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Clarch Theme - Early Detection


Theme Lead - Professor Kamlesh Khunti
Theme Manager - Mr Bill O'Leary
 

The Leicester Diabetes Centre are involved with three projects from this theme. 

  • The Attend Study
  • The SWEETheart Study
  • The Prism Study

 

What is the theme about?


In the Early Detection Theme there are seven main areas of investigation: Detecting medical conditions in people early is a vital step in ensuring that they receive all the necessary support, care and advice. Early detection can also mean that the interventions used are less intrusive than if the condition goes undiagnosed for some time – diet and exercise in people with diabetes for instance rather than prescribing tablets.

Early detection can also prevent, or at the least slow down, the development of some of the long term complications that will face people with a medical condition.

For these reasons the NIHR CLAHRC for LNR early detection theme studies are a vital contribution to our knowledge on early detection strategies and how they can work most effectively. Translating this knowledge into actual practice will support health care systems in developing effective screening methodologies; a key step in delivering the vascular screening programme in England.
 

  • A study examining two different ways of encouraging the take-up of self-assessment for people at risk of diabetes
  • A study based in pharmacies examining the impact of self assessment and HbA1c testing for those at high risk of diabetes
  • A study looking at the prevalence of diabetes, newly diagnosed diabetes and pre-diabetes in a mixed ethnic population following an MI
  • A study on ways to improve early presentation of TIA/Stroke patients to specialist services
  • A study on interventions to reduce strain in carers of ethnic minority stroke victims
  • A study examining the use of Dynamic Plaque Indices to reduce risk in (A)symptomatic carotid artery stenosis
  • A study examining the barriers to engagement in bowel cancer screening


http://www.clahrc-lnr.nihr.ac.uk/index.php/early-detection


Study 1: The ATTEND study
 

Assessment of response rates and yields for Two Tools for Early detection of Non-diabetic hyperglycaemia and Diabetes

The study has ended

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The study has ended

Principal Investigators: Professor Kamlesh Khunti and Professor Melanie Davies

Other key staff: Mr Steve Hiles, Mr Andy Willis, Dr Laura Gray, Dr Margaret Stone, Dr Helen Eborall, Dr Azhar Zafar and Mr Bill O’ Leary

Partners involved: University Hospitals of Leicester NHS Trust, NHS Leicester City, NHS Leicestershire County and Rutland, NHS Northamptonshire and Nene Commissioning

 


Aims


  • To develop and test the feasibility and utility of two screening strategies (based on risk factor assessment) to identify people with undiagnosed diabetes, non-diabetic hyperglycaemia or those at high risk of either of these within a multi-ethnic UK population

  • To assess the specificity and predictive power of two self-assessment screening strategies as screening tools for type 2 diabetes mellitus

  • To assess the patient and practitioner general acceptability of two self assessment screening strategies as screening tools for T2DM


Read the summary & study outcomes at: www.clahrc-lnr.nihr.ac.uk/index.php/the-attend-study



Study 2: The SWEETHeart Study


Early detection of impaired glucose regulation post myocardial infarction 

This study is in follow up

Principal Investigators: Professor Kamlesh Khunti and Professor Melanie Davies

Partners involved: University Hospitals of Leicester NHS Trust and NHS Leicester City
Other key staff: Dr Nitin Gholap, Mr Steve Hiles, Dr Laura Gray, Dr Samiul Mostafa, Professor Iain Squire, Dr Gerry McCann and Mr Bill O’ Leary

 

Aims


  • Compare the prevalence of diabetes and non-diabetic hyperglycaemia post MI in South Asians and Europeans

  • Assess if early detection of such abnormalities using OGTT/ HbA1c in the course of acute coronary syndrome (ACS) will help identify high risk patients who are likely to have a worse prognosis

  • Study the profile and difference of several biomarkers in post ACS period and their correlation to short and long-term prognosis in South Asian and White European patients

  • Develop a predictive risk score model based on the use of traditional and novel risk factors to help screen high risk patients who are likely to have adverse clinical outcomes post MI
     

Read more about the study at:http://www.clahrc-lnr.nihr.ac.uk/index.php/the-sweetheart-study
 

Study 3: The PRISM Study


Pharmacy based screening of high risk individuals using stepwise methods
 

Principal Investigators: Professor Kamlesh Khunti and Professor Melanie Davies

Other key staff: Dr Margaret Stone, Dr Laura Gray, Dr Helen Eborall, Mr Stephen Hiles, Mr Bill O’Leary, Mr Andrew Willis

Partners involved: NHS Leicester City, NHS Leicestershire County and Rutland, NHS Northamptonshire


Aims
 

  • To test the effect of pharmacy screening using a self assessed risk score followed by near patient HbA1c testing in pharmacies or general practices on levels of uptake of a second stage blood test (OGTT) conducted at the GP surgery compared to screening with a risk score alone

  • To assess the patient, pharmacist and general practitioner acceptability of two different screening methods for impaired glucose regulation (IGR) and T2DM
     

Summary


The department of health recently introduced a ‘vascular checks’ programme, to offer screening to all aged 40-74 years to identify those at risk or suffering from cardiovascular disease and related diseases such as type 2 diabetes mellitus (T2DM). Despite no clear guidance on which method should be used to identify those at high risk of diabetes it is clear that invasive screening procedures are expensive and time consuming. Risk scores are one way of filtering out people at a lower risk and focusing more costly screening methods on high risk individuals.
 

This study is a pragmatic randomised trial aiming to recruit 2,406 participants from Leicester City and Northamptonshire pharmacies. We will assess the efficacy of two screening methods for opportunistically screening individuals for T2DM.


Study outcomes

 

  • The primary outcome is uptake of high risk individuals to an OGTT test at the GP

  • The secondary outcomes include; patient, pharmacist and practitioner views, yield in positive tests for T2DM and IGR, proportion of patients who have had a diabetes screening test in the previous 12 months and association between illness perception and uptake to the final confirmatory test


The project outcomes may show positive clinical and economic benefits of engaging individuals at high risk of type 2 diabetes mellitus in a pharmacy setting.
 

Other Study projects in this theme


There are other study projects under this theme deatils of which can be found on the Clahrc - lnr website www.clahrc-lnr.nihr.ac.uk/index.php/early-detection