Diabetes

Barts Health is at the cutting edge of diabetes and metabolism research. Patients under our care are provided with the most advanced and successful treatments. Within our specialty, The Royal London Hospital is one of the ‘top five institutions for research’ in England according to the National Institute for Health Research.

A team of specialist diabetes nurses are based in our hospitals across North and East London and also within the community. Our nurses, who have a special interest in diabetes management and care, offer support to both inpatients and outpatients.

Research

We have wide ranging interests as part of the Blizard Institute for Cell and Molecular Science, at Barts and The London School of Medicine and Dentistry.

Our team has produced internationally recognised work in the fields of genetics of diabetes (Prof Graham Hitman), autoimmune diabetes (Prof David Leslie) and the physiology of obesity (Dr Simon Coppack). In addition, the department has received substantial grants from the European Union, and the Medical Research Council, to study methods of preventing diabetes in people of South Asian origin.

Our service treats patients from our hospital sites and our team closely collaborates with other specialties at the Trust such as cardiology and the liver clinic.

Newham Hospital has a purpose built diabetes unit at the Shrewsbury Road Health Centre. The unit is run by a large multi-disciplinary diabetes team which works closely with primary teams to deliver diabetes care for people with complex diabetes related problems, women with diabetes during pregnancy, and young people with diabetes.

• Specialist adult diabetes clinics
• Specialist obesity clinics
• Lipid disorders service
• Referring to our services
• Take part in research

Specialist adult diabetes clinics

Many of our services are for our adult patients, these are listed below. We do offer services for children with diabetes, or who are obese, including specialist clinics and a weekly weight-loss group for 12 to 18 year olds. For more information on our services for children and young people, please visit the children’s services section.

• acute diabetes
• complex diabetes
• fast track nurse-led clinic
• diabetic-renal clinic
• diabetic foot clinics
• cystic fibrosis-related diabetes service
• young adult and adolescent diabetes
• insulin pump therapy (CSII) clinic
• new patient diabetes clinic
• evening diabetes clinic
• diabetes in pregnancy (before, during and after)
• structured self-management course for patients with type-2 diabetes in Bengali and English.
• structured self-management course for patients with type-1 diabetes
• specialist clinics for patients with type-1 diabetes requiring insulin pump therapy.

We offer specialist diabetic investigations and treatments. These are:

• glucose monitoring service
• 24 hour blood pressure monitoring and treatment
• ECGs (electrocardiograms to measure the electrical activity of the heart)
• oral treatments for diabetes
• insulin starts, titration and management

We also offer any new treatments available for diabetes not currently available in primary care.

Specialist obesity clinics

Our obesity service treats patients from all over the south of England and we take referrals from GPs and other hospitals. The clinic specialises in those with severe or morbid obesity, usually with a BMI above 40 kg/m.

We offer the following services:

• consultant-led clinics for patients with obesity, metabolic and lipid disorders
• specialist clinics for obese patients
• expert dietician/physician clinics
• psychology
• surgical treatments for obesity

Lipid disorders service

Our clinics see patients with disorders of the lipids (cholesterol and triglycerides), offering investigations, diagnosis and treatment, such as combination drug therapy for lipid lowering. A disease management plan can also be drawn up with input from a dietician. Referrals to this clinic come from GPs and other hospitals.
We care for people with the following conditions:

• abnormal lipid disorders including high cholesterols, high triglycerides and low HDL (high-density lipoprotein cholesterol)
• patients who find it hard to tolerate statins for a variety of reasons
• patients with diabetes and lipid disorders
• patients with HIV and lipid disorders
• familial hyperlipidaemia including familial hypercholesterolaemia

We also offer risk assessments before starting lipid-lowering medication.

Referring to our service

Referring to our service/attending our clinics

If you are living in Tower Hamlets and are registered with a GP you can be referred to our Community Diabetes Service. Please contact your GP for this or a healthcare professional. This service includes consultations with a psychologist. You can refer yourself for psychology by calling 020 8223 8836 or emailing us.

If you are already under the community diabetes service and wish to reschedule/cancel an appointment, you can do so by calling 020 8223 8836.

For patients at Newham Hospital, if you would like to attend our diabetic foot clinics, you can refer yourself by calling: 020 7476 4000. If you would like to see the Clinical Psychologist, Dr Donna Oxley, you can also refer yourself by calling 020 8536 2161.

