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IDEAS Magazine

An Interview with Professor Richard Holt

Katie Umbers interviews an expert in diabetes and endocrinology


Professor Holt trained at the University of
Cambridge and the London Hospital
Medical College. He undertook his post-
graduate training in diabetes and
endocrinology and his PhD was on the
subject of growth hormone and the causes
of growth failure in children with liver
disease. Richard is now a Professor of
Diabetes and Endocrinology and is also an
honorary consultant physician at the
University Hospital Southampton NHS
Foundation Trust.

Why did you choose to study Medicine?
Originally, I applied to Cambridge to read
Natural Sciences but during my gap year I
went on a scientific expedition to the
Tristan da Cunha Islands, where I got
talking to the expedition doctor who made
me realise that I wanted to study medicine.

What drew you to do post-graduate
work in diabetes and endocrinology?
During my time as a medical student I
enjoyed doing an elective in human
nutrition which inspired my choice to
specialise in Metabolism and
Endocrinology. Despite being employed
by Southampton University I do still
practise as a doctor and my clinical
responsibilities include the pregnancy and
diabetes clinic, the young adult diabetes
clinic as well as the cystic fibrosis and
diabetes service.





Your PhD was on the subject of growth
hormone and the causes of growth
failure in children with liver disease.
Can you tell us more?
I decided to do a three and a half year
PhD, which was based around
endocrinology, on growth hormone (GH)
and the causes of growth failure in
children with liver disease. Growth
hormone is released by the pituitary gland
and into the blood stream and then
stimulates the liver to produce a second
hormone, IGF-I (insulin-like growth
factor-I). IGF-I has growth-promoting
effects on almost every cell in the body.
My PhD was specifically related to why
children, who have liver disease, dont
grow properly. I studied in Kings College
London and my research had both
laboratory and clinical components.

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IDEAS Magazine

What is the effect of the Growth
Hormone in sport and how can you test
for it?
Growth hormone increases muscle strength
and mass and burns fat so there is more
muscle in proportion to the persons
weight, which then increases the power to
weight ratio. One can see why an athlete
would find these effects desirable! The
sports with the highest usage of the growth
hormone include sprinting, cycling,
swimming and rugby. I worked with the
World Anti-Doping Agency to help
develop a test for GH abuse in sport which
was introduced in the 2012 London
Olympic Games and led to the
disqualification of two Russian
powerlifters at the Paralympic Games. To
test for the hormone we measure the
amount of two indicator proteins, IGF-I
and PIIINP in a blood sample. It is vital
that these tests are fool proof as you are
removing the athletes livelihood by
accusing them of drug abuse which is why
the test took over ten years to perfect.

Youve also researched into the links
between mental illness and diabetes.
How are they related?
My clinical work led to my interest in
mental health and diabetes and I
researched into it further with Robert
Peveler, who was also a Professor at
Southampton University. We examined
some of the reasons why diabetes is 2 to 3
times more common in those with severe
mental illnesses, such as bipolar and
schizophrenia, and why their physical
health care is worse than the general
population. As well as researching and
writing papers on this subject, I have
lectured on this field both internationally
and in the UK. I also studied the
relationship between depression and
diabetes, which is more complex because
people with depression are more likely to
develop diabetes while someone who has
diabetes is more likely to become
depressed.

Can diabetes affect pregnancy and if so,
can the baby inherit the disease?
Diabetes can affect pregnancy in a number
of ways as women with diabetes find it
harder to conceive, are more likely to
miscarry and have a higher chance of
having a baby with birth defects. In the
long term babies born to mothers with
diabetes have a higher risk of developing
the disease themselves. Part of this is
genetics; for example, if both parents have
type 1 diabetes, there is a one in three
chance of the child developing diabetes;
the risk is nearly 75% if both parents have
type 2 diabetes.

Diabetes has been described as a
tsunami about to hit the NHS. Do you
think that future medics are going to be
faced with diabetic patients more
frequently than at the moment?
In any sphere of medicine diabetes is
becoming more common and the
prevalence of diabetes has doubled every
twenty years since World War Two.
Currently over 3 million people have
diabetes in the UK and by 2030 there
could be around five million people with
diabetes. The increase is mainly due to our
ageing population and rising obesity.
Obesity increases the likelihood of
diabetes and is one of the biggest problems
the NHS is facing at the moment.

Thank you for your time Professor Holt.