Our programme and projects
The role of the King’s Health Partners Institute of Diabetes, Endocrinology & Obesity is vital in ensuring our local population has equitable access to the best healthcare that delivers the outcomes that matter most to them.
Collectively, we are the largest provider of diabetes and endocrinology services in the UK, serving a large, culturally diverse population of approximately two million people across London and south east England.
Living with diabetes and obesity can be incredibly challenging from physical and mental health perspectives, and can lead to other longer-term complications, such as heart disease and some forms of cancer and stroke.
We aim to speed up the time it takes the NHS to access new and better-quality treatments and approaches to improving health and wellbeing.
We have five strategic aims:
- One Team approach - more effective, integrated care across King’s Health Partners to deliver efficient clinical pathways and better outcomes for patients
- research and innovation - working across our organisations to offer patients and service users the very best care, based on reliable research evidence that works
- Mind & Body approach - ensuring a coordinated 'whole person' approach across physical and mental health to improve the care our patients receive
- education - developing diabetes and obesity education programmes for healthcare professionals and service users that draws from the expertise of our world-class clinical and research teams across King’s Health Partners
- systemwide leadership and insight - ensuring we have coordinated leadership across our local and national initiatives to enable collaboration across primary, community and secondary care to support diabetes and obesity prevention and treatment.
Our clinical strengths
King’s Health Partners is leading in the provision of technology for type 1 diabetes, with collectively the largest number of insulin pump users in the UK.
King’s College Hospital NHS Foundation Trust is recognised as a Centre of Reference for type 1 diabetes and runs the largest service in the UK, with expertise in hypoglycaemia. We have pioneered many new treatments, published numerous research papers and are a leading centre for islet transplants.
In 2000, King’s College Hospital developed and introduced Dose Adjustment For Normal Eating (DAFNE), the leading structured education programme for adults with type 1 diabetes in the UK. The programme enables patients to self-manage their disease through a skills-based education programme. Since DAFNE started we have seen excellent outcomes data for participants, with improvements in glycaemic control with reduction in hypoglycaemia.
Since 2015, Guy’s and St Thomas’ NHS Foundation Trust has been running a highly commended Youth Empowerment Skills (YES) Programme across south London. Originally run as a pilot, the programme is co-designed and co-delivered by young people and focuses on all aspects of life as a young person, not just their diabetes. The programme fosters self-confidence and strengthens engagement with diabetes care, provides social resources and support both during and after the programme. The programme improves health outcomes for young people with diabetes, as well as diabetes self-management skills and management of acute complications.
Understanding the connections between physical and mental healthcare is fundamental to the treatment of diabetes and obesity. The Diabetes Psychiatry and Psychology service at King’s College Hospital NHS Foundation Trust is a specialist service that provides assessment and interventions for people experiencing mental health problems and diabetes distress. The award-winning service has received international recognition and we are the leading referral centre in the country. With more than 20 years experience we are the UK's longest running provider of this service. Our reputation in this area has led to other notable achievements, including a successful bid from NHS England to deliver a national pilot service for people with type 1 diabetes and eating disorders.
King’s Health Partners obesity services are nationally and internationally renowned. Research by Prof Francesco Rubino and his team has pioneered alternative diabetes treatments (video below). For the past 18 years, their work has advocated for the investigation and use of bariatric surgery as a means of reversing type 2 diabetes. Numerous clinical trials have since proven the link between surgery on the gut and remission of the disease. In addition, our Endocrinology service was rated outstanding in a recent external Getting It Right First Time (GIRFT) review.
Our projects aim to deliver:
- scalable and transferable innovations to transform the way we deliver care with ‘first ever’ clinics using new techniques, devices and therapies
- comprehensive holistic pathways of care that treat the whole person through integrating mental and physical health
- new and highly innovative clinical procedures and models of care for, and on behalf of, the wider system, for example fractyl endoscopic duodenal resurfacing
- joint clinical testing with King’s College London Transcampus Initiative in areas such as alcoholic fatty liver disease and lipopheresis
- the development of a comprehensive tertiary endocrinology service
- growth of telemedicine and virtual clinics.
Diabetic foot ulcers and amputations are among the most serious and debilitating complications of diabetes. Research conducted across King’s Health Partners has established that when a person with diabetes develops a foot ulcer, they have an approximate 55% chance of dying within five years of diagnosis (a prognosis worse than many cancers).
Our Institute, in collaboration with the Health Innovation Network, is leading on the transformation of the diabetic foot pathway across south east London, and have supported the development of three new multidisciplinary foot clinics in areas where there is limited service provision - Bexley, Bromley and Greenwich. The potential impact of these new pathways in terms of reduced morbidity and costs to the healthcare economy is substantial. This programme is being delivered as a fully integrated King’s Health Partners initiative.
