In this series we take a look at some of the exciting diabetes research developments announced recently, and what the findings could mean for people living with or affected by diabetes.
Psoriasis medication might help to stop the type 1 immune attack
Immunotherapies have the potential to transform how we treat type 1 diabetes by tackling its root cause for the first time and moving us closer to preventing and curing the condition.
Right now, our researchers are developing and testing several different types of immunotherapies for type 1 diabetes. These work in different ways, but all are designed to stop the immune system from attacking insulin-making beta cells in the pancreas.
The findings of a recent study suggest that an immunotherapy medication currently used to treat the skin condition psoriasis, called Ustekinumab, might also be beneficial for type 1 diabetes by helping to shield insulin-making beta cells from the immune system attack.
Researchers at Cardiff, King’s College London, Swansea, and the University of Calgary tested Ustekinumab in adolescents aged between 12 and 18 years who were newly diagnosed with type 1 diabetes.
Forty-one participants received the drug and 21 in the control group took a placebo. After 12 months, C-peptide levels, a marker of insulin production, were found to be 49% higher in the group who received Ustekinumab than C-peptide levels in the control group. The increase in insulin production in the Ustekinumab group was linked to a decrease in the number of destructive immune cells.
Ustekinumab was found to be safe and tolerated by the participants, although it needs to be tested in larger groups of people who differ in age and stages of type 1 diabetes in further trials.
How tiny blood vessels are impacted by sleep duration in type 2 diabetes
Diabetes can cause complications on a tiny scale which can have a very big impact. These ‘microvascular’ complications, like retinopathy, which affects the eyes, result from damage to small blood vessels. This damage can harm larger blood vessels, and lead to the development of macrovascular complications, like coronary artery disease or stroke.
A growing body of evidence suggests that the risk of developing these diabetes-related complications is influenced by sleep quantity and quality. Now researchers in Denmark have showed that, in people living with type 2 diabetes, getting too little or too much sleep is linked to an increased risk of damage to small blood vessels.
The team explored whether sleep duration is linked to microvascular damage in 396 people newly diagnosed with type 2 diabetes. They classified sleep duration into three categories: short (less than 7 hours), optimal (between 7-9 hours), and long (9 hours or more), and identified those with microvascular damage by assessing specific markers in the blood and by the presence of retinopathy.
The researchers found that the proportion of people with microvascular damage was 38%, 18%, and 31% for short, optimal, and long sleep duration groups respectively. Short sleep duration was linked with a 2.6-fold increased risk of microvascular damage compared with optimal sleep duration. Similarly, long sleep duration was linked to a 2.3-fold elevated risk compared to optimal sleep duration.
The risk of microvascular damage was particularly heightened in older people who didn’t get enough sleep. Participants aged 62 years and over who slept less than seven hours had a 5.7 times increased risk of small blood vessel damage compared to people the same age in the optimal sleep duration group.
This finding suggests that older individuals with type 2 diabetes who habitually sleep less than seven hours a night may be more vulnerable to diabetes complications.
These findings will be presented at the Annual Meeting of the European Association for the Study of Diabetes (EASD) in September.
The unique pieces in the puzzle of diabetes distress
Diabetes distress is what people feel when they are overwhelmed by the relentlessness of living with diabetes. Diabetes distress can make it much harder to manage the condition which in turn can increase the risk of diabetes complications.
We need to understand what drives diabetes distress and how to alleviate it. While technology to track blood sugars in real-time (continuous glucose monitoring or CGM) can help with daily diabetes management, not much is known about if CGM adds to or reduces diabetes distress.
A research team from Germany has recently investigated if diabetes distress is most influenced by what people perceive their blood sugars to be or by actual CGM readings. They conducted an observational study over 17 days on 379 participants with type 1 diabetes or type 2 diabetes.
They combined data collected using an app with CGM data to map links between blood sugars and diabetes distress. The app gathered people’s perceptions of their blood sugars (the extent to which they felt burdened by low, high, and fluctuations in their blood sugars) and CGM-recorded blood sugar data. Participants were followed up three months later.
Overall, findings showed that how people perceived their blood sugars was more influential on diabetes distress than blood sugar data collected by CGM.
Those whose distress was mostly linked to their perception of their blood sugars also reported poorer mental health at the three-month follow up. Whereas individuals whose distress was more strongly driven by their CGM-collected data had better mental health at three months. However, the researchers found there were a lot of differences in how people responded to perceived and CGM-collected blood sugar levels.
These varying results crucially highlight the need to further understand the complex drivers of diabetes distress and that the experience of diabetes distress is unique for each person.By increasing this knowledge, personalised treatment strategies can be developed.
Clarity in a sea of mixed results: gestational diabetes & breast cancer
Gestational diabetes occurs when pregnancy hormones make the body less sensitive to insulin. This is known as insulin resistance and results in high blood sugar levels.
Insulin resistance has also been linked to breast cancer. However, whether gestational diabetes increases the risk of breast cancer is contested in the research world, with some studies suggesting that it increases the risk while others that it decreases the risk.
In one of the largest studies to date on gestational diabetes and breast cancer, researchers from Denmark looked at data over a 22-year period on over 700,000 women who gave birth in Denmark. The researchers studied the women for nearly 12 years. Findings showed that 24,140 women developed gestational diabetes in one or more pregnancies and 7,609 women were diagnosed with breast cancer.
This study concluded that women who had gestational diabetes were no more likely to develop breast cancer than those without gestational diabetes. This was the case across all cancer categories: breast cancer overall, premenopausal breast cancer, and postmenopausal breast cancer.
Despite this, Dr Christensen urged women with gestational diabetes to remain vigilant:
"(They) need to be alert to the fact that they are at higher risk of some conditions, including type 2 diabetes. And all women, regardless of whether or not they have had gestational diabetes, should be breast aware and check their breasts regularly for changes."
It’s important to note that the study population were predominantly Caucasian so now we need further research into other populations and healthcare systems.
These findings will be presented at the Annual Meeting of the European Association for the Study of Diabetes (EASD) in September.