Take part in research

Are people with Type 2 diabetes more likely to develop dental caries?

We would like to invite you to take part in our one dental-visit study in which we aim to see how diabetes mellitus could affect teeth by evaluating risk factors causing dental caries (dental decay) in people with Diabetes Type 2 and compare to people without any type of diabetes. This study will give us a deeper insight and more knowledge about the complication of diabetes to oral health. This study is have been approved by regulatory authorities

You may be able to take part if you:

• Are 18 years of age or older
• Have been diagnosed with diabetes type 2 or Not been diagnosed with any type of diabetes

Participants will be asked to undergo:

• One dental clinic visits
• Saliva, plaque and blood sample collection

The participant will receive:

• Dental screening and cleaning if required
• Vitamin D and average blood glucose levels (HbA1c) tests
• Oral health care instructions and products

If you are interested to know more or to book an appointment, please contact the principal investigator, Ashwaq Alkahtani on email or phone 020 7882 8975.

Appropriate reasons for referral to the diabetes clinics include, type 1 diabetes, poor glycaemic control in patients on maximum oral hypoglycaemic medication who require insulin, presence of proteinuria and renal impairment, painful neuropathy poorly responsive to standard therapy and uncertain type of diabetes.

Clinics and consultants

• St Bartholomew’s and The Royal London Hospital clinics and referrals
• Mile End Hospital clinics and referrals
• Newham University Hospital clinics and referrals
• Whipps Cross University Hospital clinics and referrals
• Specialist Lipid Service

St Bartholomew’s , Mile End  and The Royal London  Hospitals   clinics and r eferrals

Referrals  to our acute services  can be made using  the e-referrals system :

• Obesity: Obesity - Diabetes and Metabolism (SBH) - Barts Health NHS Trust - R1H
• Lipids: Lipid - Diabetes and Metabolism (RLH) - Barts Health NHS Trust - R1H

General Diabetes:

• The Royal London: Diabetes and Metabolism - Diabetic Medicine (RLH) - Barts Health NHS Trust - R1H
• St Bartholomew's: Diabetes and Metabolism 1 - Diabetic Medicine (SBH) - Barts Health NHS Trust - R1H
• Mile End: Diabetes and Metabolism - Diabetic Medicine (MEH) - Barts Health NHS Trust - R1H

Young adults: Diabetes and Metabolism – Young Adults Diabetes Service - Barts Health NHS Trust - R1H (MEH)

Pre-conception: Diabetes Pre – Conception Clinic (MEH) Barts Health NHS Trust – R1H

Mile End Hospital Referrals:  Community Diabetes Service  (Tower Hamlets only) :

All referrals should come through the single point of access (SPA) referral form.

The Diabetes Centre
2nd Floor 
Mile End Hospital
Bancroft Road
London, E1 4DG

• Tel: 020 8223 8836
• Email: BHNT.CommunityDiabetesService@nhs.net
• Urgent advice:  0207 3777 000 | Bleep 1712

St Bartholomew’s and The Royal London Hospital clinics and referrals

New | Complex patient | Joint Diabetes-renal clinics at The Royal London Hospital and Mile End Hospital

Professor Tahseen Chowdhury

Young adult | Adolescent diabetes/pump clinic (CSII) | Monogenic Diabetes (MODY) at The Royal London Hospital and Mile End Hospital

Dr Bobby Huda

Antenatal clinic and pre-conception counselling

Dr Bobby Huda

The Royal London Hospital inpatient Diabetes Nurses:

• Tel: 0207 3777 000 | Bleep 1286
• Tel: 0207 3777 000 | Bleep 1434
• Mob: 0790 005 3502 | 0771 332 3941

Renal Diabetes Inpatient Specialist Nurse:

• Tel: 0207 3777 000 | Bleep 1287

St Bartholomew’s Clinics

Lipid clinic

Dr Ruth Ayling

Obesity clinic

Dr Simon Coppack

New | Complex/young adult | Type 1 clinic

Dr Bobby Huda/ Dr Nigel Glynn / Dr Candy Sze / Dr Dominic Cavlan / Sarah Finer

Amy Shlomowitz: lead Diabetes Specialist Nurse for Bartholomew’s Diabetes Clinic and Lead Insulin Pump Diabetes Specialist Nurse for Barts Health (based at St Bartholomew’s and Mile End Hospital)

