About Us
This section has been designed to give you information about the Bath Diabetes team. It also has some limited information about Endocrine referrals: Click on relevant title to fast track down the page.
Diabetes and Endocrinology at the RUH
About the department
- We provide a specialist service for patients in BANES, North and West Wiltshire and North Somerset (formerly Mendip), covering the full range of problems associated with diabetes and all endocrine conditions.
- We are based at the Diabetes Centre in the RUH, but also hold diabetes clinics at Chippenham, Devizes, Paulton, Trowbridge, Warminster, Frome and Shepton Mallet hospitals
- In addition to general diabetes clinics, we hold the following specialist clinics:
Young Persons’ Diabetes Clinic
Young Persons’ Endocrine Clinic
- There are four consultants and a strong team of Diabetes Specialist Nurses (DSN); two inpatient liaison nurses and five community-based DSNs.
- We have close links with the Paediatric department and strive to ensure smooth transition from Children’s to Adult services for Young People with diabetes and other endocrine conditions
Location
From the main entrance, come through doors behind the atrium coffee bar. Follow the corridor round to the right and left and up to a T-junction. Turn right and follow the corridor until the second corridor on the left. The Diabetes & Endocrinology department is a short way along this corridor on the right-hand side. (link to map)
Facilities
The waiting area is puropse built with full air-conditioning/central heating. There is a hot drinks machine. Please note the machine does not accept 50p or £1 coins. Cool tap water is also available. There is a large range of information leaflets and magazines to read and in some clinics we have additional educational dispays. The department is fully accessible, including assisted toilets. There is a small supply of children’s toys.
Coming to clinic
Hospital transport is limited and reserved ONLY for those who have no other means. Therefore, we ask you to make your own arrangements wherever possible. All patients with diabetes should have a blood test done one week prior to their appointment. This can be arranged at your GP surgery, the Walk in Centre or here at the RUH. The doctor will have given you a form at your previous appointment, but if it is your first visit please ask your GP for a form. Please bring a urine sample, your home blood glucose readings (book or meter) and your most up-to-date prescription to the clinic appointment. On arrival at the clinic, you will be seen by a nurse who will weigh you and measure your blood pressure. You will then see the doctor.
Contact us
Reception is staffed from 08.00-15.30 Monday to Friday. Tel: 01225 834101 (please leave a message on the answerphone if there is no response) Fax: 01225 824529 For specific staff members, please see contact details under ‘The Team’
The team
Hospital Consultants Secretary Telephone
- Dr Tony Robinson Pauline Hughes 01225 824527
- Dr Lyn Higgs Donna Wheatley 01225 824991
- Dr Alexandra Ward Angela Hernandez 01225 826232
- Dr Kate Allen Liz Thorne 01225824991
Other medical staff
- Associate specialist Dr Venkatesha Babu Bl 7726
- Specialist registrar Dr Jyothish Govindan Bl 7018
- Specialist registrar Dr Rasha Mukhtar Bl 7021
- There are also 3 Foundation Year 1 doctors, two FY2 doctor and an SHO-grade doctor. Bleep numbers for these doctors vary, so please contact the Switchboard.
Retinal Screening Team
- Rosie Bulford Retinal Screening Programme Manager X1225
- Julie Fletcher Retinal Screening ManagerManager X 1255
- Sachin Sonchhatla Administration X 4115
Bernie Hall - Team Leader: Bernadette.Hall@wiltshire.nhs.uk
Debbie Nethercote – DSN Debra.Nethercote@wiltshire.nhs.uk
Nikki Hillier – DSN Nicola.Hillier@wiltshire.nhs.uk
Lesley Amer - DSN Lesley.Amer@wiltshire.nhs.uk
Sally Wylie – DSN Sally.Wylie@ruh-bath.swest.nhs.uk
Sally Catchpole – DSN Sally.Catchpole@ruh-bath.swest.nhs.uk
Inpatient Diabetes Liaison Nurses
Secretaries:
For Information
Lynne Greenhalgh (Diabetes Specialist Dietitian)Lynne.greenhalgh@salisbury.nhs.ukTel: 01722 425176Fax: As above
Podiatry
Kim Harman BANES 01225 824061
Directory of Outpatient Services
General clinic information
Location – see ‘About the Department’. {Link to map} Preparation for clinic:
- Hospital transport is limited and reserved ONLY for those who have no other means. Therefore, we ask you to make your own arrangements wherever possible.
- All patients with diabetes should have a blood test (for diabetes control, kidney function, cholesterol levels) done one week prior to their appointment. This can be arranged at your GP surgery, the Walk in Centre or here at the RUH. The doctor will have given you a form at your previous appointment, but if it is your first visit please ask your GP for a form.
- Please bring a urine sample, your home blood glucose readings (book or meter) and your most up-to-date prescription to the clinic appointment. What to expect in clinic:
- On arrival at the clinic, please report to the receptionist
- The facilities available in the waiting room are detailed in the ‘About the Department’ section
- You will be seen by a nurse who will check your height, weigh you and measure your blood pressure. You will then see the doctor.
