Marriage and Type 2, getting Type 1 in later life and other EASD 2017 highlights – by Emily Burns
The European Association for the Study of Diabetes (EASD) annual conference just drew to a close, and I’m bringing you the latest. Here’s the first EASD blog, summing up the stories you might have seen in the newspapers and what they actually mean.
In sickness and in health
Researchers in Denmark have suggested that your partner’s health could be affecting your own.
They didn’t find a link between Type 2 and being married to someone with Type 2, but it looked like obesity played a role. Interestingly, it only affected the men: having an obese husband didn’t increase the risk of Type 2 diabetes for women, but having an obese wife increased the risk of Type 2 for men.
So what does this mean? In theory, it means that a man’s risk of Type 2 diabetes could be higher if they’re married to an obese woman. Enter pinch of salt.
While it’s maybe not surprising that our partner’s health and lifestyle could impact on our own, and that the environment we live in plays a big role, the risk of Type 2 diabetes is complex.
The data used here refers to the nineties, with the average age of the people involved around 60 years. The research team have suggested that the gender difference could potentially be related to family roles: at this point in time in the UK, could the women involved have been more likely to control what the family ate?
Times have changed – would the risk still stand today? And what if we zoomed out from ‘husband and wife’ to the many different relationships people hold?
We don’t have those answers yet, although the research team are hoping to build a database where they can begin to examine the impact of different family relationships on the risk of Type 2 diabetes.
Dr Robert Ryder was on hand to give an update on the NHS service in Birmingham testing the effectiveness of a type of weight loss surgery called the Endobarrier in treating people with Type 2 diabetes.
The service is currently available for people having difficulties managing their Type 2 diabetes and obesity, and the team has implanted 50 Endobarriers so far.
They’ve followed 31 participants after the device has been removed, and it looks like it has had a positive impact on weight, blood glucose control and liver fat. While the results are promising, we need to see the results of larger, longer studies to understand its true benefits. Dr Ryder suggested that other services across the UK could be established, linking together to collect data and monitor the benefits.
Putting Type 2 into remission
Remission of Type 2 diabetes was high on the agenda. Professor Roy Taylor summed up what we know so far around low calorie diet research and Professor Mike Lean published a review in the BMJ calling for more recognition of remission in the healthcare community.
Professor Taylor took us on a journey from the Diabetes UK-funded Counterpoint study, testing the effects of the low calorie diet in 11 people with Type 2, to the Counterbalance study in a further 46 people.
While evidence is building to suggest that Type 2 diabetes can be put into remission, there are still questions we need to answer. Who might be able to achieve remission, can it be achieved for the long-term, and what kind of treatment needs to be delivered within the NHS? The Diabetes UK-funded DiRECT trial is helping to answer these questions, and we’re looking forward to seeing the first set of results later this year.
Artificial sweeteners and the risk of Type 2
Some studies have suggested that artificial sweeteners might be linked to a higher risk, so an Australian team did some investigating. They tested the effects of two artificial sweeteners, sucralose and acesulfame-K, in 27 people. The people who received the sweeteners for two weeks appeared to have less control over their blood glucose levels than those who didn’t receive any sweeteners.
Conclusions? This definitely warrants further research, especially so we can provide evidence-based advice on diet. But hopefully future research will capture a more ‘real-life’ setting. In this study, the sweeteners were placed directly into the gut, rather than being taken orally as would happen in everyday life. On top of this, the amount of sweetener provided was equivalent to 1.5 litres of soft drink every day!
So let’s watch this space, and in the meantime: soda water and lime anyone?
Developing Type 1 in later life
Researchers in Exeter are using UK BioBank data to understand why some people develop Type 1 diabetes later in life. Their latest research suggests that there could be a specific genetic reason.
Type 1 diabetes typically affects children and young adults, although we now know that many adults also develop the condition (sometimes known as ‘late onset’ Type 1). One of the challenges is that people who develop diabetes later in life can often be misdiagnosed with the wrong type.
Without going into too much detail, there are a couple of changes (or ‘variations’) in a particular group of genes (called ‘DR3’ and ‘DR4’), that have the strongest link with Type 1 diabetes risk.
The team looked at 120,000 people in the UK BioBank database. They found that people with these ‘high risk’ genetic changes make up just 6 per cent of the population, but they account for 60 per cent of people with Type 1 diabetes – so they must be pretty important.
But it gets interesting when you start to drill down into the different ‘high risk’ groups. The team found that the age a person is diagnosed with Type 1, depended on the particular combination of ‘high risk’ genetic changes they had. With one combination, the average age of diagnosis was 17 years, while for another, it was 38 years. This suggests that people who develop Type 1 diabetes later in life actually have a different form of the condition (at least on a genetic level).
What does this mean? Firstly, it could help researcher to develop risk calculators. The Exeter research group has already made headway in this field, to help reduce the number of people with diabetes who are misdiagnosed with the wrong type. Having genetic information to add to those calculators could really help.
Secondly, it adds more weight to the notion that Type 1 diabetes is not simply one condition – there could be subtypes, with nuances in each. This is particularly important when considering the development of new treatments (different people could react in different ways) or prevention strategies.