• Tel: 020 8223 8973
• Mob: 077130 99191

St Bartholomew’s Hospital Diabetes Nurses:

• Tel: 020 3765 8972 | 020 3765 8973
• Mob: 07775 823 165
• Service email: SBH_Diabetes@bartshealth.nhs.uk

For urgent advice contact: Professor Tahseen Chowdhury
Tel: 0208 223 8384 via secretary or contact the on-call Endocrine/Diabetes registrar – via switchboard (020 7377 7000)

Mile End Hospital clinics and referrals

Lead Diabetes Nurse

Roisin Wright

Providing Tower Hamlets community Diabetes services and Mile End Hospital referrals including:

• Pre-Diabetes education

• X-Pert Diabetes type 2 Diabetes education

• Type 1 Diabetes structured education programme

• Diabetes Specialist Nurses

• Dieticians

• Psychology

Lead Insulin Pump Diabetes Specialist Nurse for Barts Health

Amy Shlomowitz (Based at St Bartholomew’s and Mile End Hospital)

Tel: 020 8223 8973

Mob: 077130 99191

Insulin Pump Administrator

Tel: 0208 223 8968

 

Mile End Hospital Referrals:

Mile End Hospital Referrals – Community Diabetes Service (Tower Hamlets only):

All referrals should come through the single point of access (SPA) referral form.

The Diabetes Centre
2nd Floor 
Mile End Hospital
Bancroft Road
London, E1 4DG

Tel: 020 8223 8836
Email: BHNT.CommunityDiabetesService@nhs.net
Urgent advice:  0207 3777 000 | Bleep 1712

Psychology

Diabetes Clinical Psychologist (Patients can self-refer):

Tel: 020 8223 8836

Email us

Retinal Screening

Diabetes eye screening (Provided by Homerton University Hospital):

Tel: 0208 510 5911

Newham University Hospital clinics and referrals

Referrals should be sent to one of the following people (Choose and Book is not applicable):

Consultant Physician and Clinical Lead (Diabetes and Endocrinology)

Dr Philippa Hanson

Type 1 Diabetes and insulin pump clinic

Pre-surgery clinic

Tel: 0207 476 4000 | Bleep 4238

Preconception clinic

Tel: 0207 476 4000 | Bleep 4150

Diabetes Research Nurse

Desiree Campbell- Richards  

Endocrine Specialist Nurses

Tel: 0207 476 4000 | Bleep 4635

Antenatal care

Diabetes Specialist Nurse: Tel: 0207 476 4000 | Bleep 4909
  
Diabetes Specialist Midwife: Tel: 0207 476 4000 | Bleep 4016

Psychology

Diabetes Clinical Psychologist (Patients can self-refer)

Tel: 0208 536 2161

Email us

Diabetic foot clinic

Referrals can be made by:
• Healthcare professionals in GP practices
• District nurses
• Vascular and diabetes specialist nurses.

Pre-conception clinic (for women with Type 1 / Type 2 diabetes) 
Referrals should be faxed to 020 7363 9298

Newham University Hospital Diabetes Nurses:

• Tel: 020 7476 4000 | Bleep 4150
• Tel:   020 74764 000 | Bleep 4238

Whipps Cross University Hospital clinics and referrals

Please refer by using the Choose and Book system where possible.

Dr Abdul Lakhdar (Whipps cross  and Forest Medical Centre, Loughton)

New /Complex Type 1 and Type 2 and pump patients | Joint Diabetes –Renal | General Endocrine | Lipid

Dr Rina Davison

Type 1 and 2 clinic | General Endocrine |Antenatal | Pre-conception |Transition clinic - Insulin Pumps and Young Adults

Dr Kalpita Majumdar

Type 1 and 2 clinic | Insulin pump clinic | Adolescent | Monthly Foot Clinic with a weekly foot round | General Endocrine clinic

Dr Deepa Chandran

Type 1 and 2 clinic | General Endocrine | Antenatal

Whipps Cross University Hospital Diabetes Nurses:

Clinics:

