define predictors of drug response and identifying extreme responders and progressors to glucose lowering drugs in diabetes.
Collaborator Contribution Design and carrying out of clinical studies to define predictors of drug response and identifying extreme responders and progressors to glucose lowering drugs in diabetes.
Impact Grant application to MRC
Start Year 2012
 
Description MASTERMIND Industrial partnership 
Organisation AstraZeneca
Country United Kingdom 
Sector Private 
PI Contribution Presentation of issues relating to stratification in Type 1 diabetes and presenting possible solutions and approaches
Collaborator Contribution Critical appraisal of research aims and research plans
Impact MRC application Strand 1 and Strand 2
Start Year 2013
 
Description MASTERMIND Industrial partnership 
Organisation Eli Lilly & Company Ltd
Country United Kingdom 
Sector Private 
PI Contribution Presentation of issues relating to stratification in Type 1 diabetes and presenting possible solutions and approaches
Collaborator Contribution Critical appraisal of research aims and research plans
Impact MRC application Strand 1 and Strand 2
Start Year 2013
 
Description MASTERMIND Industrial partnership 
Organisation GlaxoSmithKline (GSK)
Country Global 
Sector Private 
PI Contribution Presentation of issues relating to stratification in Type 1 diabetes and presenting possible solutions and approaches
Collaborator Contribution Critical appraisal of research aims and research plans
Impact MRC application Strand 1 and Strand 2
Start Year 2013
 
Description MASTERMIND Industrial partnership 
Organisation Sanofi
Department Aventis
Country France 
Sector Private 
PI Contribution Presentation of issues relating to stratification in Type 1 diabetes and presenting possible solutions and approaches
Collaborator Contribution Critical appraisal of research aims and research plans
Impact MRC application Strand 1 and Strand 2
Start Year 2013
 
Description MASTERMIND Industrial partnership 
Organisation Takeda Pharmaceutical Company
Country Global 
Sector Private 
PI Contribution Presentation of issues relating to stratification in Type 1 diabetes and presenting possible solutions and approaches
Collaborator Contribution Critical appraisal of research aims and research plans
Impact MRC application Strand 1 and Strand 2
Start Year 2013
 
Description MASTERMIND Strand 2 data analysis 
Organisation University of Dundee
Department School of Medicine
Country United Kingdom 
Sector Academic/University 
PI Contribution Analysis approaches for drug response data and of results of analysis of the CPRD
Collaborator Contribution Analysis approaches for drug response data and of results of analysis of the UKPDS Analysis approaches for drug response data and of results of analysis of the DARTS MEMO study
Impact Unified approach and ability to compare outcomes in different data sets for validation
Start Year 2013
 
Description MASTERMIND Strand 2 data analysis 
Organisation University of Oxford
Department Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU)
Country United Kingdom 
Sector Academic/University 
PI Contribution Analysis approaches for drug response data and of results of analysis of the CPRD
Collaborator Contribution Analysis approaches for drug response data and of results of analysis of the UKPDS Analysis approaches for drug response data and of results of analysis of the DARTS MEMO study
Impact Unified approach and ability to compare outcomes in different data sets for validation
Start Year 2013
 
Description Personalised Medicine to Treat Patients with Diabetes, Berzelius Symposium No. 96, Malmo, Sweden 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Personalised medicine to treat patients with diabetes
Berzelius Sympoisum No 96
Malmo, Sweden
Year(s) Of Engagement Activity 2018
 
Description Precision medicine in Diabetes - Present and future, at 15th Portuguese Congress of Diabetes, Algarve, Portugal 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Precision medicine in Diabetes - Present and future
15th Portuguese Congress of Diabetes
Quarteira, Algarve, Portugal
Year(s) Of Engagement Activity 2019
 
Description AMRING Neonatal Diabetes Expert Group Meeting, Paris 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Advice and recommendations on: Review of the existing data on AMGLIDIA, Place of AMGLIDIA in the therapeutic strategy, Review of the current patient journey and medical needs, interest for a dedicated European expert networking
AMRING, European Neonatal Diabetes Expert Meeting, Paris, France
Year(s) Of Engagement Activity 2018
 
Description Banting Memorial Lecture,Diagnosing diabetes subtypes improves clinical care, Diabetes UK, London 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Banting Memorial Lecture
Diagnosing diabetes subtypes improves clinical care
Diabetes UK, Excel Centre, London.
Year(s) Of Engagement Activity 2018
 
Description Better diagnosis of types and subtypes of Diabetes improves clinical care: new research from Exeter, Diabetes Unit, KEM Hospital, Pune, India 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Better diagnosis of types and subtypes of Diabetes improves clinical care: new research from Exeter
Year(s) Of Engagement Activity 2018
 
