Dr Angus Jones
Published on: 11 July 2016
Research by Dr Angus Jones addresses the personalisation of diabetes treatment.
In this Researcher in focus, we speak to Dr Jones about the role of weight and age, in the diagnosis of diabetes, the rise of Type 2 diabetes in Devon and Cornwall, and the importance of clinical research.
Congratulations on your NIHR fellowship; can you tell me what research you hope to do with this funding?
The funding will be used for research aimed at helping doctors tell what type of diabetes a person has and therefore give the best treatment when a person is first diagnosed.
People with Type 1 diabetes are treated with injected insulin from diagnosis the body rapidly stops making its own insulin and they can become very unwell without these injections. In contrast people with Type 2 diabetes are best treated initially with tablets and/or lifestyle change. For a lot of people diagnosed the type of diabetes they have isn’t clear when they are first diagnosed, so many patients receive the wrong advice and treatment.
This is because the main features which help us tell the two conditions apart are someone’s age and if they are overweight, with Type 2 diabetes diagnosed in older people who are often (but not always) overweight, and Type 1 diabetes in the young and thin. However as obesity has become more common we are now seeing a lot of Type 2 diabetes in young people, and many people with Type 1 diabetes are obese, so these features are often not helpful in telling the two conditions apart.
To improve this situation we are doing two things. Firstly we are using large existing studies to produce a clinical calculator that can combine different clinical features to make the most accurate diagnosis. This will be combined with our calculator for rarer genetic forms of diabetes which is already used by thousands of doctors via our website and ‘Diabetes Diagnostics’ smartphone app.
Secondly we will test this calculator and assess new tests for classification of diabetes by recruiting 1000 young people newly diagnosed with diabetes and following them for three years to see if the calculator and new tests are able to predict who loses their own insulin secretion and needs early insulin treatment.
We are running this study in over 30 research centres in England and Wales.
Recent news reports say that Type 2 diabetes cases in Devon and Cornwall rise faster than the UK average; why do you think that is?
I suspect the most likely reason is that we have quite an elderly population; being older is the strongest risk factor for Type 2 diabetes, even more so than body weight, and as medical care improves we are living longer and are more likely to get Type 2 diabetes. Some of these differences may also be because we’ve changed the way in which we diagnose Type 2 diabetes.
We now do it on a simple non-fasting blood test which means that we do a lot more testing and diagnose many more cases of mild Type 2 diabetes, without any symptoms. This is very common in the elderly and we wouldn’t have known about these cases a few years ago.
For diabetes research, what are the important, unanswered questions?
One key area is how best to treat people with Type 2 diabetes. We now have a large number of different treatments to lower blood glucose. While we know that a drug called metformin is probably the best first treatment most patients will need multiple treatments, and we don’t know which is the best treatment to use after this, so we are in the interesting position of having guidelines that give very little guidance!
One way to improve this situation would be to treat patients with the drug which is most likely to be effective for them, an approach called ‘stratified’ or personalised medicine. This is an approach we are developing in Exeter, as part of a national study called MASTERMIND led by Professor Andrew Hattersley.
The other approach that will be helpful to choose which treatments is to find out their long term effects and the effect of these treatments on diseases of the heart and circulation, which are very important complications of diabetes but only modestly reduced by lowering blood glucose. Most studies of new drugs are quite short and don’t necessarily tell us long term safety and whether a treatment really does result in people living longer healthier lives. In the last few years, we have started to see results from some very large international trials which give us important information on safety and effectiveness of individual drugs on important effects, for example reducing death or risk of heart attacks. However what we are still missing is studies that directly compare different therapies.
What does being a clinician scientist involve?
Being a clinician scientist means that I am a medical doctor funded by the NIHR (National Institute of Health Research) to carry out research aimed at directly improving the treatment of patients. I continue to undertake clinical work as an honorary consultant in the Royal Devon and Exeter Hospital but alongside this I work with colleagues from a variety of backgrounds to undertake research aimed at improving diabetes care. It’s a very varied job, in any one week I might spend time in clinic or on the acute medical unit, in research meetings, paper and grant writing, analysing data, giving a talk or helping with a study.
As a clinician scientist, why do you think that clinical research is important?
Clinical research is hugely important because it’s at the basis of every decision that we make in medicine.
We want to do things which help people become more healthy, help them live longer, and help them to avoid disease. While research in the laboratory is vital to developing new treatments and tests clinical research is the only way that we can know if a treatment, intervention or test is safe and effective in patients and should be used in the NHS. Clinical research tells us what decisions, what treatments, and what approaches are most effective in providing better outcomes for patients.