To mark World Diabetes Day, Susan Wong, Professor of Diabetes and Metabolism, Division of Infection and Immunity, Cardiff University School of Medicine talked to us about the Exhibition 100 Years of Insulin What Diabetes Means to Us. She explained why she's interested in the intersection between science, art and the wider community and discussed her cutting-edge research.
What was the motivation/interest in organising this exhibition?
It is 100 years since the discovery of insulin that led to its development as a life-saving treatment for people who live with type 1 diabetes (previously known as insulin-dependent diabetes).
We wanted to highlight and celebrate the advances in our understanding of the essential nature of insulin and how the lived experience of people who have lived with diabetes, has changed over many years.
We wanted to present the experience of people living with diabetes alongside the research into type 1 diabetes in Cardiff, to expand public knowledge of this condition and the difference between the different types of diabetes. The exhibition is both in gallery and online, in order to reach as many people as possible.
We also wanted to give a voice to people with a connection to any, and all types of diabetes, whether as a someone who lives with diabetes, family members, friends, or healthcare professionals.
In addition, the exhibition showcases artwork completed by the artist Bridget O’Brien during her residency with our research group.
What do you think is the value in this type of participation by patients?
Diabetes is often misunderstood, and people do not understand that this term represents different conditions, with different treatments and different implications for individuals. Diabetes affects 4 million people in the UK, of whom 10% live with type 1 diabetes – dependent on insulin.
What unifies all people who live with diabetes is the anxiety of living with these conditions, but also the tremendous resilience that people often show. Although we are celebrating these 100 years in which there have been considerable advances in ways that help people live with diabetes, it is very important to have the insight and experience of people who live with diabetes to see many viewpoints, and give a much larger picture.
Can you describe “What Diabetes Means to Me” is?
Within our exhibition, we have as one of the 6 displays, a collective piece which we have called “What Diabetes Means to Me”.
The aim was that this would form part of the voice of people with a connection to diabetes to mark the centenary of the discovery of insulin. At the first workshop, a parent of a child living with diabetes said that they had never been asked how they felt about diabetes. The project therefore aimed to capture the direct experience of people living with diabetes, but also the important messages from brothers, sisters, fathers, mothers, wives, husbands, health care professionals and indeed anyone with a connection. These 108 contributions represent this voice – from ages 3 to 84, and in breadth from the USA, through the UK and east as far as India and China.
Could you please explain your research work?
Our research focuses on why people may develop type 1 diabetes, the form of diabetes where the immune system attacks the insulin producing cells, leading to the need for insulin replacement. In our work we aim to understand why and how this attack occurs, as well as work on strategies that could in the future protect these cells from the immune attack. We have focused on the white blood cells – T cells which attack and damage insulin producing cells, and B cells which produce antibodies, a marker of immune activity. Our work also supports ongoing clinical trials of therapy that works on the immune system to reduce this attack.
Why did you get interested in endocrinology and diabetes as an area of work?
As early as the time when I was a medical student, I was struck by the importance of ‘balance’ within the human body, and how well everything is regulated automatically and works in an amazing network of chemical and neurological connections. We take this for granted. In people living with diabetes, keeping this internal chemical ‘balance’ is hard work, and there are consequences for all aspects of life without this balance. I had the good fortune to have Dr Peter Watkins as a teacher, and mentor, particularly in the early part of my career, and his interest, enthusiasm and care for people living with diabetes had a large influence.
How does your research area help people living with diabetes?
Our research work is in basic science to understand why people develop diabetes. However, although this may not have an immediate effect on people living with diabetes, we hope that our insights into the immune damage by white blood cells, will inform the development of effective immunotherapy (treatments directed against the damaging cells). This would have benefit, not only for people who live with type 1 diabetes, for whom other research is being carried out to replace cells that produce insulin, but also protect people at risk of future development of type 1 diabetes.
How do you see diabetes in research going?
For type 1 diabetes, further research will help to refine ways to make it easier to take insulin, such as with more sophisticated insulins, pen devices that are easy to use, insulin pumps and sensors that make up the function of an artificial pancreas. However, research will also aim towards reducing the need for insulin altogether – research into ways of replacing insulin – such as with stem cells, but in parallel with work on the immune attack to protect any replacement cells that produce insulin from the same process that caused the original diabetes from occurring again. This research on the immune system will hopefully ultimately also be applied to prevent attack on the insulin-producing cells in people at risk of developing type 1 diabetes.
How has Covid impacted your research?
Covid has, without doubt, had an impact on some of our research. In our work, we are particularly grateful to volunteers who live with type 1 diabetes, as well as those who don’t, as we study different types of immune cells and donations of blood samples for study of the immune system was initially held up. We also cannot study immune cells if people are, or have recently been ill with an infection, or have recently had a vaccination. However, we hope to catch up with this soon.
What area would you focus on in terms of public education and education in diabetes and why?
More work in schools around type 2 diabetes. A greater awareness of understanding the different types of diabetes. Removal of any ‘blame’ attached to living with diabetes – of whatever type.
The understanding that different types of diabetes are often hidden, and that support is needed for people who live with any type of diabetes for the extra work involved in everyday life to do things to keep the internal balance that people who do not have diabetes take for granted.
