Personal reflections on the development of GIP and incretin therapeutics for diabetes

This lecture will chart landmarks in the discovery of the incretin hormones, gastric inhibitory polypeptide (GIP) and glucagon-like peptide-1 (GLP-1), their actions and exploitation for obesity-diabetes therapy. The journey will highlight the pioneering contributions from Ulster to demonstrating the surprising therapeutic potential of GIP. It will consider the development of stable GIP analogues together with the early controversy generated by discovering beneficial effects of both GIP agonism and GIP antagonism. Subsequent demonstration of additive effects by the group of combining acylated long-acting analogues of GIP and GLP-1 in animal models of diabetes led to the early design and testing of proof-of-concept unimolecular dual (GIP/GLP-1) and triple (GIP/GLP-1/glucagon) agonists. These turned out to be forerunners of the industry-produced drugs, and such agents are currently enjoying much attention for obesity-diabetes. Incretin therapeutics also hold potential to address many of the associated complications such as cardiovascular disease, dementia, bone disorders and infertility.

The National Diabetes Audit (NDA) has formed the infrastructure for evaluating and guiding the implementation of the NHS England Diabetes Programme.  

In 2016, the NHS in England established the Healthier You: NHS Diabetes Prevention Programme (NHS DPP) to prevent or delay the onset of type 2 diabetes in adults diagnosed with prediabetes, and by 2018, the programme achieved nationwide coverage.  Independent evaluations which used NDA data have demonstrated reduced type 2 diabetes incidence in participants as well as at English population level associated with programme implementation. 

This session will focus on new, as yet unpublished, evaluations of type 2 diabetes risk for both the general population and population diagnosed with prediabetes, and assessments of the effectiveness of the NHS DPP using the NDA.  It will also give a broader international perspective on prediabetes, and updates on the NDA and the evolving NHS DPP

Specialisms: Community care, Specialist care, Primary care

Themes: Commissioning, Education, Service provision, Public health, Prevention

10:10 - 10:15: Chairs introduction - update on the NDA

Garry Tan, Consultant and Clinical lead, National Diabetes Audit

10:15 - 10:20: The evolving NHS DPP

Jonathan Valabhji, Clinical Chair in Medicine, Imperial College London

10:20 - 10:30: Prediabetes - an international perspective 

Kamlesh Khunti, Professor of Primary Care Diabetes and Vascular Medicine, University of Leicester

10:30 - 10:45: Variations in the incidence of type 2 diabetes in England and in the response to the National Health Service Diabetes Prevention Programme

Emma Barron, Imperial College London, NHS Chelsea and Westminster Trust 

10:45 - 10:50: Panel discussion and questions

Jonathan Valabhji, Clinical Chair in Medicine, Imperial College London

Kamlesh Khunti, Professor of Primary Care Diabetes and Vascular Medicine, University of Leicester

Emma Barron, Imperial College London, NHS Chelsea and Westminster Trust 

Garry Tan, Consultant and Clinical lead, National Diabetes Audit

Chair: Garry Tan, Consultant and Clinical lead, National Diabetes Audit

Specialisms: Clinical Science

Themes: Technology & Innovation

Pregnancy-specific HCL rollout and improved maternal/neonatal outcomes

This session will discuss the importance of physical activity, with a focus on the results from Refocus-ise. It will also discuss the MiFoot project (seated exercise for those with foot ulceration) and focus on pathway and guidance on exercise for those living with diabetes. The session closes with a 20-minute interactive panel discussion featuring Sam Whittle, Vicki Johnson, Julia Burdon, Nusrat Kausar (dietitian) and Joelle Baynham (podiatrist).

11:50 - 12:10 Refocusise....Welcome to Diabetes Rehabilitation

Samantha Whittle, Diabetes Clinical Nurse Specialist, University Hospitals Dorset NHS Foundation Trust

12:10 - 12:30 - Exercise in type 2 diabetes-related foot ulcer disease: Expert considerations & the MiFoot study

Vicki Johnson, Lead Research Associate for Complex Interventions, University Hospitals of Leicester NHS Trust

12:30 - 12:50 Interactive Panel discussion

Samantha Whittle, Diabetes Clinical Nurse Specialist, University Hospitals Dorset NHS Foundation Trust

Vicki Johnson, Lead Research Associate for Complex Interventions, University Hospitals of Leicester NHS Trust

Nusrat Kausar, Clinical Director and Dietitian (Primary Care Dietitians / BHR PCN)

Joelle Baynham, Consultant Podiatrist - Diabetes Inpatients, University Hospitals Dorset NHS Foundation Trust

Julia Burdon, Education and Research Associate, Chartered Physiotherapist, Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust

Chair: Julia Burdon, Education and Research Associate, Chartered Physiotherapist, Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust

This session will explore the “next big thing” in diabetes through three complementary lenses: disease-modifying therapies in type 1 diabetes (T1D), next-generation incretin-based pharmacotherapy in type 2 diabetes (T2D), and fully automated device systems.

Case discussions of people with positive diabetes autoantibodies, staging of diabetes, eligibility for Teplizumab (possibly), dietetic advice, when to start insulin etc

An interactive session exploring where to find evidence and how to use it best to inform multi-professional service developments and business planning to improve outcomes for people with foot problems and diabetes

14:10  - Finding and creating the data; the NDFA and beyond

Professor Fran Game 

14:20 - Using the data to develop limb salvage interventions 

Helen Milnes, Consultant Podiatric Surgeon, University Hospitals Birmingham 

14:30 -  ACT NOW to empower people with diabetes

Nadine Price, Diabetes Specialist Podiatrist, Gillian Hanson Diabetes Centre, Whipps Cross Hospital

Chairs:

Jayne Robbie, Specialist Podiatrist, University Hospitals Birmingham NHS Trust

Joelle Baynham, Consultant Podiatrist, Diabetes Inpatients and Deputy NMP Lead, Bournemouth

