PGfAR and Diabetes UK - Joint funding call on diabetes complications
Programme Grants for Applied Research (PGfAR) is partnering with Diabetes UK. In Competition 32, launched in February 2020, co-funding was available for proposals that aimed to prevent or slow the progression of diabetes complications in people with Type 1 or Type 2 diabetes who are at extremely high risk. This document outlines the specification for the joint funding call on diabetes complications. Competition 32 closed in Jun 2020.
The 2015-2016 UK National Diabetes Audit found that people with diabetes account for 25-30% of hospital admissions for cardiovascular complications and that those with Type 1 diabetes are younger than those with Type 2 diabetes or without diabetes.
An early onset of Type 1 diabetes during childhood and adolescence is associated with a higher risk of microvascular complications (microalbuminuria, retinopathy, neuropathy) and a five times higher risk of cardiovascular events than for those with onset in adulthood.[2,3]
Young-onset Type 2 diabetes (15-30 years of age) is associated with a higher prevalence of diabetes complications, a more adverse profile of cardiovascular risk factors and greater mortality than for those diagnosed with Type 2 diabetes in adulthood – and even for those with young-onset Type 1 matched for age of onset.
Although there has been a decline in the number of people with more advanced chronic kidney disease (CKD) – CKD stages 3-5 – due to diabetes, there are rising numbers of those with CKD stages 1 and 2, which may reflect improvements in detection and management. Despite this, the risk of end-stage kidney disease is still 19 times greater for people with Type 1 diabetes and 4.5 times for people with Type 2 diabetes. People with diabetes account for 40-70% of hospital admissions (and 40% of bed days) for amputations and renal replacement therapy. Age-specific mortality rate ratios are increased at all ages, with an associated reduction in life expectancy, largely due to cardiovascular disease.[6,7] Moreover, as diabetes is diagnosed around 10 years earlier in UK non-white populations, they are exposed to a higher risk of specific complications. Long-term care home residents have higher rates of diabetes complications as do those with severe mental illness, especially if they are not on appropriate psychiatric treatment.
In response to these challenges, there have been substantial advances in generating guidelines to optimise diabetes care. However, there continue to be people with Type 1 and Type 2 diabetes who remain at extremely high risk of acute and/or chronic complications, usually due to suboptimal diabetes management and/or elevated risk factor levels. Underlying reasons may be biological or social and may indicate a need for additional intervention beyond the usual standard care pathway.
This area of unmet need has also been identified as important by people with diabetes and healthcare professionals. One of the recent priorities identified by the James Lind Type 2 Priority Setting Partnership was: “How do we identify people with Type 2 diabetes who are unlikely to engage with their treatment plans, including medication and lifestyle changes, and what are the best strategies to overcome this?” (Priority 16).
NIHR Programme Grants for Applied Research (PGfAR) and Diabetes UK invite applications for collaborative, multidisciplinary programmes of applied research which aim to prevent or slow the progression of diabetes complications, in people with Type 1 or Type 2 diabetes who are at extremely high risk.
Applications should fall within the remit of the PGfAR programme. Applications should also contain a comprehensive updated summary of previous high quality research on this topic.
Where the programme includes the development and testing of interventions, it is expected to provide evidence for efficacy, sustainability and cost effectiveness of novel approaches, beyond the usual standard of care. Such approaches may, for example:
- seek to re-engage in a different way with those who have not been attending standard care
- involve strategies for improving psychological support or strategies for additional attempts at risk factor control
- include innovative strategies to prevent and detect complications earlier using appropriate tools including lifestyle changes, drug therapies, education and self-management tools and psychological support.
- Consider the effectiveness and cost-effectiveness of novel technology specifically targeted to these high-risk groups to minimise complication development and progression.
Any intervention described should, where possible, aim to optimise engagement with multi-disciplinary teams and it should be clear how high risk individuals/groups are to be identified.
The programme of research and any interventions should include people with Type 1 or Type 2 diabetes who are at high risk of developing complications for any reason. Including (but not exclusively) one or more of the following risk factors:
- Developed one or more diabetes-related complications before the age of 40 years
- Onset of Type 1 diabetes in childhood
- Onset of Type 2 diabetes at younger than 30 years
- Persistent suboptimal control of glycaemia or other risk factors (e.g. weight, blood pressure, lipids) established to lead to complications
- Unengaged with diabetes services for any reason: e.g. language, ethnicity, mental health, deprivation, learning difficulties, addictions, mobility, transport issues
- In the lowest decile for attendance rates at scheduled appointments for any reason
- NHS Digital. National Diabetes Audit, 2015-16 Report 2a: Complications and Mortality. England: NHS Digital, 2017 (accessed 26th June 2019)
- Amin R, Widmer B, Prevost a T, Schwarze P, Cooper J, Edge J, et al. Risk of microalbuminuria and progression to macroalbuminuria in a cohort with childhood onset type 1 diabetes: prospective observational study. BMJ. 2008;336(7646):697–701.
- Hietala K, Harjutsalo V, Forsblom C, Summanen P, Groop P-H, FinnDiane Study Group. Age at onset and the risk of proliferative retinopathy in type 1 diabetes. Diabetes Care. 2010 Jun;33(6):1315–9.
- Constantino MI, Molyneaux L, Limacher-Gisler F, et al. Long-term complications and mortality in young-onset diabetes: type 2 diabetes is more hazardous and lethal than type 1 diabetes. Diabetes Care 2013; 36(12): 3863-9.
- Livingstone SJ, Looker HC, Hothersall EJ, Wild SH, Lindsay RS, Chalmers J, Cleland S, Leese GP, McKnight J, Morris AD, Pearson DW, Peden NR, Petrie JR, Philip S, Sattar N, Sullivan F, Colhoun HM. Risk of cardiovascular disease and total mortality in adults with type 1 diabetes: Scottish registry linkage study. PLoS Med. 2012;9(10):e1001321.
- Livingstone SJ, Levin D, Looker HC, Lindsay RS, Wild SH, Joss N, Leese G, Leslie P, McCrimmon RJ, Metcalfe W, McKnight JA, Morris AD, Pearson DW, Petrie JR, Philip S, Sattar NA, Traynor JP, Colhoun HM; Scottish Diabetes Research Network epidemiology group; Scottish Renal Registry. Estimated life expectancy in a Scottish cohort with type 1 diabetes, 2008-2010. JAMA. 2015 Jan 6;313(1):37-44.
- Rawshani A, Sattar N, Franzén S, Rawshani A, Hattersley AT, Svensson A-M, et al. Excess mortality and cardiovascular disease in young adults with type 1 diabetes in relation to age at onset: a nationwide, register-based cohort study. Lancet. 2018 Aug 11;392(10146):477–86
- Winkley K, Thomas SM, Sivaprasad S, et al. The clinical characteristics at diagnosis of type 2 diabetes in a multi-ethnic population: the South London Diabetes cohort (SOUL-D). Diabetologia 2013; 56(6): 1272-81.
- Newton CA, Adeel S, Sadeghi-Yarandi S, et al. Prevalence, quality of care, and complications in long term care residents with diabetes: a multicenter observational study. J Am Med Dir Assoc 2013; 14(11): 842-6.
- Wu CS, Gau SS. Association Between Antipsychotic Treatment and Advanced Diabetes Complications Among Schizophrenia Patients With Type 2 Diabetes Mellitus. Schizophr Bull 2016; 42(3): 703-11.
In Competition 34, co-funding is available for programmes of applied research which investigate the implementation, in primary care, of approaches to help people recently diagnosed with Type 2 diabetes put the condition into remission. Read about the joint funding call in the call specification.
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