- The doctor that you see will be a consultant or a member of their team. There may be medical students present, but you have the right to ask to see the doctor alone.
Diabetes Clinics
- General
- Young persons’
- Foot
- Joint vascular
- Renal
- Pump
- Antenatal
General Clinic
- Clinics are held every day of the week at the RUH and several times a month at the various community hospitals. New patients generally seen at RUH and then followed up at community hospitals where appropriate
- Responsible consultants: Drs Allen, Robinson, Higgs, Ward
- Referral criteria:
- All patients with type 1 diabetes
- Patients with type 2 diabetes with poor control or complications
- Any patient where the type of diabetes is uncertain at diagnosis (eg possible MODY)
- Secondary diabetes (eg cystic fibrosis-related)
- Referral mechanism:
- Choose and Book
- Generic letter to the department
Young Persons’ Clinic
- Clinics are held on a Tuesday evening between 4 and 6pm every 4 weeks.
- Responsible consultants: Drs Higgs and Ward
- A diabetes nurse specialist and dietician are also present
- Transition clinics are held quarterly with members of the paediatric diabetes team.
- Referral criteria:
- Anyone with aged 16-21yrs or still in full time education (up to 23)
- Referral mechanism:
- Choose and Book
- Generic letter to the department
Foot Clinic
- Clinics are held on Thursday afternoons
- Responsible consultant: Dr Higgs
- A specialist podiatrist is also present
- Referral criteria:
- Acute foot ulceration
- Chronic ulceration not responding to community treatment
- Suspected Charcot foot
- Referral mechanism:
- Urgent fax to Diabetes Centre (01225 824529)
- Patients will generally be seen within a week
Joint vascular clinic
- Clinics are held on Thursday morning every 4 weeks
- Responsible consultants: Dr Higgs and Mr Budd/Pai (Vascular surgeons)
- A specialist podiatrist is also present
- Referral criteria:
- Diabetic foot disease with a prominent vascular component
- Referral mechanism:
- Urgent fax to Diabetes Centre (01225 824529
- Dr Higgs will triage to this clinic if appropriate
Renal clinic
- Clinics are held monthly on a Wednesday morning
- Responsible consultant: Dr Higgs
- Referral criteria:
- Patients with diabetes and deteriorating renal function (eGFR<45) or rising protein excretion, but not suitable for direct nephrology referral
- Referral mechanism:
- Letter to Dr Higgs who will triage to this clinic if appropriate
Pump clinic
- Clinics are held on Wednesday afternoon every 4 weeks
- Responsible consultant: Dr Ward
- A specialist nurse and dietician are also present
- Referral criteria:
- All patients with diabetes on continous insulin therapy (insulin pump)
- Referral mechanism:
- Direct referral to Dr Ward
Antenatal clinic
- Clinics are held on every Friday morning in Princess Alexandra Wing
- Responsible consultants: Dr Robinson and Miss Dunlop
- A specialist nurse and midwife are also present
- Referral criteria:
- All patients with diabetes at the point their pregnancy is confirmed
- All patients undergoing active treatment for Graves’ disease, prolactinomas and other endocrine conditions which may alter in pregnancy
- Referral mechanism:
- Urgent fax or phone call to Dr Robinson’s secretary (Tel: 01225 824527, Fax: 01225 824529)
- Patients will usually be seen within that week
Endocrine clinics
- General
- Joint thyroid
- Joint pituitary
- Joint Thyroid Eye Clinic
- Young persons’
General clinic
- Clinics are held on Tuesday, Wednesday, Thursday and Friday at the RUH
- Responsible consultants: Drs Allen, Robinson, Ward
- Referral criteria:
- All patients with endocrine conditions requiring secondary care management
- Exclusions: thyroid nodules (refer joint thyroid clinic), simple obesity (not funded by PCT), paediatric endocrinology (refer paediatrics)
- Referral mechanism:
- Choose and Book
- Generic letter to the department
Joint thyroid clinic
- Clinics are held 3out of 4 weekly usually on a Tuesday mornings at the RUH
- Responsible consultants: Drs Ward, Allen, Robinson with Mr Maddox or Mr Budd(Endocrine surgeons)
- Referral criteria:
- Thyroid nodules (with normal TFTs)
- Primary hyperparathyroidism (Mr Maddox clinic only)
- Adrenal nodules (after work up in general endo clinic)
- Procedures: Fine needle aspiration of thyroid nodules
- Referral mechanism:
- Choose and Book,
- Generic letter to the department
Joint pituitary clinic
- Clinics are held alternate months on a Wednesday afternoon (preceded by a pituitary radiology meeting)
- Responsible consultants: Dr Allen and Mr Nelson (Pituitary surgeon, Frenchay hospital)
- Referral criteria:
- Pituitary tumours
- Craniopharyngioma