Neighbourhood health, integration of diabetes services, specialist support and workforce development

Medicines and medical devices go through rigorous approval systems before they are placed on the market for use. However, post-market vigilance identifies safety issues that may only occur in certain patient populations, certain circumstances or that are rare and therefore not observed in clinical trials. To support a product’s positive benefit/risk profile in clinical practice, the MHRA applies a number of methods to monitor the safety of medicines, medical devices and blood components for transfusions on the market. Information on adverse events from users and healthcare professionals, literature and other sources are used in signal identification and trending activities, with quality checks built into escalation pathways leading to potential regulatory actions. With a focus on diabetes medicines and medical devices, the presentation will exemplify the importance of patient and healthcare professional reporting of adverse events, whilst exploring how reporting to manufacturers and reporting MHRA is linked and where it differs. Elements of how potential safety signals are assessed will be discussed, including escalation routes and the relevance of stakeholder input. The presentation will show examples of safety signal outcomes and engage with the audience on what additional resources it might consider helpful to further support the safe use of products.

14:05 - 14:20 Diabetes Management Devices: ensuring a positive benefit/risk balance in advancing technologies

Inga Bellahn PhD, Head of Metabolic Disorders and Renal Systems, Benefit Risk Evaluation team II, Safety and Surveillance, Medicines and Healthcare Products Regulatory agency

14:20 - 14:35 Post-marketing pharmacovigilance of Diabetes medicines: a case study

Jenn Matthissen, Head of Gastrointestinal system, nutrition, endocrine & fertility, Benefit/Risk Evaluation Team II, Safety and Surveillance, Medicines and Healthcare Products Regulatory agency

14:35 - 14:45 Questions and Answers 

Inga Bellahn PhD, Head of Metabolic Disorders and Renal Systems, Benefit Risk Evaluation team II, Safety and Surveillance, Medicines and Healthcare Products Regulatory agency

Jenn Matthissen, Head of Gastrointestinal system, nutrition, endocrine & fertility, Benefit/Risk Evaluation Team II, Safety and Surveillance, Medicines and Healthcare Products Regulatory agency

Chair: Partha Kar, Consultant Physician, Portsmouth Hospitals NHS University trust

Link in with our Diabetes UK North of England team and fellow professionals to explore our work and collaborate on future opportunities. Connect, share, or simply sit back and listen.

Chair: Thomas Lambert, Healthcare Engagement & Systems Change Manager, Diabetes UK

The presentations will educate and include a tailored approach to the management of pancreatic type 3c diabetes, provide an update of autologous islet cell transplantation for patients with pancreatic diabetes including recent outcomes from Leicester. Exploring PEI (pancreatic exocrine insufficiency) across all forms of diabetes; how to screen and when to treat and will delve into the relationship between diabetes and pancreatic cancer including discussion of the UK-EDI trial results. This symposium will bring together national experts in the field of pancreatic diabetes to discuss the best practice for the management of patients with this form of diabetes. It is suitable to a wide range of specialists including primary and secondary care colleagues, including dieticians, diabetic nurses, diabetologists, gastroenterology and hepatobiliary. The symposium will shine a light on this. 

14:55 - 15:10 Beyond standard diabetes care: a tailored approach to Type 3c Diabetes

Dr Philip C Johnston MD FRCP, Consultant Diabetes and Endocrinology, Honorary Lecturer Faculty of Medicine, Health and Life Sciences, Queens University Belfast, Regional Centre for Endocrinology and Diabetes, Royal Victoria Hospital

15:10 - 15:25 TP-IAT the Coming of Age

Ashley Dennison, Professor of HPB Surgery, University Hospitals of Leicester, Leicester HPB Unit

15:25 - 15:40 The Forgotten Pancreas: Exocrine Insufficiency in Diabetes 

Laura McGeeney, Diabetes Specialist Dietitian, Cambridge University Hospitals NHS Foundation Trust

15:40 - 15:55 Using the link between Pancreatic Cancer-related diabetes to inform early cancer detection

Eithne Costello, Professor of Molecular Oncology, University of Liverpool

Chair: Zaed Hamady, Consultant Hepatobiliary, Pancreatic, and Robotic Surgeon, University Hospital Southampton NHS Foundation Trust

Professor John Wilding, Professor of Medicine, Honorary Consultant Physician, Aintree University Hospital, Liverpool

Every clinician is asked ""should I exercise?"", and most answers are about avoiding hypoglycaemia. This session reframes activity as something that can improve glucose, tests whether that holds outside the lab, gives clinicians a tool to judge safety before exercise, and ends with the practical barriers, above all for children. It brings together new trial results, new paediatric data and a view from the charity sector in one hour. Learning outcomes.

By the end of the session, delegates will be able to:

1. Distinguish the evidence that activity improves glucose under controlled conditions from the evidence that an activity prescription works in daily life, in type 1 and type 2 diabetes.

2. Use starting glucose, trend arrow and planned duration to discuss hypoglycaemia risk before exercise with an adult or child with type 1 diabetes.

3. Name the main barriers to physical activity for children and young people with type 1 diabetes, and one action they can take locally to reduce them.

16:55 - 16:58 - Welcome and introduction by chairs

Professor Noel Morgan, Editor-in-Chief, Diabetic Medicine

Professor Rob Andrews, University of Exeter

16:58 - 17:08 - Moving to lower glucose: what we know, and what we don't

Breaking up sitting is established practice in type 2 diabetes. In type 1 diabetes, short walks every 30 minutes raised time in range in a laboratory trial without increasing hypoglycaemia, and about 20 minutes of everyday activity lowered a high glucose by a mean 2.2 mmol/L (40 mg/dL) in a matched analysis of 1,546 activity bouts. That is efficacy. Effectiveness in daily life is untested.

