Advancing diabetes research

Professor David Simmons

Why have you chosen to spend most of your career working in diabetes research?

I started in hypertension research when a student. As a junior doctor working clinically, I was exposed to the beginning of the diabetes epidemic and the concurrent major treatment and access challenges, and decided to focus on the epidemiology of diabetes to answer many of the unanswered questions of the day. The communities I worked with said (and I paraphrase) that if I am to describe their diabetes epidemic, I should be involved in developing strategies to address the needs that were uncovered. I have been combining descriptive and intervention work ever since.

Is the prevalence of diabetes in Australia improving or is there a long way to go?

The prevalence of diabetes in some communities might have plateaued, but the age at onset with increasing numbers of children and young people with diabetes, is a growing problem. This of course leads to growing numbers of women with type 2 diabetes in pregnancy (both diagnosed and undiagnosed) in our clinics, with a growing number of affected babies. Disparities are evident so particular communities are much more heavily affected than others (based on e.g ethnicity, socio-economic status).

How has your ongoing research helped to improve the diabetes outcomes for the groups you have studied?

We have contributed in a number of ways including better ways by which GP and diabetes specialist services working together improve the care of people with type 2 diabetes, reducing their risk of diabetes complications like kidney failure, blindness and amputations. We have also generated the evidence that Māori and Pacific people with type 2 diabetes in New Zealand should have access to the new drugs to reduce their risk of kidney and heart disease. Research among young adults with type 1 and type 2 diabetes has helped inform the development of wider multidisciplinary services to reduce the risk of diabetes ketoacidosis and unplanned pregnancies with glucose levels that can lead to birth defects in the babies. Our most recent trial, TOBOGM (treatment of Booking Gestational Diabetes Mellitus) has shown that we should be detecting and treating GDM much earlier in a sizable proportion of pregnancies. The work to develop guidelines using this new evidence is already underway around the world, and TOBOGM has already informed both American and Scottish guidelines with an Australian conference to discuss this coming up soon.

What research projects are you currently working on?

We have a range of research projects currently underway. The largest SPHERE project is PPDP, the Pasifika Preventing Diabetes Program, under an NHMRC Partnership grant with local health districts, Primary Health Networks and others, all in partnership with the Pasifika community. This is looking at how we can prevent type 2 diabetes and its complications with a “through the church” culturally tailored lifestyle and peer support program. We also have the APHLID-M randomised controlled trial funded by the federally funded TTRA-MTP across South Western Sydney and South Eastern Sydney hospitals, Sydney Children’s Hospital Westmead and Goulburn Valley base Hospital in Shepparton. This is testing whether a specially designed phone app can improve mental health and diabetes self-management in young adults with diabetes and a range of mental health issues. Our latest project is working with the Age and Ageing Clinical Theme on adapting and trialling an education platform, the Western Diabetes Education Program, for use among elderly people with diabetes. The aim is to give more confidence, knowledge and skills to those in the aged care sector around the day-today care of those with diabetes. We have another educational project with the Aboriginal Health and Wellbeing Clinical Theme for those with type 2 diabetes taking SGLT2 inhibitors.

As the Director of the Diabetes, Obesity and Metabolism Translation Unit (DOMTRU), have you seen an improvement in the translation of research into practice?

Yes, there have been enormous strides in the treatment of both type 1 and type 2 diabetes over the last 10 years and many of these discoveries and technological advances are being put into practice, for example, glucose sensors are now funded by the Federal government for those with type 1 diabetes, and the new SGLT2 inhibitors and GLP1 Receptor Agonists are increasingly being used for those with type 2 diabetes. However, there is still further to go, for example, we’ve shown that we can put type 2 diabetes into remission using an adapted approach for Australian general practice but this needs a policy framework to introduce it. Similarly, insulin pumps that can talk to sensors in something called hybrid closed loop systems which can improve blood glucose and reduce frightening hypoglycaemia (low glucose) episodes, are not yet subsidised in Australia. We currently have an MRFF funded trial of one of these systems for use in type 1 diabetes in pregnancy with partners in Canada.

As Director of SPHERE’s Diabetes Obesity and Metabolic Disease Clinical Theme (DOM) how important is SPHERE to diabetes research?

SPHERE has been enormously important in our work. The collaboration with those from other SPHERE partners, other Themes and the overall framework, has provided different perspectives and skills and a springboard for different research activities. We otherwise would not have gotten together without SPHERE. SPHERE has also supported our work in integrated diabetes care through a SPHERE symposium at our annual Tech and Talk conference. And of course, SPHERE has contributed partner funding in a range of research projects. SPHERE has been an enabler in propelling our research along, translation across the SPHERE catchment, linked clinicians into the research & vice versa. It has been a great avenue for ECRs and early clinicians to kick start their research. I’ve found it a great way to give back as a mentor & build capacity for the next generation of research leaders.

What is the best part of your job?

Hard to say! Watching and being part of the achievements of others whether its grants, PhDs, papers, recruitment into studies or completing grants and papers successfully.

Describe your typical week

I don’t have a typical week! It is anchored in a diabetes in pregnancy clinic one day and a young adult or pre-pregnancy diabetes clinic on another day. In between, there is a lot of research, management, policy, clinical and education work!

Greatest professional achievement

I am proud of setting up the University of Melbourne Department of Rural Health and Rural Clinical School in Shepparton, the Diabetes Foundation Aotearoa in South Auckland and completing a number of big research projects that have influenced the care, and hopefully outcomes, of people with or at risk of diabetes.

Notable achievements

• Over 400 refereed publications.

• Has won national and international awards for his work Including:

- The Norbert Freinkel Award 2020 from the American Diabetes Association

- The Pederson 2022 Award by the (European) Diabetes in Pregnancy Study Group for his work in Diabetes in pregnancy and the Australian Diabetes Society (ADS)

- Jeff Flack Award 2022 for outstanding contribution to diabetes data collection in Australia.

• President of the Australasian Diabetes in Pregnancy Society (ADIPS) and was a member of the World Health Organisation technical working group on the criteria for hyperglycaemia in pregnancy.

• Previously the chair of Diabetes UK Health Professional Education Steering Group. He is a visiting academic to the University of Orebro Sweden and is a Professorial Fellow at the University of Melbourne.