A pioneering project by specialists in the Metabolic Unit and Clinical Biochemistry Department at the Western General Hospital has been shortlisted for two prestigious awards: the BMJ Awards 2019 and the Advancing Healthcare Awards 2019.
The ‘C-peptide Testing in Diabetes’ project has transformed the lives of some patients diagnosed with Type 1 diabetes by enabling them to stop taking insulin.
The project started in July 2017 and aimed to improve the accuracy of diagnosis of Type 1 diabetes.
Everyone needs insulin. Required daily, it is vital for transporting glucose into the body’s cells. People with Type 1 diabetes do not produce any insulin, which means they need lifelong monitoring of blood sugar and daily insulin treatment.
“Diagnosing diabetes is straightforward – you simply identify an elevated blood glucose,” explained Professor Mark Strachan, Consultant in Diabetes and Endocrinology, Metabolic Unit, Western General Hospital, and the project’s lead.
“Determining the cause of diabetes is more complicated because there are many different causes of diabetes. As well as Type 1 and Type 2 diabetes, there are monogenic and secondary causes. Monogenic diabetes is rare and results from mutations (changes) in a single gene.
“Different forms of diabetes are managed in different ways, so it’s essential to get the correct diagnosis. The principal goal of the project was to identify individuals who had been misclassified as having Type 1 diabetes and then potentially change their treatment to allow them to stop their insulin therapy.”
At the heart of the project is a simple blood test and its catalyst was, quite literally, one patient, Sophie Fleming, who was diagnosed with Type 1 Diabetes when she was eight-years-old.
Sophie managed her diabetes with multiple daily injections of insulin and, more recently, with an insulin pump. Controlling her blood sugar levels was difficult and she had advanced diabetic retinopathy, a complication of diabetes caused by high blood sugar levels damaging the back of the eye – the retina.
When Sophie was pregnant with her first child, it was discovered that she actually had a rare genetic form of diabetes and the result meant that – for the first time in 27 years – she could stop her insulin treatment and manage her diabetes with tablets. Sophie’s blood sugar levels are now the best they have been throughout her life with diabetes.
Sophie’s case led the specialist team at the Western General to introduce routine screening with the C-peptide blood test for patients with Type 1 diabetes. C-peptide is a short chain of amino acids released into the blood as a by-product of the pancreas producing insulin. An elevated result means that the individual may not have Type 1 diabetes and acts as an indicator to doctors that further tests are required to work out why the person has diabetes.
To date, the team has screened over 750 people with Type 1 Diabetes with C-peptide, and identified 11 individuals who no longer need insulin.
“The project has been extremely successful and is changing lives,” said Professor Strachan. “The positive impact of stopping insulin on quality of life cannot be over-emphasised. We have introduced ‘precision medicine’ to the diabetes clinic, improving diagnostic accuracy by using investigations such a C-peptide, antibodies and – where appropriate – genetic testing.
“We have taken work from a research environment into routine NHS care, using our findings, wherever possible, to offer alternatives to insulin as diabetes therapy.”
As well as delivering major health benefits, the project offers significant potential cost-saving benefits. C-peptide testing costs £6 per sample and no additional laboratory staff were needed to carry out the screening. The annual cost of insulin therapy for a patient with Type 1 diabetes using multiple injection therapy is estimated at £890. The annual cost of treatment using an insulin pump is £2,700.
The project has been endorsed by the Scottish Diabetes Group and the Scottish Clinical Biochemistry Managed Clinical Network. Its findings have led centres in Glasgow and Borders to start their owna C-peptide programme. Professor Strachan is keen for all patients in Scotland diagnosed with Type 1 Diabetes to undergo C-peptide blood test screening.
The ‘C-peptide Testing in Diabetes’ project is shortlisted in the Diabetes category for the BMJ Awards 2019. The Western General team will be in London on 24th April to present their project to a judging panel. The BMJ Awards take place at a black tie ceremony later that day in the Park Plaza Hotel, Westminster Bridge.
The Clinical Biochemistry team have been shortlisted for the Advancing Healthcare Awards for allied healthcare professionals and healthcare scientists.
“We are all incredibly excited,” said Professor Strachan. “We are hoping that a large team from the Metabolic Unit can attend the BMJ Awards ceremony and represent NHS Lothian in style! We are also hoping that Sophie, the catalyst for the whole project, will be able to join us as well.”
Sophie’s life was transformed by the project, and it took a while for the results of the screening to sink in. “My first reaction was just elation, and disbelief,” said Sophie. “I didn’t quite believe that this would turn out the way they were expecting it to.
“I actually didn’t take my insulin pump off for a couple of days after cutting down on insulin – and even then I kept it beside my bed for a good six weeks, programmed ready to plug back in and ready to go again.
“Because after so many years of daily insulin injections and multiple blood pricks to monitor glucose levels, I just didn’t think I’d be on anything but insulin. The test result has changed my life.”
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