John Pemberton, Diabetes Dietitian, Birmingham Women's and Children's NHS Foundation Trust

17:08 - 17:20 - EXTOD-Active: first results

A randomised controlled trial of real-world active breaks, 3 minutes of walking every 30 minutes through the working day, with time in range as the primary outcome in sedentary adults with type 1 diabetes.

Joseph Jenkins, School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham

17:20 - 17:35 - GlucoseGo: predicting hypoglycaemia before exercise, in adults and now in children

A traffic-light tool built from 16,430 exercise sessions in people aged 12 to 80, using three things a person can see before they start: starting glucose, trend arrow and planned duration. Then new data in children under 12 (Exeter, unpublished).

Catherine Russon, Data Scientist, University of Exeter Medical School

17:35 - 17:47 - Hypoglycaemia should not be the barrier: getting children and young people with type 1 diabetes moving

What stops children and families, including stigma, where sport's governing bodies fall short on type 1 diabetes policy, and what clinicians, clubs and schools can do next.

Chris Bright, Breakthrough T1D UK

17:47 - 17:55 - Questions from the floor with all speakers

Chairs:

1. Professor Noel Morgan, Editor-in-Chief, Diabetic Medicine

2. Professor Rob Andrews, University of Exeter Medical School

60 min

This session will provide a critical and up-to-date overview of developments in the field of Type 1 Diabetes and disordered eating (T1DE), focusing on the gap between clinical need and available services and current research and clinical developments.

16: 55 - 17:00: Chair's opening remarks

Hilary Nathan, Director of Policy and Communications, Breakthrough T1D

17:00 - 17:15: What Happened?

Sarah Alicea, Clinical Lead – Type 1 Diabetes & Eating Disorders (T1DE), Barts Health NHS Trust & North East London ICB

17:15 - 17:30: What Now?

Dr Marietta Stadler, Clinical Senior Lecturer & Hon Diabetes Consultant, King’s College London

17:30 - 17:45: What next?

Dr Rose Stewart, Consultant Clinical Psychologist & National Lead for Adult Diabetes Psychology, Betsi Cadwaladr University Healthboard & NHS Wales Performance and Improvement Unit

17:45 - 17:55: Panel Discussion & Chair's Closing Remarks

Sarah Alicea, Clinical Lead – Type 1 Diabetes & Eating Disorders (T1DE), Barts Health NHS Trust & North East London ICB

Dr Marietta Stadler, Clinical Senior Lecturer & Hon Diabetes Consultant, King’s College London

Dr Rose Stewart, Consultant Clinical Psychologist & National Lead for Adult Diabetes Psychology, Betsi Cadwaladr University Healthboard & NHS Wales Performance and Improvement Unit

Chair: Hilary Nathan, Director of Policy and Communications, Breakthrough T1D

The increasing availability of C-peptide, diabetes antibody and genetic testing has meant that an increasing number of people living with diabetes find that their initial diabetes diagnosis was incorrect. How can we as primary and secondary care clinicians explain the new diagnosis in a way that causes least psychological harm? How can we best support those struggling with a new diagnosis and change in treatment? 80% of people diagnosed with MODY initially received an alternative diagnosis and Maggie Shepherd has many years of clinical and research experience supporting people living with a new MODY diagnosis and their families. Claire Howells is an expert by experience who was diagnosed with T1DM after 30 years of being told she had T2DM. DSN Tamsin Fletcher will share her experience of supporting patients in this situation, and specialist diabetes psychologist Vicky McKechnie will give practical advice for non-psychologist clinicians and those with lived experience in supporting others adjusting to a new diabetes diagnosis.

4.58 - Supporting individuals with monogenic diabetes who were previously misdiagnosed and received unnecessary insulin treatment

Maggie Shepherd, Consultant nurse in Monogenic diabetes and honorary clinical professor, University of Exeter 

5.10pm - DSN experience of supporting people with misdiagnosis

Tamsin Fletcher, lead DSN University Hospital of North Midlands, Director DSN Forum 

5.22pm - Interview with Claire Howells regarding her lived experience of finding out she had T1 after many years of living with assumed T2DM

Claire Howells

5.34pm - Overview and practical skills for non-psychologists

Dr Vicky McKechnie, Highly Specialist Clinical Research Psychologist, Imperial College London

Chairs:

Kriss Owen, GP partner and clinical lead for diabetes Derby and Derbyshire ICB

Emma Wilmot, Associate Professor and Honorary Consultant Diabetologist, University of Nottingham and University Hospitals of Derby and Burton

60 min

Lost between two specialties? Reconnecting eye care and diabetes care

Diabetic retinopathy is often managed through separate diabetes and ophthalmology pathways, leaving patients navigating multiple services with limited coordination. This interactive workshop will bring together people living with diabetes, ophthalmologists, diabetologists and diabetes healthcare professionals to explore how care can be better integrated. Using patient experiences and facilitated discussion, delegates will identify practical solutions to improve communication, shared care and patient outcomes across the diabetes-eye care pathway.

16:55 to 17:00 - Welcome and Introduction

Dr Becky Thomas, Senior Lecturer in Population Health and Medical Sciences, Swansea University

17:00 - 17:10 - Lived experience perspective: navigating diabetes and eye care  

Person living with diabetes and diabetic retinopathy - Speaker to be confirmed

17:10 - 17:15 - Ophthalmology perspective: what happens after referral 

Peter Scanlon, Consultant Diabetologist, Gloucestershire Hospitals NHS Foundation Trust

17:15 - 17:20 - The diabetology perspective: why eye disease matters beyond vision 

Dr Garry Tan, Consultant and Clinical Lead, National Diabetes Audit

17:20 - 17:40 - Interactive group exercise: where does care become fragmented

All speakers

17:40 - 17:50 - Feedback and discussion: building a more connected pathway

All speakers

17:50 - 17:55 - Key messages and close

All speakers

Chair: Dr Becky Thomas, Senior Lecturer in Population Health and Medical Sciences, Swansea University

