Professor Alan Sinclair is an international expert in diabetes and clinical gerontology and is Director of the Foundation for Diabetes Research in Older People at Diabetes Frail Ltd in Worcestershire, England.
Professor Sinclair is also Hon Professor of Metabolic Medicine at Aston University and consultant geriatrician and diabetologist at the Luton & Dunstable University Hospital in Bedfordshire, England. He is a former Professor of Medicine at the University of Bedfordshire and Dean at the Bedfordshire & Hertfordshire Postgraduate Medical School. He has provided advice for the UK NICE organisation, Care Quality Commission (CQC) and the UK Government Department of Health on matters relating to diabetes in older people.
He has interests in ageing and frailty, nutrition, stroke illness, end of life diabetes care, care home diabetes and cognitive dysfunction / Alzheimer’s disease. He co-led the development of the IDF Guideline on Managing Older People with Type 2 Diabetes and led a successful IAGG programme on diabetes which was presented in Seoul, Korea in June 2013. Alan has been designated a WHO Expert in Diabetes and more recently been appointed to a World Expert Group on Frailty by the WHO. He was awarded the Presidential Medal of the IAGG in 2013 for services to older people and diabetes. He is the author of many papers in the area of geriatrics, nutrition and diabetes. Professor Sinclair is involved in collaboration in 6 EU-projects connected with frailty and older people with the MIDFRAIL project involving patients with diabetes.
He is currently editing the 4th edition of his well established textbook, Diabetes in Old Age, published by Wiley-Blackwell with three other distinguished Editors, Prof Medha Munshi of Harvard, Prof Trisha Dunning of Geelong, Australia, and Prof Rodriguez Manas of Madrid, Spain. Professor Sinclair is the National Clinical lead in England for the Older Peoples Diabetes Network. After successfully establishing in 2008, the first Institute of its kind devoted to diabetes in older people (Institute of Diabetes for Older People, IDOP) he has now moved to create Diabetes Frail, a not for profit research organisation dedicated to developing high quality research in older people and in those with diabetes.
Areas of Expertise (6)
DR Barometer Program
Re-enablement in Diabetes
Ageing frailty and sarcopaenia
Cognitive dysfunction and dementia in diabetes
International Association of Gerontology and Geriatrics (IAGG) Presidential Medal (2013) (professional)
Professor Alan Sinclair was awarded the International Association of Gerontology and Geriatrics (IAGG) Presidential Medal for services to diabetes in 2013, in recognition of his work to improve the healthcare of older people with diabetes and the education of health professionals
World Health Organization (WHO) Recognised Expert in Diabetes - for more than 10 years (professional)
Alan Sinclair was recognised as an official expert in diabetes after being invited to participate in a WHO led Workshop on Rehabilitation.
World Health Organization (WHO) Recognised Expert in Frailty (2014) (professional)
Alan Sinclair was appointed to the World Health Organization (WHO) Expert Group on Frailty in view of his expertise in diabetes - Professor was the first to introduce the idea that diabetes was a model of frailty
UK Department of Health (NHS Diabetes) first Clinical Lead for Older People with Diabetes in England: established the National Older Peoples Diabetes Network (professional)
Professor Sinclair was asked to lead several initiatives to enhance the diabetes care of all older people in the UK - many of these were designed and created by Professor Sinclair, himself.
Newcastle under Lyme School, Staffordshire, UK - seconday school education preparing for University entrance (1969-72): A - levels in Chemistry, Biology, Physics, Pre-University Examinations 1972
London University - St Barthomews's Hospital College of Medicine (1973-9): BSc Hons - 1st Class Hons in Biochemistry; MBBS, Medicine 1979
University of Sydney, Australia: MSc Medicine, Medicine 1993
This was funded by a BGS-Nuffield Foundation Scholarship and involved research with Professor John Turtle and Prof Dennis Yue
London University: MD, FRCP (1995), Diabetes 1992
This was my doctorate work examining the relationship between diabetes and oxidative stress in human and animal models of diabetes
- European Working Party on Diabetes in Old Age : Chair
- England Older People Diabetes Network (OPDN) - Chair
Media Appearances (3)
Cure for Type-1 diabetes discovered!
