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A deep dive into 30 years of progress and challenges

Professor Jonathan Valabhji

Diabetes now affects over half a billion people globally, including 3.8 million people in England. Type 2 diabetes, which accounts for 90-95% of all cases, has obesity as its primary modifiable risk factor. Expanding waistlines, both nationally and globally, have driven a steady increase in type 2 diabetes rates in recent decades. To mark World Diabetes Day, Professor Jonathan Valabhji OBE, from the Department of Metabolism, Digestion and Reproduction, reflects on his 30 years of experience in the field, in clinical practice, in national leadership, and in clinical and epidemiological research.  

My background in Diabetes research and clinical practice 

I qualified as a doctor in 1990 from St Bartholomew’s Hospital Medical College, London. I undertook specialist training in diabetes, endocrinology, and general medicine in North-West London, and landed at Imperial College in 1997 to undertake my MD (Doctor of Medicine degree) as a British Heart Foundation Junior Research Fellow. In those early years, I was interested in cardiovascular disease in diabetes, which at that point was responsible for the majority of deaths in people with diabetes. My work centred on understanding the paradox in type 1 diabetes: although patients often displayed healthy cholesterol profiles, they were at elevated risk of heart attacks and strokes. I spent 3 years in a lipid laboratory, using ultracentrifugation (a technique used to separate and isolate particles based on their density) to isolate high-density lipoprotein (HDL) cholesterol particles from blood samples, to try to disentangle the paradox.  

Population-level progress in cardiovascular health  

While I like to think that some of that early research advanced the field a little, it was other epidemiological and societal factors that saw cardiovascular disease fall in people with diabetes over the next two decades. Public health initiatives, such as reduced smoking rates, and improved management of blood glucose, blood pressure, and cholesterol, have collectively driven a marked decrease in cardiovascular complications, resulting in longer lifespans for people with diabetes. However, with this success came new challenges, as other and multiple long-term conditions (MLTCs) have increasingly become leading causes of illness and death. This has complicated care for patients, healthcare professionals, and the NHS.  At the same time, obesity has driven younger onset of type 2 diabetes, contributing to accelerated development of MLTCs at younger ages. 

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Early onset Type 2 Diabetes: A growing concern

Dr Shivani Misra

While traditionally seen as a disease of older adults, type 2 diabetes is increasingly affecting younger people. This “early onset” form carries a higher risk of complications and earlier death. To mark Diabetes Awareness Week, Dr Shivani Misra from the Department of Metabolism, Digestion and Reproduction sheds light on her research which aims to tackle early onset type 2 diabetes in individuals from minority ethnic backgrounds.

When I was at medical school, I learned that type 2 diabetes was a condition that affected middle-aged or older adults often living with obesity. However, these days the demographics of who is affected by type 2 diabetes have drastically changed. More and more younger adults and children are affected with type 2 diabetes and we call this early onset type 2 diabetes, typically defined as a diagnosis before the age of 40 years.

What we do know from large analyses across the world, is that when you’re diagnosed with type 2 diabetes at earlier age, your diabetes can progress through to complications very rapidly and also reduce life expectancy. Of even greater concern is the impact on women living with early onset of type 2 diabetes, in whom pregnancy can be complicated because of  type 2 diabetes and there’s a higher risk of foetal death, sadly.

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The Future is Fungal

illustration of fungi

Jenny Shelton takes us through the incredible potential of fungi and how this diverse, yet often overlooked, species may hold many of the answers to global challenges, from climate change to food insecurity. 

Fungi play important roles in nature, food production, medicine, industry and bioremediation yet we have only discovered ~150,000 out of a potential 6.3 million fungal species. Just recently, a PhD student found undiscovered fungal species in seeds stored at the Millennium Seed Bank and estimates the whole collection might contain up to 1 million new species! You might be surprised to learn that fungi are more closely related to animals, and therefore humans, than they are to plants, and that the combined biomass of all fungi on Earth is 200 times greater than the entire human race.

The responses I often get when I tell someone I’m a mycologist is “Eurgh, I hate mushrooms!” or “Can you cure my athlete’s foot infection?”. It’s no surprise that this is their reaction given how little fungi feature in the U.K. school curriculum, or even in most biology and medical degrees, but it is such a shame given how magnificently diverse the Kingdom of Fungi is. (These responses also, unknowingly, capture the yin and yang of fungi: while this article is about the good that they can do it is important to acknowledge that fungal infections cause misery to millions of people around the world every year.)

Keeping in mind the challenges facing us – climate change, global food insecurity and infectious disease pandemics –I hope you will agree with me that the solutions to many of our problems could be fungal! (more…)

Survival of the fitness: from Ancient Greece to modern day preventive medicine

With London’s biggest running event of the year upon us, sport-expert Tim Grove gives a low down on the benefits of running for a healthy heart. 

Is physical activity good for us?

London Marathon – the biggest sporting spectacle of the year – is fast approaching. This Sunday will see over 40,000 runners take part in the gruelling 26.2-mile course starting at Blackheath and finishing in front of Buckingham Palace. The event is highly televised with elite runners, celebrities, politicians and fundraisers all taking part together. The London Marathon has gained popularity since its inception in 1981 and has raised over £450 million for charity, making it the world’s largest annual fundraising event. With its high media profile, the London Marathon certainly sparks the enthusiasm of the general public with many taking to streets in the bid to train for next year’s event or for shorter distance races. (more…)

Death of a cell: the vital process of tidying up cell debris to prevent blood clots

In this post, Dr Anusha Seneviratne breaks down the conundrum of cell death and how this process protects our bodies from blood clots.

Your cells die every day. Don’t worry, your body is protecting itself. In a process known as apoptosis or programmed cell death, cells that are no longer needed commit suicide. Some cells are only required for a short time, they may be infected by a virus or develop harmful cancerous mutations. Cell death is also an essential part of development from an embryo. For example, mouse paws begin as spade-like structures and only form the individual digits as the cells in between die. During apoptosis the cells fragment into smaller apoptotic bodies, and their cell surface is flipped open to display lipid molecules called phosphatidylserines, which act as an ‘eat me’ signal to recruit cells called macrophages to engulf them, before their contents spill out and damage the surrounding tissue. This is a process known as efferocytosis. (more…)

Weighing up dodgy diets

Weighing up dodgy diets

From gluten-free to detox diets, Dr Anusha Seneviratne dissects the scientific evidence (or lack of) behind eccentric diets. 

Magazines and newspapers are full of so-called ‘tips’ or ‘advice’ for the image conscious, detailing extreme diets followed by the rich and famous to achieve dramatic weight loss, or new diets apparently supported by the latest scientific research. One example is the gluten-free diet, made fashionable particularly in the sporting world by former world number one tennis player Novak Djokovic (1). Having had a reputation for being physically weaker than his rivals, Djokovic was eventually diagnosed with coeliac disease and the resulting gluten intolerance. Eliminating gluten from his diet transformed his career. (more…)