Professor Stephanie Amiel is trialling a new talking therapy programme designed to improve management of hypo unawareness. The programme, named HARPdoc, was a success in the pilot study – the 24 people who completed the programme had 0 severe hypos in the following year, down from almost 20 a year before. Prof Amiel is now trialling the programme with a larger group of people.
How did you get involved in type 1 research?
How did I get involved in T1 research? As with many of us back then, in part serendipitously! My first job after qualifying in medicine was with Prof Harry Keen, in the early days of intensified insulin management for people with type 1. Harry and his colleagues had just developed the concepts of insulin pump therapy and insulin pens had just arrived, making MDI (multiple daily injections) a practical reality. Prof Keen also had an interest in people with very unstable diabetes control with and recurrent DKA, which provided a clinical challenge for his team, as we needed to go in when one of these people was admitted, as their DKA required slightly different management from routine cases. And we were on call if anything went wrong with a pump.
Then, when I was looking for research experience, Harry took me to a meeting where I met Prof Tamborlane, one of the inventors of the US version of the pump, and then a lead investigator with the DCCT. Through that meeting, I found myself with an invitation to undertake research in type 1 diabetes at Yale with him (a paediatrician) and his colleague and mentor Robert Sherwin, an adult diabetologist, as was I. We worked on the impact of tight glycaemic control on abnormalities of counter-regulation to hypoglycaemia and on insulin sensitivity in adolescence – and the rest, as they say, is history!
Has JDRF’s support made a difference to your research?
I met JDRF while at Yale. Prof Robert Sherwin funded my first year there but we applied for a JDRF Fellowship (I remember writing it with Bill Tamborlane and multiple flasks of black coffee in the Tower hotel in London during my first ever EASD meeting at the Barbican centre there – we could probably find the date!) – I was awarded a fellowship supported by the Charlotte Benefactors for a Cure, and was able to stay a full 3 years and complete my projects – forming the basis for an on-going career in research in hypoglycaemia in diabetes, often with JDRF support. I also later was involved with JDRF UK, working on their scientific advisory board. It has been a fruitful relationship.
What keeps you motivated in your work as a scientist?
Many things keep me motivated – of which the main one is that we still haven’t solved the problems of hypoglycaemia for many of our patients with type 1 diabetes. But we have made considerable progress which keeps us going. There are the wonderful people I have had the privilege to meet and often work with, who have provided ideas, inspiration and companionship – and there are the people with diabetes and their families who selflessly support the research, sometimes benefitting from what we have learned and always teaching us more, and keeping the research informed by what matters to them. It is serious business but along the way there has also been a lot of fun!
What is your hope for your research in the future?
My most immediate hope is that the clinical trial we are just embarking on, funded by JDRF, will be a success! We are investigating a new intervention that we hope will help that 10% of adults with type one who seem to be unable to avoid hypoglycaemia despite everyone’s (mostly their own) best efforts. They contribute almost a quarter of all severe hypoglycaemia seen in people with type one in a year – so distressing for them and their families. If our project is a success we will have described an intervention that should be easily translatable into clinical practice – and proven an hypothesis that we have formed over the years of intensive physiological research!
Meanwhile I am also excited by a new study with colleagues in the UK looking at better ways of helping adults with diabetes incorporate their insulin management more effectively into the lives they want to live; by the growing global consensus on what hypoglycaemia really is; and by the potential for technology to make all of the above redundant for people with diabetes!
When not in the lab, how do you spend your free time?
I am an experimental medicine researcher and now, for the first time, a clinical triallist – a steep learning curve! So my lab includes my clinic and the people with diabetes I strive to serve. I am not sure I would call that free time! I spend a lot of time away from work at the laptop, or on the telephone, thinking about diabetes. But when I am not working with diabetes, I like to hike among the hills of the English Lake District; oil paint on canvas images that at least remind me of what I was looking at them when I was painting them; go to the opera and theatre; go walking with friends and most of all spend time with my husband either doing the above (except the oil painting – that is his signal to do the garden) or just hanging loose, preferably with a good book, a log fire and a glass of wine!