60 min

From Fragmented Care to Integrated Excellence: The DIAST Model of Diabetes Care on Wirral

How can we deliver specialist diabetes care closer to home while reducing pressure on secondary care and strengthening the primary care workforce? This session explores the development and impact of the Diabetes Integrated Advanced Specialist Team (DIAST), an innovative, nurse-led model bridging primary and secondary care across Wirral. By embedding specialist diabetes expertise within primary care networks, DIAST combines structured clinical triage, specialist-led interventions, practice-based education, clinical supervision and clear escalation pathways to ensure people living with diabetes receive the right care, from the right professional, at the right time. Using real-world service data, the session will demonstrate how this approach has contributed to substantial reductions in high-HbA1c patient cohorts and secondary-care referrals, while building clinical confidence and capability across general practice. It will explore the leadership, collaboration and practical implementation required to establish and sustain an integrated workforce model, alongside the opportunities and challenges of translating this approach into other neighbourhoods and healthcare systems. Delegates will leave with practical insights into how specialist nurses can extend their impact beyond individual consultations, drive meaningful service improvement and help shape more proactive, integrated and sustainable diabetes care.

GLP1 use is increasingly common and all clinicians need an understanding of the effect on muscle mass so we can assess and advise appropriately. Opinions vary as to whether lean mass loss through obesity medications is physiological or pathological and we will highlight the evidence for both arguments, concluding that a focus on muscle is needed for high risk populations regardless of the aetiology.  The session will include practical strategies on measuring muscle mass in clinical practice.

08.47 Frailty and sarcopenia- muscle as the exemplar of biological ageing

Prof Tom Yates, Director of the Leicester Lifestyle and Health research group, University of Leicester 

08.55 Defining sarcopaenic obesity in various ethnicities

Dr Emanuella De Lucia Rolfe, Senior research fellow, University of Southampton

09.03 Practical skills in measuring muscle mass

Dr Tom Wilkinson, Research Fellow in Muscle and Functional Health, Diabetes research centre, University of Leicester

Dr Emanuella De Lucia Rolfe, Senior research fellow, University of Southampton

09.11 Muscle and GLP-1RAs: next steps for clinicians

Prof Claire Meek, Professor of Chemical pathology and Diabetes, Leicester Diabetes Centre

Chairs:

Sam Seidu, Professor of Primary Care Diabetes and Cardiometabolic medicine, Leicester Diabetes Centre and University of Leicester

Kriss Owen, GP partner and clinical lead for diabetes Derby and Derbyshire ICB

40 min

This session will bring the audience up to date with what ABCD has been doing over the last 12 months. But also, looking forward to our strategy for the next 3 -5 years. In addition, we will discuss the progress made on restarting our audit programme. We will also highlight our commitment to helping the national programme on screening for early Type 1 diabetes. We will also have discussions on the activities of the Diabetes Technology Network. 

Specialisms: Clinical science

Themes: Commissioning, Technology, Prevention

09:35 - 09:45: An update on ABCD activity

Prof Ketan Dhatariya, Professor of Medicine / Honorary Consultant in Diabetes, University of East Anglia and Norfolk and Norwich University Hospitals

09:45 - 09:55: The ABCD roadshow

Dr Aaisha Saqib, Consultant in Diabetes, Guy’s and St Thomas’ Hospital

09:55 - 10:05: Screening for early stage type 1 diabetes

Professor Parth Narendran, Professor of Diabetes, University of Birmingham

10:05 - 10:15: An update on the ABCD audit programme

Davide Lacuaniello, Consultant in Diabetes, East and North Herts NHS Trust and Jersey health

David Hopkins, Consultant in Diabetes, East and North Herts NHS Trust and Jersey health

10:15 -10:25 An update on DTN activity 

Alistair Lumb,  Consultant in Diabetes, Oxford University Hospitals NHS Foundation Trust

10:25 - 10:35: Questions and Answers

Prof Ketan Dhatariya,  Professor of Medicine / Honorary Consultant in Diabetes, University of East Anglia and Norfolk and Norwich University Hospitals

Dr Aaisha Saqib, Consultant in Diabetes, Guy’s and St Thomas’ Hospital

Prof Parth Narendran, Professor of Diabetes,  University of Birmingham

Davide Lacuaniello, Consultant in Diabetes, East and North Herts NHS Trust and Jersey health

David Hopkins,  Consultant in Diabetes, East and North Herts NHS Trust and Jersey health

Alistair Lumb, Consultant in Diabetes, Oxford University Hospitals NHS Foundation Trust

Chair: Prof Ketan Dhatariya, University of East Anglia and Norfolk and Norwich University Hospitals, Professor of medicine / Honorary Consultant in Diabetes

Screening children for type 1 diabetes through measurement of islet autoantibodies (IAb) allows the early identification of individuals before the onset of symptoms, greatly reducing presentation in diabetic ketoacidosis (DKA) at clinical onset, allowing time to prepare for insulin therapy, and the opportunity for therapeutics to delay disease onset. This also brings up psychosocial challenges, not just when the results are given, but also living with this knowledge for months or even years. Our session will bring an evidence-based perspective on the impact of families at these key stages, and consider how we should flex as healthcare professionals to ensure adequate support is provided.

