Type 1 diabetes (T1D) is an autoimmune disease characterised by the destruction of insulin-producing pancreatic beta cells. The current estimate of prevalence of T1D in the UK is 266,000 (0.4%), which translates to ~1 in every 250 people. Globally, temporal trends of incidence continue to rise at an average annual rate of 3-4%. Type 2 diabetes (T2D) is caused by insulin resistance and is largely mediated by lifestyle factors, approximately 90% of people living with diabetes in the UK have T2D. Multimorbidity is the presence of two or more long-term health conditions and is associated with decreased quality of life, premature death, and high treatment burden. Multiple long-term conditions (MLTCs) are a global healthcare priority and strategic aim for the NIHR, MRC, and Academy of Medical Sciences. The risk of MLTCs is much higher in people living with diabetes due to microvascular and macrovascular complications caused by chronic hyperglycaemia, dyslipidaemia, and heightened inflammation.
Clinical practice guidelines almost entirely focus on single conditions in isolation in siloed care pathways which leads to sub optimal care and a multitude of problems, including increased healthcare use and associated cost, polypharmacy, and the complexity of self-care. Chief Medical Officers across the UK have concluded clustering of diseases is fundamental to the management of MLTCs and that they should be embedded into medical training and continuous professional development.
Utilising the vast wealth of existing patient data available, the proposed research will facilitate a better understanding of the magnitude of MLTCs among people living diabetes in the UK. Defining patterns of MLTCs offers the potential of stratifying care between phenotypes which could inform guidelines allowing clinicians to provide more comprehensive care pathways (i.e., precision tailoring of care). Targeting modifiable determinants of MLTCs will be an efficient approach to preventing multimorbidity and its associated risks in people living with diabetes. Collectively this could lead to better models of health care for patients.
The overall aim for the studentship is to advance understanding on MLTCs in people with diabetes. This will be achieved through the following key objectives:
- Systematically review the global evidence base in an attempt to identify the prevalence and effectiveness of interventions to manage MLTCs in people living with diabetes.
- Determine the prevalence, patterns, and determinants of MLTCs in people living with diabetes: a population-based study using electronic health records.
- Develop best practice guidance for the prevention and management of MLTCs in people living with diabetes.
Successful completion by the right candidate is likely to lead to submission of an NIHR (or similar) fellowship application. The student will be supported to apply for further grant funding through NIHR, MRC, Wellcome or similar.