- Other space occupying lesions in pituitary fossa affecting pituitary function
- Referral mechanism:
- Letter to Dr Allen
Young persons endocrine clinic
- Clinics are held on Thursday afternoon every 3 months
- Responsible consultants Dr Allen and Dr Billson/Edmonds (consultant paediatricians)
- Transition clinic for patients between paediatric and adult endocrine services
- Referral mechanism:
- Most patients referred internally from paediatrics:
- Letter to Dr Allen
- Wednesday Morning every 3 months
- Responsible Clinicians: Dr Allen, Ward and Mrs Sally Webber
- Letter to Sally Webber (Ophthalmology)
Lipid clinic
- Clinics are held on Tuesday and Thursday mornings at the RUH
- Responsible consultant: Dr Taylor (Clinical Biochemist)
- Referral criteria:
- Primary lipid disorders,
- Resistant dyslipidaemia for consideration of combination therapy
- Primary and secondary cardiovascular disease prevention
- Referral mechanism:
- Choose and book
- Letter to Dr Taylor
Research
DIABETES AND LIPID RESEARCH CURRENT STUDIES RECRUITING
4th June 2010 DIABETES AND LIPID RESEARCH CURRENT STUDIES RECRUITING
- TIDE Study – Cardiovascular Outcome trial with a difference, type 2 diabetes
Looking at possible benefits of glitazones and/or Vitamin D in terms of cardiovascular disease, bone fractures and development of cancers. 5 year study Age > 50 with established cardiovascular disease orAge > 55 with subclinical CVD eg (1 or more of) microalbuminuria, LVH, abpi <0.9 etc orAge > 60 with at least 2 of : smoker, áLDL or on lipid lowering, â HDL, antihypertensive RxInadequately controlled on ≤ 2 oral antidiabetic agents (inc diet only), NOT insulin
- FIND-CKD – Comparison of oral iron with IV Ferric-carboxymaltose in subjects with chronic kidney disease and iron-deficient anaemia. Ferric carboxymaltose is well tolerated with shorter and less frequent administration than other iron infusions and may delay the need for EPO. e-gfr < 60 but > 15Hb 9 – 10.5Ferritin < 100mcg/lEPO naïve 18 visits over 56 weeks. Randomised to one of 2 doses of Fe-carboxymaltose or oral iron. Can provide taxis if required.
· LanScape – type 2 DMComparision of basal bolus + 1 (Lantus + Glulisine) with biphasic (NovoMix twice daily) in type 2 diabetes Currently treated with basal insulin (only) - Lantus or Levemir or NPH - ± OAD. OAD will be stopped apart from metformin. Willing (needing) to change to basal bolus regime.HbA1c 7.5 – 10.0Age 18 – 75BMI ≤ 40 34 week study.
· SGLT-2 Inhibitor * (BI1245.33) – Type 2 DM Type 2 Diabetes treated with basal Lantus, Levemir or NPH ± metformin and/or sulphonylurea, all of which continue throughout study. HbA1c 7.0 – 10.0Age ≥ 18BMI ≤ 45 Randomised to 1 of 2 doses of study drug or placebo. After 12 weeks insulin dose can be adjusted and later on oral meds can be adjusted if necessary. *SGLT-2 inhibitor reduces renal reabsorption of glucose .
· TECOS - academic trial` Trial evaluating cardiovascular outcomes with sitagliptin in type 2 diabetes. Age ≥ 50Known Cardiovascular DiseaseInadequate control on 1 or 2 of Metformin, Sulphonylurea, Pioglitazone HbA1c 6.5 – 8.0 Sitagliptin or placebo added to current treatment (which can be changed during study). 4 year follow up.
· EXAMINE – Cardiovascular outcome trial, type 2 DiabetesStudy of Alogliptin in patients admitted with acute coronary syndrome up to 60 days before randomization. Starting dose of gliptin dictated by renal function. Plan to recruit most from chest pain unit but you may see some on other wards. Age > 18HbA1c > 7, upper limit depends on treatmentMonotherapy or combination including insulin.NO gliptin nor GLP1 analogueUsual exclusions
· ALOGLIPTIN Type 2 diabetes inadequately controlled with metformin only.HbA1c 7.5 - 10BMI ≤ 45Age 18 - 80 DPPIV inhibitor (one of 2 doses) or glipizide added to metformin. 2year study. Must not have been treated with Gliptin or GLP-1 analogue in past 12 weeks.
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ASCEND – a study in patients with diabetes to assess whether aspirin therapy is beneficial in subjects who have no history of cardiovascular disease. 10,000 people aged over 40 will be randomized to aspirin or placebo, and also may receive fish oils. Follow up will be mainly by questionnaire for at least 5 years.
For further details :http://webserver.ruh-bath.swest.nhs.uk/clinical_directory/clinical_depts/wolfson_centre/diabetes.asp?menu_id=5
Diabetes uk - http://www.diabetes.org.uk/
NICE - http://www.nice.org.uk/
British thyroid association - http://www.british-thyroid-association.org/
Society of Endocrinology- http://www.endocrinology.org/
Royal United Hospital - http://www.ruh.nhs.uk/