Specialisms: Specialist care, Paedatrics, Basic science, Clinical science

Themes: Clinical research, Basic research, Paediatrics, Psychology

09:35 - 09:46 Screening - results from ELSA

Dr Lauren Quinn, Clinical Research Fellow, University of Birmingham

09:47 - 09:59 Living with IAb positivity - perspectives of young people/ parents - results from the UK Islet Autoantibody Registry

Dr Tricia Tooman, Research Fellow (Qualitative), University of Edinburgh

10:00 - 10:11 The lived experience

Dr Julia Townson, Principle Research Fellow, Cardiff University

10:12 - 10:23 Healthcare professional perspectives – impact on service delivery

Dr Rabbi Swaby, Clinical Research Fellow 

Dr Rachel Besser, Consultant Paediatric endocrinologist and Clinician Scientist, University of Oxford

10:24 - 10:35 Discussion

Dr Lauren Quinn, Clinical Research Fellow, University of Birmingham

Dr Tricia Tooman, Research Fellow (Qualitative), University of Edinburgh

Dr Julia Townson, Principle Research Fellow, Cardiff University

Dr Rabbi Swaby, Clinical Research Fellow 

Chair: 

Dr Rachel Besser, Consultant Paediatric endocrinologist and Clinician Scientist, University of Oxford

Dr Tabitha Randell, Consultant in Paediatric Endocrinology and Diabetes, Nottingham Children’s Hospital

What makes the best transition and young adult service? Together Type 1 will find out by pitting four services from each of the UK's nations against each other in the contest to end all contests.

11:35 - 11:40: Chair's opening remarks & Contest rules

11:40 - 12:00 Setting the Scene

Dr Stephen Stanaway, Consultant Diabetologist, Betsi Cadwaladr University Health Board

Dr Rose Stewart, Consultant Clinical Psychologist & National Lead for Adult Diabetes Psychology, Betsi Cadwaladr University Health Board

Dr Jackie Elliot, Clinical Lead for Diabetes, Sheffield Teaching Hospitals

12:00 - 12:25 Judges' Questions

12:25 - 12:30 Winner is announced

12:30 - 12:35 Panel discussion - What makes the best transition and young adult service? and Chair's closing remarks

Chair: Jon Matthias, Communications Coordination Manager, Together Type 1 Diabetes UK

Diabetes remains the commonest cause of end stage kidney disease in the UK. A growing cohort of people with early onset Type 2 diabetes are developing CKD at younger ages. In this session will will update the audience on some recent advances in diabetic kidney disease, including updated UK guidelines, managing obesity in CKD and future therapies.  

11.35 - 11.52 Practical management of obesity in people with diabetes and chronic kidney disease

Dr Sagen Zac-Varghese, Consultant in Diabetes and Endocrinology, Lister Hospital

11:52 - 12:09 Management of post transplant diabetes in 2027

Professor Tahseen A Chowdhury, Consultant in Diabetes, The Royal London Hospital

12:09 - 12:26 Future therapies for diabetic kidney disease

Professor Kieran McCafferty, Clinical Professor of Nephrology, Barts and the London School of Medicine and Dentistry

12:26 - 12:35 Question and Answer 

Dr Sagen Zac-Varghese, Consultant in Diabetes and Endocrinology, Lister Hospital

Prof Tahseen A Chowdhury, Consultant in Diabetes, The Royal London Hospital

Professor Kieran McCafferty, Clinical Professor of Nephrology, Barts and the London School of Medicine and Dentistry

Chair: Professor Tahseen A Chowdhury, Consultant in Diabetes, The Royal London Hospital

12:45 - 13:30 - Diabetes UK Professional Interest Network - Eye Health

This is a practical session on working out which eye screening service covers your area and how you – as a clinician - can go about getting access. Who is this session for? Clinicians working in diabetes who want to get access to eye screening data on their patients (appointment dates, photos, grading etc)  Why should they attend? To learn how they would start the journey to obtaining access to eye screening data for their patients. Obtaining this information helps clinicians to personalise care for patients and to streamline decision making (eg understanding retinopathy status for GLP1RA starts).

Topic 1: How can I get access to eye screening results as a diabetes clinician?

What do I need to do as a diabetes clinician to get access to eye screening data?

A follow on from the eye health workshop the day before which will map out the difficulties and frustrations about pathways between clinicians and eye services (hospital and eye screening).

1. Summary of previous day’s findings from workshop

Becky Thomas

2. Overview of screening services – which service covers your area?

Peter Scanlon and Kate Jordan

3. NEC/Inhealth access

Garry Tan 

Topic 2: Eye screening: Do we really need eye drops?

1. Screening without eye drops in in Asian and Afro-Caribbean Groups

Peter Scanlon

2. An evaluation of screening without eye drops with TopCon camera (rolling shutter)

Becky Thomas, Kate Jordan and TopCon speaker

Conclusion and summary

All speakers

Lead facilitator: Garry Tan, Consultant and Clinical Lead, National Diabetes Audit

Co-lead facilitator:Peter Scanlon, Consultant Diabetologist, Gloucestershire Hospitals NHS Foundation Trust

Facilitator: Dr Becky Thomas, Senior Lecturer in Population Health and Medical Sciences, Swansea University

Additional facilitators: Kate Jordan, TopCon speaker 

45 Min

From the voices who made it: a journey from clinic to community in diabetes and pregnancy care

Members of the Guy’s and St Thomas’ diabetes and pregnancy team reflect on two decades of collaboration across diabetes, obstetrics, nursing and midwifery, connecting research and clinical practice with learning and partnerships across trusts, primary care and third sector organisations. The lecture explores what it takes to listen to women and allow what they say to change the service. It places pregnancy within a continuing relationship with diabetes care, built around women’s health throughout their lives. The team reflects on an ethos of continually questioning whether care could be delivered better, and being willing to work differently. This means inviting challenge from women, external partners and the data, and being prepared to act on what they reveal. It also means building relationships that last beyond pregnancy, so women continue to receive care from people who know them and understand their changing lives. Reflecting Mary MacKinnon’s commitment to teamwork and patient voice, the session considers how services can respond to diverse experiences and recognise whose voices are missing. It invites delegates to question their own assumptions: how well do we listen, what are we willing to change, and how can we make women’s health part of everyday diabetes care?

