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| 01 Jewish. Political. Ealing County School. Evacuated… | |
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| 02 Father tailor. Mother ran Keen’s Cleaners. Interest in medicine at Habonim. | |
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| 03 Didn’t join army. Interviewed at St. Mary’s by Lord Moran. | |
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| 04 Taught by George Pickering – experimental - got me in to diabetes. | |
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| 05 After army, Pickering invited me to research blood pressure. Attempts at MRCP. Sent to Robin Lawrence at Kings to measure younger patients. | |
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| 06 Wilfred Oakley uninterested. Lawrence’s diabetes gave insights. I’d previously seen chronic illness in TB ward. | |
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| 07 Diabetes had been seen as solved - Beginning to see long-term effects. Kimmelstiel-Wilson syndrome. Over next 20 years, hazards anticipated. | |
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08 People who trained me didn’t understand complications. Should Type 1 be treated as strictly as by Joslin?
Risk of vision loss, renal failure, heart attack & stroke. Consultants didn’t warn patients. Importance of control only recognised later. | |
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09 In 1950s, impressed by Lawrence. Diet. Enormous clinics. Doctors shared room. Lawrence hypo. Eye examinations.
At St. Mary’s did general medicine & diabetes.
1960, National Institutes of Health Fellowship, USA. | |
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| 10 In 1950s, clinic patients mostly insulin-taking. Patients waited patiently, but I was angry. Day Centres followed visit to Berlin, mid-60s. European Diabetes Epidemiology Study Group. | |
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11 Saw Dr. Volker Schliack’s house for patients’ residential training. Opened Guy’s day centre. Others opened.
In 1950s, Lawrence uninterested in non-insulin diabetes – considered mild. Years before realised Type 2 complications. Bedford Survey began 1962. | |
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12 Returned from U.S. to John Butterfield, Guy’s
(Wonderful year in Bethesda, but wanted to include clinical work.)
Productive decade. More liberty at Guy’s than St. Mary’s. Lecturer, senior lecturer, reader, then after 10 years, personal chair. Bedford Survey to discover rate of undiagnosed diabetes, with Clive Sharp… | |
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| 13 1962 - Urine samples collected from 72 or 73% of population. Glucose tolerance test for random sample showed area of uncertainty. | |
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| 14 Diagnostic uncertainty found in U.S. by Kenny West. In Bedford, added ‘borderline’ category. Birth of IGT - impaired glucose tolerance. Monitored 10 years. Half given Tolbutamide, half placebo. Little effect on rate of development. Need for early tests. Microalbuminuria. Borderline group had increased risk of heart disease. | |
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| 15 1960s increase in Type 2 - clinics overcrowded. British Diabetic Association. More equal doctor/patient partnership. | |
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| 16 1n 1960s, around 10% on Guy’s wards diabetic. Diabetes Specialist Nurse most important development since insulin. Diabetes Centres. With John Ward at Royal Hallamshire, saw outpatients visit ward. | |
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| 17 BDA helped fund Centres, with nurses, dietitian, chiropodist - now threatened. Not either primary care or hospital – need both. | |
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| 18 Even in 1960s, mini-clinics, with consultant & GPs. Ron Hill in Poole. Joan Walker, in Leicester, after war. | |
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| 19 Joan Walker did 1st UK diabetes survey, mid-1950s. Was founder member of what became BDA Medical & Scientific section. I addressed meeting, 1956. Doctors worried re discussing complications with patients there. Philip Randle formed Med & Scientific section for healthcare pros only, 1960. | |
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| 20 1970s – full impact of complications. Type 2 not mild. Tight control without ruining life. Self-measurement of blood glucose. Lawrence had used multiple doses. | |
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| 21 Lawrence adjusted quick-acting insulin before meals. Flexibility of multiple doses not recognised until end of 1970s. John Ireland, Glasgow, developed pen injector. I didn’t believe self-measurement reliable. Study re reflectance meters. Peter Sanderson, Bob Tattersall, gave meters to patients. | |
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| 22 First continuous subcutaneous infusion. Learnt from George Alberti that John Parsons had pump. With John Pickup, applied to National Institutes of Health for study. NIH planning Diabetes Control & Complications Trial, DCCT. Invited to run it, but decided not to. Joined ethical committee. Patients’ cooperation showed Lawrence & Joslin right – tight control reduces complications. | |
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| 23 Illusion that tight control complete solution. Tight control worsened retinopathy at first & more hypos. Then got better. Clear tight control helped Type 1. And Type 2? Early 1970s study made things difficult… | |
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| 26 …Dr. Eishi Miki said not much heart disease with diabetes in Japan - dumbfounded by heart disease & gangrene at Joslin clinic. Japanese who moved to U.S. had increased risk. Changed advice to patients – forget dairy fats & eat high fibre foods… | |
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27 …study showed patients had previously only cut out sugar. Now general population given same advice. Twice as important for diabetics to reduce cholesterol.
In 1970s, worked with dietitians, but gave dietary advice myself. | |
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| 28 Mid 1970s, 12 centres started `WHO multinational study of vascular disease in diabetes` at CIBA Foundation. Showed little in Japan – lots elsewhere. | |
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| 29 By 1980s, realised importance of screening for eye & kidney disease, high blood pressure & foot care. Chaired WHO expert committee, 1979. Patient collaboration essential… | |
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| 30 …each region should develop own plan. St. Vincent Declaration, end of 1970s. More patients spoke than healthcare professionals. Diabetes National Service Framework. | |
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31 1980s, early screening for Type 2 complications spread.
Not enough specialists for Type 2 increase… | |
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| 32 …Role for primary care. In 1940s & 1950s GPs scared - referred to hospital. Continued until 1980s. As numbers increased, patients moved to GPs without preparation. Need for GPs & specialist to cooperate. GPs can help Type 2. I work in local practice. Diabetes Centre should be hub. | |
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| 33 1980s, human insulin. Some people returned to animal insulin. Human insulin better for most – modified for delayed effect & rapid action. | |
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| 34 Beginning of 1970s, switch from U40 & U80 to U100 organised by BDA & Dept. of Health. Reviewed injections. Local healthcare professional groups formed. | |
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35 Changeover taking hold 1980s. Centres helped.
Patients who feel human insulin loses warnings should revert. Studies show no difference. Feelings intense because lives depend on insulin – shown when British insulin put in Danish vials. | |
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| 36 End of 1980s, NHS reforms. At Guy’s, Resource Management Initiative meant healthcare professionals made policies through ‘sub-hospitals’. A plot! Prepared for internal market. Took government to court, backed by BMA. | |
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| 37 Lost. Launch of NHS Federation - public service, not private profit. I retired 1990. Continued to work at hospital & at son’s GP surgery, Watford – many South Asians. (My study with Hugh Mather had shown high incidence.) | |
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| 38 Reviewing all diabetics at surgery. They’re more comfortable at surgery than at hospital. Need for better links between specialist centre & primary care. Nurses’ role important. I learnt from nurse at Lawrence’s clinic. | |
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39 At son’s surgery, try to make patients anxious enough but not too anxious.
My research funders included Croc Foundation at San Antonio, where gave results of WHO multinational study. | |
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-t.jpg "1962 - Harry Keen Team, Bedford (damaged photo)")
