Tag: Diabetes

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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Using co-production to improve the way we talk about diabetes

Our medical students are using principles of co-production to improve their understanding of living with diabetes – those with a personal experience of diabetes are encouraged to take part. 

The practice and expectations of modern medicine have changed enormously over the past 20 years. The internet, social media and smartphones have transformed how we access knowledge and data and how we think about healthcare. Tomorrow’s doctors need to be equipped with the values and behaviours to serve our increasingly diverse population, recognise and respond to our global obligations and to flourish in a 24/7 culture where the pace of change can seem relentless.

The reimagined Imperial College School of Medicine’s undergraduate medical curriculum launched in September – this marked the first major curriculum review in the 20 years since today’s School was formed. As the leads of the Professional Values and Behaviours (PVB) domain, we were given the exciting opportunity to work with colleagues across the medical disciplines to rethink how and what we taught.

We wanted to design teaching that will help medical students harness their creativity to find solutions to complex problems and to nurture their resilience and adaptability. We also needed it to develop their ethical reasoning, sense of professional and moral identity, and for them to value team working and collaboration. We have aimed to create authentic, experiential learning opportunities that will support deeper learning and encourage students to see the relevance to their future practice. (more…)

Is mycoprotein an ideal food for managing blood sugar levels in Type 2 Diabetes?

For Diabetes Awareness Week, Anna Cherta-Murillo explains how mycoprotein, a food made of fungus, may hold the promise for managing blood sugar levels in Type 2 Diabetes.

If I were to ask you the first thing that comes to mind when you think of fungi, you would probably say mouldy walls, gone-off food, or athlete’s foot. The Fungi kingdom is often not viewed in a positive light. However, we owe a lot to fungi; they produce life-saving antibiotics, have allowed organ transplantations in humans and can recycle many types of waste. In the area of nutrition, some fungi also have the potential to affect human health in a beneficial way, although little research has been devoted to it compared to other foods. In the Nutrition Section of the Department of Medicine at Imperial, we are putting fungi into the limelight and studying the impact of a particular type of fungus on blood sugar levels and appetite in South Asian and European people with Type 2 Diabetes (T2D).

The problem

1 out of 20 people worldwide has T2D, with South Asians being more prone to the disease compared to Europeans (Figure 1). People with T2D have higher blood sugar levels than normal, which over time can increase the chances of developing long-term complications such as blindness, kidney disease and heart failure. It is therefore important to manage blood sugar levels in people with T2D in order to keep blood sugar in the normal range. The first-line strategy to achieve this is by improving dietary intake. Healthy, balanced diets are generally characterised as being high in dietary fibre and protein, which decrease both blood sugar levels and appetite. If blood sugar levels are reduced toward normal levels, the chances of having T2D-related complications are reduced. Likewise, if appetite is decreased, intake of energy-rich foods will likely also decrease, helping to reduce body weight, which is a key risk factor for T2D. However, an ongoing problem with healthy diets is that they are not suitable for all cultures and most of the research around them has been conducted in people of European origin, therefore not being applicable to South Asians. Furthermore, people often find it difficult to stick to these diets. (more…)

Could the EndoBarrier be the next weapon of mass reduction?

Endobarrier

In this post, Dr Aruchuna Mohanaruban tackles the most asked questions about the EndoBarrier – a medical device for the treatment of type 2 diabetes and obesity.

UK obesity rates have continued to rise at an alarming rate, with figures higher than any other developed nation. Strongly associated with obesity is the increased susceptibility to developing type 2 diabetes (T2DM) which currently affects 3.2 million of the UK population. Bariatric surgery – a type of surgery aimed at inducing weight loss – usually by altering the stomach and/or intestines has revolutionised the treatment of these conditions and can lead to a 60% remission in diabetes. However, with demand for this type of surgery outstripping supply, there is a greater need to develop non-surgical alternatives to combat the ever-rising obesity and diabetes epidemic. (more…)