• New type 1 and type 2 clinics
• Complex patient clinics
• Adolescents
• Pre-conception advice
• Antenatal clinic
• Monthly Type 1 Support Group (2nd Tuesday of the month)
• Diet Adjustment for Normal Eating (DAFNE) Education
• Continuous glucose monitoring system
• Ambulatory Blood Pressure Monitoring

Lead Diabetes Specialist Nurse and insulin pumps (CSII): Bhavanee Manogaraan     

Diabetes Specialist Nurses

• Tel: 0208 535 6701
• Bleep: 0208 539 5522 | Bleep 424
• Fax: 0208 535 6465

Diabetes Midwife

• Mob: 07940499044

Diabetic foot clinic

Diabetic Foot clinics are monthly every Monday afternoon. Diabetes foot ward rounds are every Tuesday afternoon weekly

Podiatry referrals:

• Email: nem-tr.podiatry.redwf@nhs.net
• Tel: 0208 539 5522 | Ext 6266

Specialist Lipid Service

The Specialist Lipid Clinic at Barts sees patients with the following problems:

Familial Hypercholesterolaemia

See NICE Guidance CG71 and  Familial Hypercholesterolemia part 1 [docx] 57KB , Familial Hypercholesterolemia part 2 [pdf] 29KB and  Familial Hypercholesterolemia part 3 [docx] 248KB

Consider referral in patients:

• with pure hypercholesterolaemia with cholesterol >7.5mmol/L and/or LDL >4.9mmol/L
• and a Dutch Lipid Clinic score of at least five
• and/or who meet the Simon Broome criteria

Please state clearly how the patient meets criteria for referral

Enclose the results of:

• two full lipid profiles (cholesterol, HDL, LDL, triglycerides), ideally pre-treatment
• renal and liver profiles
• HbA1c
• TFTs

Hypertriglyceridaemia

See NICE guidance CG181 and Hypertriglyceridaemia [docx] 84KB 

Consider referral in patients with:

• fasting triglycerides persistently >10mmol/L (if alcohol  and/or poor glycaemic control excluded)
• fasting triglycerides persistently 4.4 - 9.9mmol/L and nonHDL cholesterol >7.5 mmol/L

Please state clearly how the patient meets the criteria for referral. Enclose the results of:

• two fasting lipid profiles
• renal and liver profiles
• HbA1c
• TFTs

Consideration for PCSK9 inhibitor therapy

See NICE TA393* and TA394* and  Consideration for PCSK9 inhibitor therapy [docx] 48KB

Consider referral in patients:

• with FH if:

LDL is persistently >5mmol/L without CVD or >3.5mmol/L with CVD

•  without FH if:

LDL is persistently >4mmol/L if at high risk of CVD* &>3.5 mmol/L if at very high risk*

PCSK9 inhibitors are currently not recommended for primary prevention

Please state clearly how the patient meets the criteria for referral

Enclose the results of:

• two full lipid profiles (cholesterol, HDL, LDL, triglycerides) at least three months apart
• renal and liver profiles
• HbA1c
• TFTs

Statin intolerance

Attempt trial of two or three statins, see Stain Intolerance [docx] 110KB 

Consider referral of high-risk patients in whom treatment goals are not attained

Please state clearly how the patient meets criteria for referral and include details of all statins prescribed (with dates and doses) and any relevant laboratory results (e.g CK)

Enclose the results of:

• full lipid profile
• renal and liver profiles
• HbA1c
• TFTs

Hypercholesterolaemia/other dyslipidaemia

See NICE Guidance CG181 and  Hypercholesterolaemia/other dyslipidaemia Part 1 [docx] 108KB and  Hypercholesterolaemia/other dyslipidaemia Part 2 [docx] 111KB 

See section on Familial Hypercholesterolaemia

Consider referral in patients:

• with pure hypercholesterolaemia with cholesterol >7.5mmol/L and/or LDL >4.9mmol/L
• and a Dutch Lipid Clinic score of at least five
• and/or who meet the Simon Broome criteria

In absence of features suggestive of Familial Hypercholesterolaemia:

Consider referral if:

• cholesterol >9mmol/L or non-HDL >7.5 mmol/L or LDL >8.5 mmol/L or triglycerides >10 mmol/L

Please state clearly how the patient meets criteria for referral

Enclose the results of:

• two full lipid profiles (cholesterol, HDL, LDL, triglycerides), ideally pre-treatment
• renal and liver profiles
• HbA1c
• TFTs