15:00 to 15:03 Introduction to Peter Davies

Jason Cheung, Consultant Diabetologist, Norfolk and Norwich University Hospital NHS Foundation Trust

15:03 to 15:30 - My journey living with type 1 diabetes for 70 years, Peter Davies, person with type 1 diabetes lived experience

Peter Davies, Living with type 1 diabetes for 70 years

15:30 to 15:40 - Q&A

Chair: Jason Cheung, Consultant Diabetologist, Norfolk and Norwich University Hospital NHS Foundation Trust

40 min

Explore what excellent inpatient diabetes care should look like, with updates on the Joint British Diabetes Societies for Inpatient care (JBDS-IP) guidelines and initiatives, the new EASD reference group (Diabetes Inpatient Study Group), audit insights and innovations, plus practical discussion on closing the implementation gap across hospital settings. Learning outcomes 1.Describe current developments in inpatient diabetes care. 2.Apply key standards and guidance to improve inpatient diabetes safety and quality.  3. Identify practical approaches to closing the gap between standards and day to day clinical practice.

Exploring obesity, insulin resistance, GLP-1 therapies and the future of Type 1 diabetes management

Welcome and introduction

Paula Johnston, NHS GIRFT workstream delivery manager for Diabetes & Endocrinology; DISN UK committee member

Year in inpatient diabetes

Dr Omar Mustafa, chair JBDS-IP; consultant diabetologist, King’s College Hospital, London

From standard to excellence: case-based care journey

Dr Pari Avari, Consultant Diabetologist, Imperial College Healthcare NHS Trust, London

Dr Stella George, Consultant in diabetes and endocrinology, East and North Hertfordshire NHS Trust, Stevenage

Focused keynotes to address the care challenges identified in the case above

Dr Daniel Flanagan, Plymouth

Eva Lynch, DCAP

GIRFT update

Professor Gerry Rayman, Ipswich

Panel discussion and Q&A

All speakers and chair

Chair:

Paula Johnston, NHS GIRFT workstream delivery manager for Diabetes & Endocrinology; DISN UK committee member

Attaining target glycemia can be a challenge in Type 1 Diabetes (T1D) due to insulin-induced weight gain.  Adjunct therapy with modern glucose-lowering agents developed for type 2 diabetes (T2D) has great potential but may be insufficiently efficacious and carries risks of hypoglycemia and ketosis.  We present the results of TTT1, the first Phase 3 clinical trial to assess the efficacy and safety of adding a Glucagon-Like Peptide 1 receptor agonist (GLP-1RA) and a Sodium-Glucose Co-transporter (SGLT2) Inhibitor to insulin therapy in overweight adults with T1D and glycemia above target (HbA1c 7.5 – 11.0 % inclusive).  The primary objective was to compare change in HbA1c on ‘triple therapy’ (dapagliflozin, semaglutide and insulin) with dual therapy (placebo, semaglutide and insulin). Secondary objectives include comparisons of triple therapy with standard insulin therapy; and dual therapy (semaglutide and insulin) with standard insulin therapy.  These results will help guide future combination adjunct therapy in the treatment of T1D.

16:40 - Background and design

17:00 - Main results

17:20 - Implications for the evolving landscape of adjunct therapy in type 1 diabetes

Chairs:

Professor Ramzi Ajjan, Professor of Metabolic Medicine, Leeds University and Leeds Teaching Hospitals Trust.

Dr James Boyle, Honorary Professor, School of Medicine, Dentistry & Nursing, University of Glasgow

People living with type 2 diabetes are often labelled "non-adherent" when they do not follow dietary and self-management advice. This expert panel asks whether that framing is fair, or whether, for many, the advice we give assumes choices they do not really have. Drawing on research and clinical practice this session will: (1) examine how food environments and household food insecurity shape dietary choice; (2) explore the realities of self-management for people facing health inequalities; (3) set out practical actions clinicians and services can take to better support people living with type 2 diabetes

16:45 - Food environments and food insecurity

Professor Amelia Lake, Professor of Public Health Nutrition, Teesside University.

17:00 - The realities of self-management for people facing health inequalities

Dr Shoba Poduval, Academic GP and Senior Clinical Lecturer in Primary Care, Wolfson Institute of Population Health, Queen Mary University of London

17:15 - Food insecurity in type 2 diabetes: practical actions for clinicians and services

Dr Ruth Boocock, Associate Professor (Knowledge Exchange), School of Health & Life Sciences, Teesside University; Honorary Dietitian, University Hospitals Tees; Diabetes UK Clinical Champion

17:30 - Panel discussion and questions

All speakers

Chair:

Dr Ruth Boocock, Associate Professor (Knowledge Exchange), Teesside University

We will be considering 3 questions which affect us all in primary and secondary care as we seek to give the best care to our patients living with diabetes in an ever changing landscape. NICE or Not so NICE? How can we implement best care and should this be done nationally or through local pathways?  How can we best support those living with type 1 diabetes and dementia?  How can we support people with T1 or T2 diabetes at the very end of their lives in an age of technology?

4.43pm - NICE or Not so NICE? How can we implement best care and should this be done nationally or through local pathways? A lively debate between Prof Sam Seidu arguing for the importance of the research and evidence base, and Prof Naresh Kanumilli explaining the importance of local pathways agreed within ICBs or health boards.

Prof Sam Seidu, Professor of Primary Care Diabetes and Cardiometabolic medicine, Leicester Diabetes Centre and University of Leicester

Prof Naresh Kanumilli, GP and Community consultant in diabetes Manchester University NHS foundation trust 

4.58pm How can we best support those living with type 1 diabetes and dementia?

Dr Giuseppe Maltese, Consultant in Diabetes, endocrinology and geriatric medicine Epsom and St Helier University Hospitals. Honorary senior clinical lecturer King's College London

5.13pm How can we support people with T1 or T2 diabetes at the very end of their lives in an age of technology?