Description Confessions of a very lucky clinical researcher, NIHR National Paediatric Research Event. Wellcome Trust UK 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Confessions of a very lucky clinical researcher
National NIHR Paediatric research
Welcome Trust, London
Year(s) Of Engagement Activity 2017
 
Description DUK patient group presentations 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? Yes
Geographic Reach Regional
Primary Audience Participants in your research and patient groups
Results and Impact 60 patients attended the meeting which sparked questions and discussion

Patients keen to take part in future research
Education about future advances in T1D through research
Request to speak at future meetings
Year(s) Of Engagement Activity 2012,2013,2014
URL http://www.exeterdiabetes.org.uk/Core/Exeter-Voluntary-Diabetes/Pages/Default.aspx
 
Description Defining heterogeneity in diabetes to improve clinical care, Evert van Ballegooie Lecture, Evert van Ballegooie Foundation, The Netherlands 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Evert van Ballegooie Lecture
Defining heterogeneity in diabetes to improve clinical care
Evert van Ballegooie Foundation, The Netherlands
Year(s) Of Engagement Activity 2018
 
Description Diabetes, HNF1B Support Day, Dorothy Hodgkin Building, Whitson Street, Bristol, BS1 3NY 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Ask the expert session
HNF1B patient day
Bristol, UK
Year(s) Of Engagement Activity 2018
 
Description Diagnosing subtypes of diabetes to improve clinical care, Oxford Novo Nordisk Fellowship Symposium, Oxford  
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Keynote speaker Diagnosing subtypes of diabetes to improve clinical care
novo Nordisk-Oxford Fellowship Programme Meeting
Oxford, UK
Year(s) Of Engagement Activity 2018
 
Description Diagnosing the different types of diabetes and why it matters, Diabetes UK 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Went to DUK offices to present research.Staff were able to hear Andrew Hattersley describe the impact his research has had on our understanding of the rarer forms of diabetes and an explanation of how Diabetes UK funding has contributed to that. This included a look forward to the possibilities around personalised medicine.
Year(s) Of Engagement Activity 2017
 
Description Diagnostic diabetes: a paradigm shift, Sir Henry Dale Medal Lecture (BES), Harrogate, UK 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Diagnostic diabetes: a paradigm shift
Sir Henry Dale Medal Lecture
Harrogate, UK
Year(s) Of Engagement Activity 2017
 
Description Diagnostic diabetes; a paradigm shift, Dutch Endocrine Society Meeting, NH Conference Centre, Noordwijkerhout, The Netherlands;  
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Diagnostic diabetes; a paradigm shift
Dutch Endocrine Meeting
NH Conference Centre, Noordwijkerhout, the Netherlands
Year(s) Of Engagement Activity 2019
 
Description From Base Change to Better Care in Diabetes, Heather Dean Lecture, DREAM symposium, Winnipeg, Canada 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Heather Dean Lecture
From Base Change to Better Care in Diabetes
DREAM symposium, Winnipeg, Canada
Year(s) Of Engagement Activity 2017
 
Description From base change to better diabetes care, Jaap de Graap Lecture, Leiden University Medical School, Netherlands 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Jaap de Graap Lecture
From base change to better diabetes care
Leiden University Medical School, Netherlands
Year(s) Of Engagement Activity 2018
 
Description Genetic insights into the human beta-cell and the treatment of diabetes, Peter Baker Lecture, Kings College, London 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Peter Baker Lecture
Genetic insights into the human beta-cell and the treatment of diabetes
Kings College, London
Year(s) Of Engagement Activity 2018
 
Description Genetics in the diabetes clinic: the sequencer will see you now, Innovation in Medicine 2018 RCP Annual Conference, ExCel Centre, London 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Genetics in the diabetes clinic: the sequencer will see you now
Innovation in Medicine 2018
RCP, London, UK
Year(s) Of Engagement Activity 2018
 
Description Lessons from Monogenic Diabetes,- lessons for Precision Medicine in Type 2 diabetes, Precision Medicine in Diabetes conference, University of Dundee, Scotland 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Learning from monogenic diabetes - lessons for Precision Medicine in Type 2 diabetes
Precision Medicine in Diabetes - GoDARTS
Pitlochry, Scotland
Year(s) Of Engagement Activity 2018
 
Description Lessons from monogenic diabetes, nPOD Annual Symposium, Miami, Florida, USA 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Lessons from monogenic diabetes
nPOD annual symposium
Miami, Florida, USA
Year(s) Of Engagement Activity 2018
 
Description MASTERMIND Patient Event 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Participants in your research and patient groups
Results and Impact Presented interim data to the current MASTERMIND participants

.
Year(s) Of Engagement Activity 2014
 
Description Monogenic Diabetes Symposium 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Organised and also gave 3 talks at our Monogenic Diabetes Sympoisum, Exeter
Year(s) Of Engagement Activity 2018
 
Description Monogenic Diabetes Symposium 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact This two day symposium on Monogenic Diabetes is aimed at consultants, SpRs and experienced DSNs, and is designed to help busy clinicians recognise and treat patients with MODY and other forms of monogenic diabetes. It will focus on the current practices and new developments in the management of monogenic diabetes.