Review and refresh of the south east London obesity pathway
As the south east England regional hub for bariatric surgery, we focus on the life course of obesity and related metabolic disease. Focusing on prevention and behavioural aspects of obesity with aims of:
- improving access and delivering new models of care
- introducing non-surgical treatments and using technology to provide obesity treatment and prevention interventions at scale.
Our collaborations with the South East London Sustainability and Transformation Partnership are leading on pathway reviews to deliver comprehensive, unified Tier 3 and Tier 4 weight management programmes.
Campaign to reduce stigma against people with obesity
In 2020, we will launch our campaign to reduce stigma against people with obesity, using education and training to address the factors that drive stigma and how these affect access to care, such as bariatric surgery. The campaign, led by Professor Francesco Rubino, will be targeted across a broad audience, including healthcare professionals, schools, commissioners, government, NHS senior leaders, media and large business employers. Accompanying training and education packages will be tailored accordingly.
Mind & Body
Our Institute is supporting the development of diabetes healthcare systems that address the mental and physical impact of diabetes and enable staff to feel confident in discussing mental health needs with their patients.
We have developed and led a number of transformational improvement and clinical leadership programmes in this field, including:
- 3 Dimensions of Care for Diabetes (3DFD) now scaled up to 3 Dimension of Care for Long-Term Conditions (3DLC) and adopted by King’s Health Partners Mind & Body programme
- Lewisham pilot: Psychosis and Diabetes Service (PODS)
- national guidelines for inpatients with diabetes and psychiatric disorders
- pilot study with commercial testing of the effectiveness of wearable technology with motivational messaging, now selected as one of the national digital prevention interventions: Diabetes Stopwatch
- Royal College of Psychiatrists six module elearning on Psychiatry for the Modern Physician
- a data warehouse that can support analysis into correlations between diabetes and mental illness.
Current projects include:
- establishing the first ever national eating disorder service for people with type 1 diabetes
- expanding the use of IMPARTS across our diabetes services to make screening for mental health needs part of a routine appointment
- developing training and education programmes to improve staff knowledge and understanding of mental health and the interrelationship with diabetes.
Data and informatics
Our Institute is developing a Diabetes Data Warehouse to help us build a clearer picture of diabetes and its treatment within our communities. The data warehouse is a central repository of data from outpatient, inpatient, A&E services, pathology, observations, medicines and other treatments, as well as demographic and publicly available data.
Multiple data projects are in progress, including collaborations to determine associations between diabetes and prostate cancer, and the factors that influence the progression of diabetic nephropathy. The data warehouse also supports the work of our Value Based Healthcare programmes.
In 2020, we are launching a comprehensive data request service for staff across King’s Health Partners. The service will provide evidence for clinical audits, academic research and increase data-driven decision-making across diabetes services.
King’s Health Partners has a long history of setting national and international standards for diabetes, endocrinology and obesity care. Some of our major firsts and achievements include:
- the first insulin treatment in the UK was given to Dr Robert Daniel Lawrence at King’s College Hospital in 1923 to treat his diabetes, following the discovery of insulin in Canada the previous year
- as physician-in-charge, Dr Robert Daniel Lawrence went on to set up one of the first diabetes clinics in the UK at King’s College Hospital
- first development of insulin pump therapies in the late 1970s by researchers at Guy’s Hospital
- the use of growth hormone replacement therapy in patients with a deficiency to decrease the frequency and severity of hypoglycaemic episodes is now used across the world (first published in 2003)
- the first successful islet transplant in the UK in 2008 and a vanguard in the prevention of type 1 diabetes
- in 2014, diabetes Specialist Nurses at King’s College Hospital were the first to participate in a pilot for the delivery of online Cognitive Behavioural Therapy to people with diabetes
- in 2014, the world's first Professor of Metabolic Surgery was appointed in recognition of the increasing importance and prevalence of metabolic and weight-loss surgery across the world and the move towards scientific advances in bariatric surgery
- Initiating the use of Free Style Libre in the type 1 diabetes services in 2014
- structured education for adults for both type 1 and type 2 diabetes and modern management of severe hypoglycaemia
- pioneering psychological approaches to help people improve their diabetes self-management (video below) in 2014
- first in trialling a pioneering glucose sensor inserted under the skin in 2015.
The King’s Health Partners Institute of Diabetes, Endocrinology & Obesity constantly strives to enhance existing partnerships and build new ones with patients, carers and families, clinical and academic staff, industry partners and others working across the wider system.
If you have a project or idea related to diabetes, endocrinology or obesity we can provide support in the following areas:
- project management
- data and analytics
- raising awareness of your project or idea
- helping to build links with clinicians, academics and industry partners
- events management
- engagement with wider system initiatives and priorities
To find out more, please get in touch with us.
Kate Lillywhite, Programme Director, kate.lillywhite AT nhs.net
Phil Freeman, Programme Implementation Lead, phil.freeman AT kcl.ac.uk