The group conducts qualitative, behavioural research into diabetes as well as quantitative studies. We have the capability and capacity for detailed physiological studies suing stable isotope tracer techniques at The Wolfson-funded mass spectrometry unit. Studies are funded by research councils, charities and industry. CAG members are also internationally respected Principal Investigators of multi-centre clinical trials. Finally, the group has skills in managing and interpreting diabetes-related ‘big data’ from the primary care network.
Current Research Projects
Effect of SGLT2 inhibitors on Glucose Flux, Lipolysis and Ketogenesis during Hyperglycaemia in People with absolute or relative endogenous insulin deficiency. SGLT2 inhibitors are a new class of drug that have an insulin-independent mode of action, which are being used to treat type 2 diabetes. Their unique action promotes urinary glucose excretion with significant weight loss. Clinical trial programmes are under way to test their clinical utility in type 1 diabetes. However, there may be significant safety issues concerning the development of euglycaemic ketoacidosis. This study will investigate the physiological effect of SGLT2 inhibitors on glucose flux, lipolysis and ketone production during hyperglycaemia in people with absolute or relative insulin deficiency.
RESILIENT. A RandomisEd, controlled, double blind Study to assess mechanistic effects of combination therapy of dapagliflozin with Exenatide QW versus dapagliflozin alone in obese patients with Type 2 diabetes mellitus. Collaboration with Liverpool University.
MedEx. Prehabiliation to improve perioperative insulin sensitivity and cardiovascular outcomes in patients scheduled for pancreatic surgery. Mr.Jason George (MD student)
Lilly Real World Evidence Centre. Using real-world evidence (routine data gathered from patients undergoing diabetes treatments), Lilly and the University of Surrey started a five-year collaboration (2014) to evaluate key clinical questions such as the role and timing of injectable therapy, factors impacting adherence to prescribed medicines and the pattern and rationale of therapy following diagnosis.
The South London Diabetes and Ethnicity Phenotyping Study (a collaboration with Dr Louise Goff and Professor Stephanie Amiel, Kings College London. Funded by Diabetes UK)
This research addresses the high propensity of type 2 diabetes (T2D) in people of Black African origin. The purpose of the proposed project is to define the ethnicity-specific phenotype of progression to T2D for men of Black West African origin (BWAO) and White European origin (WEO) in the UK by undertaking detailed characterisation of the central components of T2D development. Detailed understanding of the ethnicity-specific pathophysiology of T2D will support individualised prevention strategies and early interventions to reduce the burden of diabetes in both populations. We have recently completed a study in which we undertook a detailed phenotype of recent-onset T2D in BWAO and WEO men. We are now in the second phase studies, in which we will extend our protocol to men of normal and impaired glucose tolerance, ultimately allowing us to define ethnicity-specific processes during the development of T2D in men of BWAO and WEO.
Are gut hormone changes why the long limb gastric bypass is more effective than the standard gastric bypass in curing diabetes? (a collaboration with Professor Steve Bloom, Imperial College London. Funded by NIHR)
The standard limb Roux-en-Y gastric bypass (RYGB) is the gold standard bariatric surgery procedure. Patients with type 2 diabetes (T2DM) lose approximately 30% of their body weight after this procedure but less than 40% achieve euglycaemia without diabetic medications. The improvement in glucose control is due to increasing immediate postprandial release of insulin and reduced insulin resistance. Long limb RYGB is a new approach which produces greater enhancement of glucose control by placing nutrients further down the small intestine, enhancing the release of gut hormones. In this study the effect of either standard limb or long limb RYGB, on insulin resistance, gut hormone and bile acid response will be investigated in matched cohorts of obese T2DM.
A randomized controlled trial of a duodenal sleeve bypass device (Endobarrier) compared with standard medical therapy for the management of obese subjects with type 2 diabetes (a collaboration with Professor Julian Teare, Imperial College London. Funded by NIHR)
Improved blood glucose control after gastric bypass surgery occurs within days of surgery before significant weight loss suggesting that the improvement is related to the surgery rather than weight loss. Despite its undoubted efficacy, few operations are performed and patients are understandably fearful of surgery despite the good outcomes.
In an attempt to avoid surgery a new device and concept has been developed called a duodenal -jejunal sleeve bypass (Endobarrier). This is a removable sleeve like device that is implanted inside part of the intestine and prevents food from being absorbed through the wall of that part of the intestine.
The aim of this trial is to determine whether patients receiving Endobarrier compared to standard of care achieve improvement in or resolution of their diabetes and whether this benefit continues after removal of the Endobarrier. 160 patients across 2 study sites are being randomised to either best medical therapy or the Endobarrier device. A subset of patients will undergo a euglycaemic hyperinsulinaemic clamp with stable isotope infusion to determine overall insulin and compartment-specific insulin sensitivity (liver, muscle and adipose depot).