Dr Alex Maslen, Palliative care specialist registrar and editor of the recent diabetes chapter updates in the Palliative care Formulary and Palliative Care green book

Chairs:

Kriss Owen, GP partner and clinical lead for diabetes Derby and Derbyshire ICB

Reena Patel, Practice nurse at Spinney Hill medical Centre and nurse representative for RCGP Faculty Board Leicester

60 min

Specialisms: Community care, Specialist care, Primary care

Themes: Pregnancy, Prevention, Treatments

GLP-1-based therapies have transformed the management of diabetes and obesity, with established benefits extending into cardiovascular, renal and metabolic liver disease. Evidence is also developing in areas such as sleep apnoea, neurodegenerative disease, addiction and substance use disorders, brain health and cognition. This symposium will examine where the evidence is established and where exciting future possibilities are emerging. It will then consider two important areas of clinical practice: lessons from implementing obesity guidelines over time, including intermittent use, weight regain and decisions about discontinuation after two years; and the use of GLP-1 therapies across preconception, pregnancy and menopause. Three focused expert presentations will be followed by a panel discussion, providing attendees with an evidence-led and clinically relevant overview of current practice, unresolved questions and future directions.

Participants will be able to: 

- Differentiate established evidence for GLP-1 therapies in cardiovascular disease, renal disease, MASH/ MASLD and sleep apnoea from emerging evidence in neurodegenerative disease, addiction and substance use disorders, brain health and cognition

- Reflect on lessons from the implementation of obesity guidelines over time, including intermittent use, weight regain and decision-making about discontinuation after two years of treatment

- Understand the evidence and clinical considerations for GLP-1 therapies in preconception care, pregnancy and menopause

- Identify key evidence gaps and future research possibilities

- Apply evidence-informed, person-centred decision-making in clinical practice

09:00 - 09:10 - The evidence: what is established and what are the exciting future possibilities? 

Established evidence for the role of GLP-1 therapies in cardiovascular disease, renal disease, MASH/ MASLD and sleep apnoea, considered alongside emerging evidence in neurodegenerative disease, addiction and substance use disorders, brain health and cognition.

Professor Carel Le Roux, Professor of Metabolic Medicine, Ulster University

09:10 - 09:20 - Use of GLP-1 therapies for obesity: looking back at guideline implementation and what happens over time

Intermittent use, weight regain and decision-making about discontinuation after two years of treatment.

Speaker to be confirmed

09:20 - 09:30 - GLP-1 use in older people including in menopause 

The evidence for preconception advice, pregnancy and menopause.

Speaker to be confirmed

09:30 - 09:40 - Panel discussion

All speakers and chairs

Chairs:

Dr Ahmad Moolla, Honorary Consultant Physician, Royal Free NHS

40 min

By the end of this symposium, delegates will be able to:

1. Describe the key findings and recommendations from recent HSSIB investigations relevant to diabetes care.
2. Recognise system factors that contribute to insulin-related medication harm across care settings.
3. Understand the complementary roles of people with diabetes, diabetes specialist nurses, pharmacists, multidisciplinary teams, and wider system partners in improving medication safety
4. Apply implementation science principles to translate patient safety recommendations into sustainable improvements in diabetes services.

Specialisms: Community care

Themes: Inpatient care, service provision & technology

09:00 - 09:05 - Welcome and introduction

Why medication safety in diabetes matters: setting the scene and introducing the HSSIB recommendations

Jason Cheung, Consultant Diabetologist, Chair of PCOC, Norfolk and Norwich University Hospital NHS Foundation Trust

09:05 - 09:15 - Learning from HSSIB: What do the investigations tell us about medication safety in diabetes?

Overview of the recent HSSIB investigations, systems thinking, recurring themes in insulin-related harm, and key recommendations for improving safety.

Craig Hadley, Senior Investigator, HSSIB

09:15 - 09:24 - The upcoming highlight notice that’s aligned with HSSIB report

Cristina Lange, Diabetes Specialist Nurse

09:24 - 09:32 - From Highlight notice to research in routine practice: An implementation science approach

Why safety recommendations are often difficult to implement, and how implementation science, audit and feedback, behaviour change, and learning health systems can support sustainable improvements in diabetes care.

Punith Kempegowda, Clinical Associate Professor, University of Birmingham &, Consultant Endocrinologist, Queen Elizabeth Hospital & Chairperson of DRSG Group 4, Diabetes UK

09:32 - 09:40 - Panel discussion and audience Q&A

All speakers

Specialisms: Clinical science, Paediatrics

Themes: Dietetics and nutrition, Paediatrics & Prevention

09:50 - 10:05 - Progress on Legend so far, preliminary data, challenges and successes

Dr Pooja Sachdev, Nottingham University Hospitals NHS Trust

10:05 - 10:20 - Beyond the Numbers: Qualitative Insights from the LEGEND Programme

Charlotte Hilton

10:20 - 10:35 - The dietitian’s perspective

Liz Procter

10:35 - 10:40 - Lived Experience 

10:40 - 10:50 - Q&A

All speakers

Chairs:

Dr Tabitha Randell Consultant in Paediatric Endocrinology and Diabetes, Nottingham University Hospitals NHS Trust

Another chair in addition to Tabitha tbc

Diabetic retinal disease (DRD) encompasses diabetic retinopathy and diabetic macular oedema and both remain a major issue for people living with T1D and T2D.  While we have improved options for treating late-stage disease, current therapies can only be used when vision loss has already occurred.  A critical unmet need is to be able to recognise and characterise DRD early in the disease process and to successfully intervene and thereby prevent progression to the sight-threatening late stages.   This session will cover cutting-edge clinical science relating to retinal imaging technologies with relevance for DRD screening and also discovery science which is understanding pathogenesis. In all cases, there is relevance to the translational pathway towards patient impact.  All the speakers are Diabetes UK funded researchers ranging from early career scientists (including a current RD Lawrence fellow) to senior professors.  The session seeks to showcase top-quality research supported by the charity in institutions spanning the UK

Specialisms: Basic science, Clinical science

Themes: Basic research, Clinical research, Prevention

09:50 - 10:00 Deep Learning for the Automated Prediction of Diabetic Retinopathy Progression 

