Friday, November 18, 2011

Diabetes...from the perspective of a researcher

First, I should perhaps explain how we met. Way back in 1989 I started my Ph.D. in the Gatty Marine Lab at St. Andrews University. In addition to the Gatty, there were Bute people, Harold Mitchell people, and various huts and cabins attached to the different buildings and outposts. Ian was in an annex, down a side-street, working with a bunch of drunks experts looking at such delights as the effect of nitric oxide on mammalian physiology (I'm going from memory and the memory is going :). So, you could say we met professionally but the truth is biologists always meet in the pub. So, we met over copious amounts of alcohol, some incredibly crazy friends including my hubby, who was the barman at our local. 

Since those halcyon days, Ian has moved on to become 'Professor' Ian Megson. Head of Department of Diabetes and Cardiovascular Science, UHI (University of the Highlands & islands, Scotland). So when I decided to do a few posts on diabetes I figured who else should I ask about the disease. Here's what Professor Megson had to say.
Diabetes is a common, debilitating and growing disease that has a major impact on patients’ wellbeing and life expectancy. A key feature of diabetes is unusually high levels of sugar in the blood which, if left untreated, has a highly damaging impact on blood vessel and nerve function, leading to increased risk of heart attacks, strokes, kidney disease, foot ulcers, loss of sensation and pain. Currently ~6.5% of the world’s population (~285 million people) has diabetes, but this number is expected to grow dramatically, with the incidence in some countries expected to reach ~30% by 2025. Healthcare costs are difficult to assess worldwide because of the enormous differences between access to healthcare in different regions; in the US alone, the overall cost of the disease was estimated at ~$175 bn in 2007.

There are two major forms of diabetes, type-1 and type-2. Although the two types share the key feature of high blood glucose, and sufferers are at risk of the same consequences, the underlying cause of the two forms could hardly be more different. Type-1 diabetes is an autoimmune disease whereby the body’s own defence mechanism destroys the cells in the pancreas that produce the hormone (insulin) that usually keeps blood sugar at normal levels. The disease is rapid in onset and often happens in childhood. The destruction of these vital cells is irreversible and the only treatment is daily injections of insulin to compensate for the inability of the body to produce its own. Whilst the incidence of type-1 diabetes is relatively low (~0.5% of the population), its early onset means that sufferers have to live with the disease for the vast majority of their life, with massive implications in terms of their wellbeing and the associated healthcare costs. We still know little about what causes this disease: a range of genetic and environmental factors have been implicated, but the low inheritance rate of the disease from parent to child and the documented cases of only one of a pair of identical twins being affected, suggests that genes alone cannot account for the disease incidence.

In the early stages of type-2 diabetes, insulin production is not affected; instead, the hormone simply fails to have the expected effect on the downstream mechanisms that usually cause uptake of sugar from the blood. Type-2 diabetes is much more common than type-1 and usually strikes later in life. Unlike type-1 diabetes, the incidence of type-2 diabetes is increasing at an alarming rate, primarily on account of the well-documented link with obesity. Whilst there is a clear genetic component to type-2 diabetes, it is the link to obesity that has led to its recognition as a “lifestyle disease” and certainly weight loss is often one of the primary targets with respect to treatment. Disease progression is much slower compared to type-1 diabetes, with an array of drug therapies available. Loss of insulin production is a feature of the most advanced cases, leading to a requirement for daily insulin injections.

There is no cure for type-1 diabetes; the best hopes in the future are the so-called “artificial pancreas”, which monitors blood glucose levels and delivers the necessary insulin dose via an insulin pump, and regeneration of fully functional insulin-producing cells using stem cell technology. In the UK, it is estimated that investment into diabetes research is only ~0.5% of the cost of diabetes healthcare. (Prof. Ian Megson)

Did you see those figures? Treatment estimated around $175 billion back in 2007, rapidly expanding epidemic (30% of population by 2025? That's almost 1 in 3 people, and given type-2 is more common in older people probably 1/2 of the older adult population). Research input in UK ~0.5% of the cost of treatment. Does this seem crazy to anyone but me? 
Thanks, Ian, for your brilliant summary :)  I will hide the dodgy photos :)
This is why I'm donating a measly 15% of my royalties from EDGE OF SURVIVAL out Monday :) to diabetes research. I don't have diabetes. So far, my family does not have diabetes. But, it's such a terrible condition to have to deal with AND it's an economic disaster (yeah, another one). I'm hoping tomorrow holds a cure for both types of the disease.

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