The National Mirror online
"In an amazing new discovery, scientists have been able to halt Type 1 diabetes for 6 months, bringing the cure a step closer. The research showed that implanting insulin-producing cells in the body could actually reverse the condition. With this discovery, hundreds of thousands of sufferers have been given hope.”
Expert Alan Sinclair’s research is featured in this article for the National Mirror
Scientists can HALT diabetes: Scientists PROVE condition can be STOPPED in six months
Express (UK) online
"Hundreds of thousands of sufferers have been given hope after world-first research showed implanting insulin-producing cells reversed the condition.”
Expert Alan Sinclair’s research is discussed in this article by Express.
Older diabetics are suffering 'needless' amputations and blindness because they get the worst care
The Daily Mail (UK) online
Older people with diabetes are suffering needless life-changing complications, including amputations and blindness, because of discrimination in favour of younger patients, a new report has warned.
Diabetes expert Alan Sinclair is featured in this article from The Daily Mail.
Event Appearances (1)
Impact of diabetes in an ageing multicultural society
Diabetes in older people – challenges, controversies and complications London, England
Featured Articles (6)
To explore the nature of functional impairment in older people with diabetes.
RESEARCH DESIGN AND METHODS
A population-based case-control study with detailed assessment of diabetes and functional status was undertaken.
Altogether, 403 case subjects and 403 matched control subjects were studied (median age 75 years, 51% female). Subjects with diabetes had more comorbidities than control subjects (mean 2.5 vs. 1.9, P < 0.0001) and were more likely to have severe functional impairment (4 vs. 1%, Barthel score
The aim of this systematic review was to determine the benefits of nutritional support in patients with type 1 or type 2 diabetes.
RESEARCH DESIGN AND METHODS
Studies utilizing an enteral nutritional support intervention (oral supplements or tube feeding) were identified using electronic databases and bibliography searches. Comparisons of interest were nutritional support versus routine care and standard versus diabetes-specific formulas (containing high proportions of monounsaturated fatty acids, fructose, and fiber). Outcomes of interest were measures of glycemia and lipid status, medication requirements, nutritional status, quality of life, complications, and mortality. Meta-analyses were performed where possible.
A total of 23 studies (comprising 784 patients) of oral supplements (16 studies) and tube feeding (7 studies) were included in the review, and the majority compared diabetes-specific with standard formulas. Compared with standard formulas, diabetes-specific formulas significantly reduced postprandial rise in blood glucose (by 1.03 mmol/l [95% CI 0.58–1.47]; six randomized controlled trials [RCTs]), peak blood glucose concentration (by 1.59 mmol/l [86–2.32]; two RCTs), and glucose area under curve (by 7.96 mmol · l−1 · min−1 [2.25–13.66]; four RCTs, i.e., by 35%) with no significant effect on HDL, total cholesterol, or triglyceride concentrations. In addition, individual studies reported a reduced requirement for insulin (26–71% lower) and fewer complications with diabetes-specific compared with standard nutritional formulas.
This systematic review shows that short- and long-term use of diabetes-specific formulas as oral supplements and tube feeds are associated with improved glycemic control compared with standard formulas. If such nutritional support is given long term, this may have implications for reducing chronic complications of diabetes, such as cardiovascular events.
The deterioration in immune function with aging is thought to make a major contribution to the increased morbidity and mortality from infectious disease in old age. One aspect of immune senescence is the reduction in CD8 T cell repertoire as due to the accumulation of oligoclonal, memory T cells and a reduction in the naive T cell pool. CD8 T cell clonal expansions accumulate with age, but their antigenic specificity remains unknown. In this study, we show that in elderly individuals seropositivity for human CMV leads to the development of oligoclonal populations of CMV-specific CTL that can constitute up to one-quarter of the total CD8 T cell population. Furthermore, CMV-specific CTL have a highly polarized membrane phenotype that is typical of effector memory cells (CD28−, CD57+, CCR7−). TCR analyses show that CMV-specific CTL have highly restricted clonality with greater restriction in the larger expansions. Clonal analysis of the total CD8 T cell repertoire was compared between CMV-seropositive and CMV-seronegative donors. Thirty-three percent more clonal expansions were observed in CMV-seropositive donors in comparison with seronegative individuals. These data implicate CMV as a major factor in driving oligoclonal expansions in old age. Such a dramatic accumulation of virus-specific effector CTL might impair the ability to respond to heterologous infection and may underlie the negative influence of CMV seropositivity on survival in the very elderly.
