An internationally renowned consultant physician who has led the way in developing key research that aim to reduce the burden of hypoglycaemia, a condition that occurs when a person's blood glucose level has dropped too low, has delivered the prestigious 2019 Banting Memorial Lecture, the highest honour bestowed by Diabetes UK.
Professor Simon Heller, research and development director and honorary consultant physician at Sheffield Teaching Hospitals NHS Foundation Trust, delivered the lecture in front of an audience of 1000 professionals in the field at the Diabetes UK Professional Conference in Liverpool on 6 March 2019.
The Banting Memorial Lecture Award is only awarded to a person internationally recognised for their eminence in the field of diabetes. It is held every year in honour of Sir Frederick Banting, who first used insulin to treat diabetes almost 100 years ago in 1922.
Prof Heller’s lecture focused on the ongoing challenge of hypoglycaemia, a century after the discovery of insulin. His esearch has played a pivotal role in helping to advance understanding and management of diabetes, and over the years he has led a number of groundbreaking studies focusing on the challenges of hypoglycaemia, a symptom of insulin treatment which is cited by people living with diabetes as the major obstacle in preventing them gain good blood sugar control.
Hypoglycaemia occurs when people are unable to match insulin to the amount of food eaten, causing blood glucose levels to run very low. The condition – which can occur at any time of day or night without warning – causes shakiness, dizziness, sweatiness, convulsions, loss of conscious, low mood and feelings of anxiety. In some cases it can cause more serious side effects such as sudden loss of consciousness.
While working in the USA, Prof Heller was the first to identify that hypoglycaemia unawareness (when blood sugars plunge dangerously low but remain undetected) occur when repeated episodes of low sugar levels are detected in the blood. This insight has been key in helping to reverse the effects of hypoglycaemia in people with type 1 diabetes.
Prof Heller has also been instrumental in helping to establish the DAFNE education programme which is now run in hospital diabetes clinics across the UK. The programme, which uses a structured approach to teach people living with diabetes to manage their diet, lifestyles and insulin treatment levels, aims to help people with diabetes live as normal a life as possible. This research is now being taken to the next level, with Professor Heller currently leading a trial looking to see how this structured programme can be supported through the use of new technologies such as smartphones and apps.
He was also the first to show an association between hypoglycaemia and prolonged abnormal heart activity overnight – potentially shedding new light on the 'Dead in Bed syndrome. The syndrome is a rare condition in which young people with type 1 diabetes who are in good health are found dead in undisturbed beds in the morning after going to bed seemingly fine. The unexpected findings showed that there was a six-fold incidence of slow heart rates in some individuals experiencing hypoglycaemia overnight, which might offer the opportunity to screen and identify those at risk.
H is also at the forefront of a world-leading diabetes project which is looking to see how mild episodes of hypoglycaemia can impact on the quality of people's lives. The £20 study, which will take place across ten countries and involves six UK centres, will see Prof Heller work with colleagues from the University of Sheffield and abroad to amass all the published evidence from clinical trials about hypoglycaemia. This will help to establish more sophisticated ways of measuring and monitoring hypoglycaemia in clinical studies. A clinical trial looking at how episodes of hypoglycaemia impair the quality of lives for those living with diabetes, even when episodes are mild, will also be established.
Prof Heller said: “I am hugely privileged to have been bestowed this honour by Diabetes UK. It’s been immensely rewarding to have taken research questions that occurred to me in clinical practice and been able to design studies that has made a difference to patients and changed diabetes practice for the better.
“My clinical work and experience has only increased my admiration for those living with diabetes, and I would like to thank them for helping me and the colleagues I have worked to gain a better understanding the disease.
“My recent work has also highlighted the potential risks of low glucose not just on the brain but on the heart, and this changing attention of emphasis now needs to be taken up by clinicians when talking to patients and agreeing glycaemic goals and appropriate glucose lowering therapy as these are important findings.”