David Robert Hadden

Abstract

Physician who was among the first to demonstrate the role of diet in diabetes. Born in Portadown, UK, on May 24, 1936, he died in Belfast, UK, on Feb 26, 2014, aged 77 years. The UK Prospective Diabetes Study (UKPDS) was a key step in the management of this disease and, like many physicians of his time, David Hadden was pleased to have been part of it. Unlike most of his peers, however, Hadden could make a further claim: that he was a prime mover in setting up a smaller but earlier study that paved the way for UKPDS. The Belfast Diet Study was an observational enquiry into type 2 diabetes undertaken in the early 1970s: a time when there was less interest in this than in type 1 diabetes. The study's findings showed the importance of a strictly controlled diet in type 2 diabetes. “It showed that the mortality rate could be reduced almost to that of a healthy population”, says Professor Brew Atkinson, a retired head of the Regional Centre for Endocrinology and Diabetes at the Royal Victoria Hospital, Belfast, where Hadden also worked. “The Belfast Diet Study was entirely organised and run as a constituent part of the NHS”, Hadden himself recalled in an unpublished memoir. “All of the clinical dietetic and biochemical aspects were undertaken within the Royal Victoria Hospital by the NHS staff…It represented very good value for money.” Born into a medical family, Hadden trained at the Queen's University Belfast, qualifying in 1959. He worked for a year in the Metabolic Unit of the Royal Victoria Hospital before being offered a fellowship to study the still novel technique of radioimmunoassay for measuring growth hormone. This took him to the USA as a Fulbright Fellow at the Johns Hopkins Hospital in Baltimore. The prevailing view was that growth hormone, like other polypeptide hormones found in plasma, existed in a free state, unbound to any other protein. Hadden's experiments, published in Nature, suggested that normal human serum did in fact contain a growth hormone binding protein. His conclusion was disputed—and remained so for more than 30 years until experimental work by other researchers proved him right. Hadden spent 1965–67 on the scientific staff of the Medical Research Council's Infantile Malnutrition Unit at Addenbrooke's Hospital, Cambridge, and Kampala in Uganda. By his own account the work had a somewhat abrupt initiation when, in a corridor of the Royal Victoria Hospital, he happened to encounter the then Professor of Medicine, Graham Bull. “Hadden”, he said, “What are you doing now, would you like to go to Africa, and what do you think is the cause of hypoglycaemia in babies with kwashiorkor?” Hadden accepted the challenge and, while investigating, began to think about the links more generally between diabetes and diet. So it was that his experience of malnutrition in Africa helped to stimulate his subsequent interest in overeating and diabetes as seen in the more affluent regions of the world. Returning to Northern Ireland he rejoined the Royal Victoria Hospital, becoming a consultant in 1967 and embarking on his groundbreaking study of diet and diabetes. He also had a long-standing interest in the management of diabetes in pregnancy. Boyd Metzger, now Professor Emeritus in Medicine and Endocrinology at Chicago's Northwestern University, first met Hadden more than 40 years ago. Both men had key roles in planning and running the Hyperglycaemia and Adverse Pregnancy Outcome (HAPO) study. “This involved glucose tolerance testing of 25 000 mothers”, says Metzger. “The findings were important because there'd been a lot of debate about whether testing for gestational diabetes was really identifying mothers and babies at risk.” The work contributed much to an understanding of the condition and what should be done about it. In 2001 Hadden became head of the Regional Endocrinology and Diabetes Centre, a post he held until his retirement. Although he gave up most of his clinical work on leaving the National Health Service at age 65 years, he continued to play a part in work on the analysis of HAPO data, and on samples collected during the course of the study, says Atkinson. “Long after he retired he was still involved in setting guidelines for the management of diabetes in pregnancy.” Hadden always showed great commitment to learning more and improving patient care, adds Metzger. “Always the gentleman, very open to discussion, and a pleasure to work with.” Hadden leaves a wife, Diana, an accident and emergency physician; a son, Robert, a consultant neurologist; and two daughters, Katharine and Emily.