The latest Type 2 diabetes news at the ADA – by Emily Burns
Last month, along with 16,000 diabetes researchers and healthcare professionals, I got the chance to attend the American Diabetes Association meeting in Orlando. Here’s what was on the agenda for Type 2 research.
DiRECT gets air time
With the first-year results of the DiRECT trial announced in December last year, the second-year results are hotly anticipated. In the meantime, Profs Roy Taylor and Mike Lean are continuing to analyse and learn from what they’ve discovered so far.
Prof Taylor made the front page of the ADA daily newspaper with his session about the underlying biology of remission: what happens inside the body that makes blood glucose levels return to normal?
To find out, Prof Taylor’s team in Newcastle have been using MRI scanners to look at levels of fat in the liver and pancreas, alongside metabolism tests.
Just over half of those who took part in the DiRECT programme were not in remission after 12 months, and Prof Taylor wants to know why. He compared 40 ‘responders’ (people in remission) to 18 ‘non-responders’ (people not in remission).
The non-responders had lived with Type 2 for slightly longer, but not much. And it wasn’t to do with the amount of weight lost – both groups had normal liver fat levels and there wasn’t a significant difference between pancreas fat levels. So what was it?
Prof Taylor turned to their insulin-producing beta cells. The responders’ beta cells had started releasing insulin properly again, and it looked like this was improving over time. This wasn’t the case for the non-responders – their beta cells weren’t recovering.
So it looks like beta cell recovery plays a major role, but at this point we don’t know who has beta cells that are more likely to recover…
Prof Mike Lean has also been digging into the data, to look for factors which might increase a person’s chance of going into remission. He found that those who lose more weight during the programme, are older, and have a lower HbA1c before they start seem to have a better chance of going into remission.
Closing the loop in hospitals
So far, lots of research to develop the artificial pancreas has been aimed at people with Type 1 diabetes. And this is incredibly important, but we funded Professor Roman Hovorka to widen the horizons to people with Type 2 diabetes.
Prof Hovorka’s collaborator, Dr Lia Bally, presented the results of their international Diabetes UK supported study. They found that the device improved blood glucose control, without increasing the risk of hypos, for people with Type 2 diabetes during hospital stays.
Prof Hovorka said: “The results surpassed our expectations. We didn’t realise the difference the artificial pancreas can make for people on insulin staying in hospital. Further research is needed to understand the wider benefits of improved blood glucose control during hospital stays.”
Using our brains
Many people with Type 2 diabetes aren’t overweight or obese. But the fact remains that obesity significantly increases the risk of Type 2 – as well as other conditions like cardiovascular disease and cancer.
Prof Lora Heisler took us on a tour through several decades of research trying to use the brain to reduce obesity. She argued that there are three ways to reduce body fat levels: reduce the amount of fat stored, increase the amount of energy used, or reduce the amount of energy taken in (i.e. food).
How can we take advantage of chemical pathways inside the brain to control appetite and reduce food intake?
Prof Heisler’s research focuses on a specific brain chemical called serotonin, or 5-HT. In the seventies, research found that higher 5-HT levels were linked to lower food intake in mammals. This led to Redux, a drug that increases 5-HT levels, being prescribed for weight loss. But this was withdrawn in ’97 after being linked with side effects in the heart. So it works, but how do we target the benefits to where they’re needed: the brain?
A drug, called Lorcaserin, works in this way, but we need more information on its long-term effects and safety. Prof Heisler explained that finding a way to combine a drug that works in the brain with existing drugs that help to manage blood glucose levels could have exciting implications.
The thing about insulin is that the majority of it should work on the liver, with fat or muscle exposed to much smaller amounts. But insulin injections make this very difficult to achieve, leading to higher levels of insulin around the body than we’d really want.
Oral insulin (if it works) can increase the amount of insulin that reaches the liver, and reduce exposure to fat or muscle. This can reduce the risk of hypos and, hopefully, prevent weight gain.
Professor Harold Lebovitz presented Biocon’s latest study in 18 people, using an oral insulin called tregopil. The results were positive, with the oral insulin able to control glucose levels just as well as injected insulin. But the study was small, so let’s see what happens next.