Research and innovation
The specialty of diabetes and endocrinology has seen major advances in therapeutics over the last 20–30 years. This has meant that the treatment of patients cared for by diabetes and endocrinology services has advanced rapidly in recent decades based on high-quality research evidence. This is underpinned by an extensive programme of research nationally and internationally, from basic through translation to clinical science. This has been supported by the publication of high-quality guidelines from NICE and other national and international professional groups such as the American Diabetes Association, the European Association for the Study of Diabetes, the European Society for Endocrinology, American Endocrine Society and the International Diabetes Federation.
The availability of new drugs is radically altering the therapeutic landscape, particularly as the specialty deals with a substantial increase in patients with diabetes and obesity. Diabetes occurs in one in five people over the age of 80 and the specialty cares for an ageing population with multiple comorbidities. Technological advances such as use of insulin pump devices (continuous subcutaneous insulin infusion or CSII) and continuous blood glucose monitoring are some of the advanced technologies that are helping to support people with type 1 diabetes to live life to the full.
Trainees in diabetes and endocrinology are encouraged to undertake a period of research. However, the proportion who take part in research programmes is variable across different regions in England. Candidates who participate in high-quality research programmes are expected to work towards a higher degree as part of their research training.
Major sponsors of research in the UK include the Medical Research Council, the Wellcome Trust, National Institute for Health Research, Diabetes UK, the Society for Endocrinology, and the pharmaceutical industry. Academic endocrinology and diabetes physicians operate mainly in university-linked teaching hospitals and academic health science centres. Consultants with both clinical and academic commitments are common in these establishments.
Historically, physicians working in endocrinology and diabetes have been at the forefront of both basic science and clinical research. Trainees and specialists have the opportunity to contribute further to that growing evidence base which has led to many innovations in recent years. Many current prominent clinical academics have a clinical background in endocrinology and diabetes. A broad training in endocrinology and diabetes provides the basis for progression to specialist posts in a wide range of settings from smaller hospitals to large tertiary referral centres, from community bases to university academic departments, with services often provided in a hub and spoke model.