Overview

I am a geriatrician with clinical and academic interests in all aspects of community geriatrics. I feel  that the emphasis in healthcare needs to move from secondary care into the community, with improvements to preventive and public health measures, and multidisciplinary working. I am keen to do research that is meaningful for people and has close clinical impact, currently working on a variety of projects relating to patient-reported outcome measures, frailty and sarcopenia, in collaboration with public volunteers and primary and secondary care.

I am fortunate to have worked in Professor Andrew Hattersley’s clinical diabetes research team for several years, and completed my PhD on Hypoglycaemia in Older People with Diabetes, and I am developing further work in this area too.

Qualifications

• 2021 FRCP (Royal College of Physicians, London)
• 2018 Advanced Postgraduate Diploma in Geriatrics (European Academy for the Medicine of Ageing)
• 2016 PhD (University of Exeter)
• 2011 MSc Diabetes (Queen Margaret University, Edinburgh)
• 2009 MRCP (Royal College of Physicians, London)
• 2004 MB ChB (University of Bristol)
• 2001 BSc Neuroscience (University of Bristol)

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Research

Research interests

Community geriatrics: I feel strongly that the emphasis in healthcare is going to need to move from secondary care out into the community, with improvements to preventive and public health measures, and multidisciplinary working. I am currently working on and developing projects relating to use of and access to healthcare resources by older people both ordinarily, and during COVID-19, working in collaboration with public volunteers, the South West Ambulance Service Foundation Trust, and primary and secondary care. This is using a range of mixed methods, from large data analysis to qualitative interviews. I am also working with these groups on the practical application and relevance of incorporating clinical frailty assessments to help support clinical decision making, as well as helping to identify further important research questions.

Diabetes in older people: Hypoglycaemia (low blood sugar levels) usually occurs as an undesirable side effect of diabetes treatment. Recognition of hypoglycaemia in older people can be difficult, due to the non-specific nature of the associated symptoms. These symptoms are similar to those of many other clinical conditions in this age group, such as causing people to feel generally unwell, sick, tired or drowsy, light-headed, and be at increased risk of having falls. Recurrent or severe hypoglycaemia may also have longer term consequences such as increasing the risk of memory problems or dementia. Type 2 diabetes is the most common type of diabetes in older people, but by measuring endogenous insulin levels, we have demonstrated that some people who meet the clinical criteria for Type 2 diabetes can actually have significant insulin deficiency – in the range normally expected in Type 1 diabetes. Using continuous glucose monitoring and questionnaires, we have seen that people with clinically-diagnosed Type 2 diabetes but severe insulin deficiency seem to be at much higher risk of hypoglycaemia than clinically-similar seeming people with Type 2 diabetes but preserved insulin production. We have shown that a simple blood test, random non-fasting C-peptide, is well-correlated with the gold-standard measure of endogenous insulin production, C-peptide in a mixed meal tolerance test. Random non-fasting C-peptide may therefore represent a useful additional clinical tool in recognizing patients at high risk of hypoglycaemia, and help guide the most appropriate treatment choices. 

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