Highlights from DUKPC – what’s new with Type 2? – by Kotryna Temcinaite

You might have seen my blog about the highlights for Type 1 diabetes research presented at the Diabetes UK Professional Conference. But there’s a lot going on with Type 2 as well.

There can be lots of different treatment options for people with Type 2 diabetes, so the idea of personalising medicine to give the most suitable medicines to those who would benefit the most is really important. This was echoed in many talks throughout the conference: how can we offer the option that’s most likely to work?

We’re not quite there yet, but good progress has been made. So what’s new in the field of Type 2 diabetes?

What should we do about exercise and diet?

Well, exercise isn’t new, but it’s extremely important. And there’s mounting scientific evidence to back it up.

Dr Rob Andrews gave an overview of the importance of exercise in Type 2 diabetes, and the best thing about it: the more you do, the greater the benefits. But it’s not always easy to stick to your exercise plans and we’re only starting to look at why. It looks like taster sessions, family activities and role models might all help to inspire people and keep them going.

Similar thoughts came from Dr Nita Forouhi, presenting the prestigious Rank Nutrition Lecture about diets: they all work for the short term, but which ones can people really stick to? And diet is also hard to measure in scientific studies. What should researchers focus on: nutrients, such as carbohydrates and proteins, or food items? Dr Forouhi had a strong message that we should focus on personalised approaches to diets and use new technology to determine what works for our bodies.

Our little friends in the gut

It’s not only important what you eat, but also who eats it with you. And I mean the bacteria living in your gut, rather than friends and family.

Dr Hilde Herrema from the University of Amsterdam is studying gut bacteria and how they could help us treat Type 2 diabetes. She presented interesting research that suggests people with less bacteria living in their gut tend to gain more weight over time and might be at a higher risk of developing Type 2 diabetes.

An almost unbelievable study in mice showed that healthy mice gained weight regardless of what they ate when bacteria from obese mice were placed in their gut. It’s still very puzzling as to what the biology behind this might be, but the exciting news is that the reverse effect might also work.

Dr Herrema talked about studies where bacteria taken from the faeces of healthy people were put into gut of obese people who couldn’t control their blood glucose levels well, and they saw an improvement. But some people responded better to the therapy than others. So the question of how we can personalise this treatment and select people who are most likely to benefit remains.

Let’s make it personal

The first drug prescribed for Type 2 diabetes was metformin, and there are clear guidelines for its use. But what if metformin doesn’t help? There are several options available and it can be hard to figure out which one is the most suitable.

A united team from Exeter, Dundee, Oxford and Glasgow wanted to approach this issue by designing what they call a ‘risk calculator’. In reality it’s an app that can assess which type of drug – sulfonylureas or thiazolidinedione – would keep blood glucose levels under control better. Doctors would only need to input the age, sex, body mass index, and blood glucose readings to get an estimate, allowing them to make a better decision.

Telling Type 1 and Type 2 apart

As I already mentioned in my blog on DUKPC highlights for Type 1, it can sometimes be difficult to give a definite diagnosis of Type 1 or Type 2 diabetes. The symptoms of both are very similar. Slim people can also have Type 2 diabetes, and people can still be diagnosed with Type 1 when they’re older.

Anita Grubb from the University of Exeter Medical School presented another risk calculator, which is able to calculate if someone is more likely to have Type 1 or Type 2. It uses simple measures, such as age, sex, blood glucose measures and body mass index. Being diagnosed correctly and offered appropriate treatment is the first and most important step towards personalised treatment.

An update from DiRECT

Prof Roy Taylor giving an update on DiRECT at DUKPC

You may know that Diabetes UK is currently funding a large clinical trial to see if a low-calorie diet – restricted to only 800 calories a day – can put Type 2 diabetes into remission for the long-term. The trial is due to finish in 2018, but Professor Roy Taylor and Dr Sviatlana Zhyzhneuskaya gave us a glimpse of its progress so far.

Although the main outcome of the trial is to see if a low-calorie diet can put Type 2 diabetes into remission long term, it’s also giving valuable insight into what happens in the body when Type 2 diabetes develops. Scientists found that people with Type 2 diabetes had three times more liver fat. The more fat there was in the liver, the worse their blood glucose levels tended to be. The connection between liver fat and Type 2 diabetes is starting to emerge, so this is really interesting work.

We’re starting to get a full picture of the different parts of life that have an influence on Type 2 diabetes, and how some treatments could work better in certain people. But the work isn’t finished; there’s a lot more we need to find out before we can begin to offer more personalised approaches for Type 2 diabetes.

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