Objective: To determine whether cognitive impairment is associated with changes in self-care behaviour and use of health and social services in older subjects with diabetes mellitus. Research design and methods: This was a community based, case-control study of subjects registered with general practices participating in the All Wales Research into Elderly (AWARE) Diabetes Study. The 396 patients aged 65 years or older with known diabetes mellitus were compared with 393 age- and sex-matched, non-diabetic controls. Adjusted odds ratio estimates of normal performance on Mini-Mental State Examination (MMSE) and Clock Drawing Test (numbers and hands) were determined. Information on self-care behaviours and use of services was obtained. [...]
To investigate the effects of supported discharge after an acute admission in older people with undifferentiated clinical problems.
A systematic review of randomized controlled trials.
We searched MEDLINE, CINAHL, the Cochrane Library, PsycLit and the Social Science Citation Index up to the end of 1997. This was augmented by hand-searching, follow-up of bibliographies and.direct enquiry of authors of included studies. Application of inclusion decisions, quality assessment and data abstraction were carried out independently by at least two of the reviewers. We tabulated the results of the included studies and used meta-analysis where appropriate to refine conclusions.
We finally included nine studies in the review, assessment of which revealed that bias was present, dictating the need for caution in interpreting results. Despite this, there was relative certainty that the proportion of those at home 6-12 months after admission is greater with supported discharge (odds ratio 1.4, 95% confidence interval 1.1- 2.0). This was associated with a consistent pattern of reduction in admission to long-stay care over the same period, without apparent increases in mortality. There was uncertainty about the effect of supported discharge on hospitalization. There were no rigorous research data on functional status, patient and carer satisfaction, and, in consequence, uncertainty about the overall effectiveness of supported discharge.
We believe that the results of this review provide reassurance that supporting discharge from hospital to home is of value. However, important sources of uncertainty remain, suggesting the need for further research.
Oxygen-free radicals and lipid hydroperoxides may have an aetiological role in the development of lesions in the central nervous system in patients with Alzheimer's disease and in those with vascular dementia. This study aimed to make a cross-sectional comparison of blood markers of oxidative stress in two groups of patients with these disorders and a control group.
Cross-sectional comparative study.
Established memory clinics in Cardiff organized by a University Department of Geriatric Medicine within an acute care NHS Trust.
Following a dietary assessment, postprandial venous blood samples were obtained from the following: 25 subjects with probable Alzheimer's disease (AD) (mean age 74.3; 10 F, 15 M); 17 subjects with probable vascular dementia (VD) (mean age 75.5; 5 F, 12 M); and 41 controls (mean age 73.4; 24 F, 17 M) for measurement of circulating lipid peroxides (LP), total antioxidant capacity (TAC), vitamin C (VitC), vitamin E (VitE) and beta-carotene (BC).
Plasma levels of VitC were significantly lower in subjects with vascular dementia compared with controls (VD, 6.5 (4.8, 8.2); controls, 10.0 (8.38, 11.6); VD vs controls, p=0.015), but no significant difference was seen between controls and patients with Alzheimer's disease (AD, mean 8.3 (6.2, 10.4)). VitE levels were significantly lower in subjects with AD compared with controls (31.1 (28.2, 34.0) vs 36.0 (32.8, 39.2), p=0.035). BC levels were similar in subjects with AD and controls, but significantly elevated in those with VD (AD, 0.28 (0.2, 0.34); VD, 0.40, (0.27, 0.53); controls, 0.28 (0.22, 0.34); VD vs controls, p=0.046). There were no significant differences in LP or TAC between the three groups.