Working with six other centres across the UK, King’s is the only hospital in London taking part in the REPOSE trial. With 280 recruited patients (40 from King’s) , the trial will test the effectiveness of insulin pumps combined with an educational course called DAFNE, when treating patients with type 1 diabetes.
Traditionally most type 1 diabetes patients use multiple daily injections of insulin recently combined with the DAFNE course. This educational programme which is taught over five days was set up to provide training to equip patients with the skills they need so that they can effectively manage their diabetes. Coupled with the injections, DAFNE has been shown to improve diabetes control, reduce risks of low blood sugars (hypoglycaemia) and improve quality of life. Insulin pumps are an alternative to injections.
The pump is a device similar in size to a mobile phone that can be worn on a belt or put in a pocket. It is connected to a narrow plastic tube that's inserted just under the skin and taped in place and contains enough insulin to meet the patient’s needs during the day. It has important potential benefits such as better control of blood sugar levels, reduced risk of hypoglycaemia and support a more flexible lifestyle and better quality of life. Until now, it has not been proved how well insulin pump therapy works when compared with injections for those who use the DAFNE learning to manage their diabetes.
Principle Investigator and Professor of Diabetic Medicine at King’s, Stephanie Amiel, said: “We are excited by this trial. Here at King’s we have about 400 type 1 diabetes patients currently using insulin pumps. Based on current evidence, we offer pump therapy to people who have problems with their diabetes which do not resolve after DAFNE training – particularly persistent problems with hypoglycaemia or poor control.
“The evidence tells us that DAFNE and injections work well, and that pumps work well – what we don’t know is whether pumps and DAFNE will do even better. REPOSE will address that question. It should tell us whether pumps are better than injections in general and help us understand what makes for successful use of the new technology. The results will assist us when helping our patients achieve the best outcomes.”
Over the next three years, half of the 40 recruited patients from King’s will be randomly allocated to have the insulin pump treatment and the other half will have the injection treatment. All will attend a DAFNE course, structured to fit the treatment they are on.
78 year old Sheila Foggie from Beckenham was diagnosed with type 1 diabetes 23 years ago at the age of 55. Transferred from another hospital, Sheila has been receiving her diabetes care and treatment at King's since December 2011. Having never had the opportunity to try the pumps, nor heard about the DAFNE course before December, Sheila is one of the patients involved in the King's REPOSE trial.
Speaking about her condition, Sheila said: "I have never really been able to control my diabetes very well. Since being diagnosed I have used the injection treatment but it has been very up and down control. I've had highs and lows in my diabetes management and if I could balance it evenly for a week that would be very good."
Sheila has just started the trial and practiced using some of the technology. From this week she is embarking on the DAFNE course.
Sheila has 12 grandchildren, one of whom was also diagnosed with type 1 diabetes, 18 years ago. "This trial is very reassuring and I am very much looking forward to it. I hope that it will not only help me with my diabetes, but also help people like my grandson to better manage his diabetes, as well as other future generations," Sheila added.
The trial has been funded by the National Institute for Health Research Health Technology Assessment (NIHR HTA) programme and being led by Sheffield Teaching Hospitals NHS Foundation Trust and the University of Sheffield and the University of Sheffield. Results of the study will be used to describe how widely pump therapy should be used and to inform the NHS on the investment needed in insulin pumps combined with education.
The study is currently recruiting adults with type 1 diabetes who have not yet experienced a DAFNE course. For more information please contact Anita Beckwith on 0203 299 9000 ext. 4712 or email firstname.lastname@example.org