Dr Paul Nderitu, University College London Senior Research Fellow and Medical Retina Consultant, Moorfields Eye Hospital

10:00 - 10:10 Mitochondrial Rejuvenation in Diabetic Retinopathy: Translational Insights 

Dr Jose R Hombrebueno, University of Birmingham, Department of Inflammation and Ageing, Associate Professor in Translational Metabolism

10:10 - 10:20 Circadian disruption effects on the diabetic retina. Lessons from diabetic mouse models 

Dr Eleni Beli, Queen's University Belfast, Senior Lecturer

10:20 - 10:30 Targeting pericytes in early diabetic retinopathy

Dr Giulia De Rossi, University College London, Institute of ophthalmology, Lecturer, Diabetes UK & Moorfields Eye Charity RD Lawrence Fellow

10:30 - 10:40 The potential role of BMP9 in diabetic retinopathy

Prof Reinhold Medina, University of Liverpool, Department of Eye and Vision Sciences,  Professor of Vision and Vascular Sciences

10:40 - 10:50 Questions and discussion

All speakers and Prof Alan Stitt, Queen’s University Belfast, Wellcome-Wolfson Institute for Experimental Medicine, Chair of Ophthalmology

Chair: Prof Alan Stitt, Queen’s University Belfast, Wellcome-Wolfson Institute for Experimental Medicine, Chair of Ophthalmology

The National Diabetes Audit shows that foot assessment is among the least-completed of the eight care processes, sitting well below HbA1c, blood pressure, and smoking status, with marked variation between ICBs. The GIRFT report identified geographical deficits in diabetes foot care provision. And the National Diabetes Footcare Audit has documented persistent variation in outcomes after foot ulceration, outcomes which include amputations and five year mortality rates that fall disproportionately on people of African and African-Caribbean heritage. This session asks why foot care is the part of the diabetes pathway that most consistently slips, and what it would take to close the gap. It addresses three layers of the problem: the system layer, where commissioning, time pressure and pathway fragmentation drive low completion rates; the clinical layer, where many UK practitioners have been trained to recognise warning signs using imagery and language built around light skin tones, and report lower confidence assessing dark skin; and the psycho-social layer, where the foot examination is often the part of the review patients and healthcare professionals are most reluctant to engage with. The session combines short presentations with case-based small-group work. Participants will leave with practical tools to recognise early signs of infection, ulceration, and neuroarthropathy across the full range of skin tones, and a clearer view of where in their own service the foot examination is being lost.

Specialisms: Community care, Specialist care, Primary care

Themes: Podiatry, Service provision

Title to be confirmed

Dr Chris Manu, Consultant Diabetologist, Diabetes Foot Service, King's College Hospital

Title to be confirmed

Luxmi Dhoonmoon, Nurse Consultant in Tissue Viability, London North West University Healthcare NHS Trust

Closing the footcare gap - reducing missed opportunities in foot care for people with diabetes

Jayne Robbie, Diabetes Specialist Podiatrist, University Hospital Birmingham

Chair: Bernadette Adeyileka-Tracz, Executive Director, Diabetes Africa

Eating, exercise, ethnicity, and environment: why one size does not fit all in nutrition and metabolic health

Why do the effects of diet, physical activity, and adiposity on metabolic health differ between individuals and populations, and what does this mean for how we prevent and manage type 2 diabetes?  Drawing on controlled human experiments, epidemiology, and intervention trials, this lecture will examine how biological susceptibility, environmental factors, and behaviours interact to shape the metabolic effects of nutrition and adiposity. It will then explore how these insights might inform realistic, equitable approaches to diabetes prevention, remission, and long-term weight management.

Personalised medicine - new perspectives on the clinician-patient-technology triad

‘Personalised medicine’ is one of the most widely used and least examined phrases in healthcare. In diabetes, it usually means ‘precision-personalised’: genomic testing that identifies monogenic diabetes, biomarkers that distinguish autoimmune from type 2 disease, stratified trials that predict which drug will work best for whom, and so on. But some clinicians, especially in primary care, have long used the same phrase to mean something quite different: knowing the person over time, understanding their circumstances, and attending to what matters to them—what we might call ‘humanistic-personalised’ care. These approaches are of course complementary, not mutually exclusive. 

The healthy tension between precision-personalised and humanistic-personalised diabetes care is further complicated by the emergence of new technologies (and new uses of old technologies). Continuous glucose monitors and hybrid closed-loop systems generate streams of data that can be read by algorithms, clinicians and patients. Risk-prediction tools and population dashboards sort people into categories for proactive management. Some people with diabetes have built their own technologies, such as do-it-yourself closed-loop systems. And an old technology, the telephone, has taken on a new life in triage and remote consultation, changing how, and how often, clinician and patient meet, and what each can know about the other. Each of these can be used to classify the patient more precisely, or to understand the person more fully. Often, it is assumed to do both.

This lecture will draw on a longstanding debate (dating from ancient Greece) about the nature of medical knowledge, which turns out to be surprisingly relevant to diabetes care today. Through three composite cases, I will explore how clinicians, patients and technologies interact in increasingly complex ways. This can generate tensions between two goals that are usually unstated: to classify the patient more precisely, and to understand what is at stake for them. I will argue that many technologies disappoint not because they are badly designed, but because they are used only to monitor, stratify and flag deviations from target. When they are also used to open conversations about how a person lives and what they are trying to protect, the clinician-patient-technology triad can become a far more productive partnership. The lecture will consider what this means for clinical practice, for the design of diabetes technologies, and for the health systems in which they are embedded. 

Inspiring stories from across the diabetes community

Four speakers, one from each of the UK's four nations, share their own stories of challenge and progress. They'll talk openly about what they've experienced and what they've learned, and what can be achieved when the diabetes community comes together. A hopeful, fitting session to conclude the Diabetes UK Professional Conference 2027.