The clinical diabetes service consists of a large multidisciplinary team that works across Hammersmith, Charing Cross and Queen Charlotte's Hospitals with dedicated diabetes specialist nurses, dieticians, podiatrists and a diabetic nurse consultant as well as designated medical and managerial staff. As these hospitals serve a very multiethnic population approximately 15-20% of all hospital in-patients have diabetes.

There are weekly clinical interdepartmental meetings and a monthly academic meeting to which an outside lecturer is invited.

The diabetic service has a national and international reputation for its clinical and scientific work on diabetic pregnancies, diabetic retinopathy, diabetic nephropathy and neuropathy. In addition the Department has extremely close research links with the Department of Nutrition.

There are strong links with primary care and agreed protocols for referral and discharge to the hospital diabetic out patients' clinics. The diabetic out patient clinic is fully computerised holding information on all out patient visits and from which all out-patient letters are generated.

Retinopathy
A weekly diabetic retinopathy clinic is run by Dr. Anne Dornhorst, Mr. Ed Schulenberg and Steve Aldington at the Hammersmith site and provides an excellent training opportunity for SpRs attached to the department.

Nephropathy
The North Thames Transplant and Renal Unit is part of the Hammersmith Hospital and has the largest number of patients with diabetes on renal replacement therapy in Europe. Within this centre over 120 renal and pancreatic transplants are performed annually. Dr. Andrew Frankel, Consultant Nephrologist, has a particular interest in diabetic renal disease and runs joint diabetic renal clinics at both sites. There is active research collaboration between the diabetic and renal department on the pathogenesis and progression of diabetic renal disease.

Diabetic Foot
A weekly multidisciplinary team meeting is held at Charing Cross at which all patients with a diabetic foot problem can be presented to the team which consists of a diabetologist, a consultant vascular surgeon, a senior podiatrist and a member of the infectious diseases department. On both sites the podiatrists run weekly foot clinics concurrently with the routine diabetic clinic.

Joint Diabetic and Obstetric Antenatal Clinic
Mr Andrew McCarthy and Dr. Anne Dornhorst hold a weekly joint antenatal clinic at Queen Charlottes hospital. There are approximately 50 women a year with pre-gestational diabetes delivering annually and further 50 women with insulin treated gestational diabetes. These clinic acts as a tertiary referral centre for women with diabetic pregnancies and who also have other complex obstetric medical problems. All women have routine access to state of the art fetal ultrasound, monitoring and cardiac scanning in addition they have access to the use of Insulin pumps and continuous glucose sensors if required.

Neuropathy
Professor Anand, head of the Peripheral Neuropathy Unit, at Hammersmith Hospital, has an international reputation in the diagnosis and management of painful diabetic neuropathies.