The programme will include plenary lectures on major topics delivered by Prof. Andrew Hattersley and his team of international experts. Separate small group casebased discussions will focus on key themes. There will be ample opportunity for interaction, networking and multidisciplinary team development.

Highlights include:

Day 1: Common forms of monogenic diabetes

Strategies to diagnose monogenic diabetes
Recognising and managing the different forms of MODY: including HNF1A, HNF4A and GCK
Management of MODY in pregnancy
Managing treatment change in monogenic diabetes

Day 2: Rarer and more complex forms of monogenic diabetes

Complex genetic syndromes with diabetes
HNF1B
MIDD
Inherited causes of insulin resistance, including lipodystrophy and insulin receptor mutations
Neonatal diabetes: genetic causes and effective management
Genetic testing in the future
Year(s) Of Engagement Activity 2017
URL http://www.youngdiabetologists.org.uk/events/242-mody-course
 
Description Neonatal Diabetes Family Day 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Study participants or study members
Results and Impact A international gathering of Neonatal Diabetes patients and families with various rare forms of genetic diabetes with workshops for families on dealing with outcomes, treatments and advice from the neonatal diabetes team at the University of Exeter, as well as ongoing research participation.
Year(s) Of Engagement Activity 2016
URL http://www.exeter.ac.uk/research/newsandevents/news/title_369479_en.html
 
Description Neonatal Diabetes Family Day - Kir6.2 and SUR1 Mutations 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact .Neonatal Diabetes Family Day

.
Year(s) Of Engagement Activity 2014
 
Description Neonatal Diabetes Family Day - Neonatal Diabetes 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Participants in your research and patient groups
Results and Impact .
Year(s) Of Engagement Activity 2014
 
Description Novel use of genetic information in the diabetes clinic, EASD-SGGD, Leiden, Germany 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Novel use of genetic information in the diabetes clinic
EASD-SGGD
Leiden, Germany
Year(s) Of Engagement Activity 2017
 
Description Patient interest group Diabetes Research Network 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? Yes
Type Of Presentation Keynote/Invited Speaker
Geographic Reach Regional
Primary Audience Public/other audiences
Results and Impact 30 patients - considerable discussion and enthusiasm to be part of patient advisory panel

Asked to give further talks for patient organsiations
Year(s) Of Engagement Activity 2012,2013
 
Description Precision diabetes: right diagnosis leads to the right treatment, ADS Annual Meeting, Perth, Australia 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Precision diabetes: right diagnosis leads to the right treatment
ADS Plenary Lecture Perth, Australia
Year(s) Of Engagement Activity 2017
 
Description Role of clinical phenotyping and biomarkers in precision medicine,Diabetes UK, Liverpool,UK 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Speaker: Role of clinical phenotyping and biomarkers in precision medicine;
(standing in for Timothy McDonald) - Time to measure C peptide in all insulin treated patients
Diabetes UK, ACC Liverpool
Year(s) Of Engagement Activity 2019
 
Description Special Considerations for MODY and neonatal diabetes - pregnancy, CV and complications risk, World Diabetes Congress on Prevention of Diabetes and it's Complications, Edinburgh, Scotland on Neonatal Diabetes 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Industry/Business
Results and Impact Special considerations for MODY and neonatal diabetes - pregnancy, CV and complications risk
World diabetes congress 2018
Edinburgh, Scotland
Year(s) Of Engagement Activity 2018
 
Description Talk: Precision diabetes: A new approach to a common disease, for the Torbay Medical Society 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Professional Practitioners
Results and Impact Presentation "Precision diabetes: A new approach to a common disease" for the Torbay Medical Society, 45 minutes with questions following.
Year(s) Of Engagement Activity 2017
 
Description The Diagnosis of MODY, Dutch MODY Symposium, Leiden 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact The Diagnosis of MODY
Dutch MODY symposium Leiden
Year(s) Of Engagement Activity 2018
 
Description Time to Measure C Peptide in All Insulin Treated Patients, Diabetes UK, ACC Liverpool 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact (stood in for Timothy McDonald)
Year(s) Of Engagement Activity 2018
 
Description Torbay Medical Society 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Professional Practitioners
Results and Impact Precision Diabetes: A new approach to a common disease
Torbay Medical Society
Torquay, UK
Year(s) Of Engagement Activity 2017
 
Description Unexpected insights into T1D:Confessions of a Monogenic Diabetologist! Rachmiel Levine Lecture, Orlando, USA 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Unexpected insights into T1D:Confessions of a Monogenic Diabetologist!
2017 Rachmiel Levine Lecture
Orlando, USA
Year(s) Of Engagement Activity 2008,2017