Around 415 million people globally are living with diabetes. Roughly 5 million people are diagnosed with diabetes in the UK and it costs the NHS nearly 10 billion pounds each year. Over the last decade, the UK diabetes organization has invested more than 66 million pounds into diabetes research. Patients with type 2 diabetes may have serious health complications such as heart disease, stroke, vision loss, nerve damage, the list goes on. This article aims to share discoveries regarding type 2 diabetes and raise awareness for people who are suffering from this condition. This article covers two findings: a potential treatment using an enzyme inhibitor and the conversion of cells into insulin-producing cells. Although these discoveries are a long way from being put into medical practice, they are big steps towards affordable and effective cures.
What is diabetes?
Diabetes is a condition that occurs when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces. It often leads to a person’s blood glucose becoming too high, as insulin is a hormone that regulates blood glucose. There are two main types of diabetes. Type 1 diabetes is a lifelong condition where the body’s immune system attacks and destroys the cells that produce insulin, and type 2 diabetes is where the body does not produce enough insulin, or the body’s cells do not react to insulin properly, due to insulin resistance. Type 2 diabetes is a lot more common and usually develops in people aged 40 or over.
How is type 2 diabetes currently treated?
Metformin is commonly used to treat type 2 diabetes when diet and exercise alone aren’t enough to control blood sugar levels. There is a substance inside of metformin – guanidine, that can lower blood sugar. It also helps patients lower their risk of cardiovascular disease and lose excess weight. There are mild but common side effects from taking metformin, such as nausea, vomiting, diarrhea, stomach aches, etc. Taking metformin for a long time can cause vitamin B12 deficiency, which makes a person feel tired, breathless, and faint. Although it is rare, some people experience more serious side effects like allergic reactions and lactic acidosis. Lactic acidosis is caused by a buildup of metformin in the body, resulting in a pH imbalance. It is a medical emergency that must be treated immediately. Allergic reactions to metformin can be serious. They include the swelling of lips and tongue, the tightening of the throat, struggling to breathe, and even suddenly fainting and losing consciousness. As some side effects can be life-threatening, it is necessary to search for type 2 diabetes treatments that are less risky.
Discovering the main cause of type 2 diabetes leads to a potential treatment with an enzyme inhibitor
A study from Oxford has revealed a major cause of type 2 diabetes and has suggested a method to treat it with an enzyme inhibitor. In the body of a person without diabetes, the beta cells in the pancreas secrete insulin when they detect high blood glucose levels. It is previously known that chronic hyperglycemia (high blood glucose) damages the ability of beta cells to produce insulin and to release it only when blood glucose levels are too high. Hyperglycemia is a result of diabetes. It is crucial to treat hyperglycemia as it causes serious complications such as retinopathy, nephropathy, cardiac disease and more. However, it is unknown how exactly glucose damages pancreatic beta cell function. The study has pinpointed the exact process of how the damage occurs and possible ways to prevent it.
High blood glucose concentration causes an increased rate of glucose metabolism. The breakdown products of glucose metabolism (metabolites) in the beta cells switch off the insulin gene, causing beta cells to produce less insulin, and in turn, resulting in them no longer responding to changes in blood glucose. This means that when blood glucose levels are too high, little insulin is secreted, so blood glucose levels remain high. This significantly contributes to diabetes. Hence, it can be reasonably deduced that slowing the rate of glucose metabolism can slow down or prevent beta cell failure. The researchers found that blocking an enzyme called glucokinase could prevent gene changes in the insulin gene. The enzyme regulates glucose metabolism, meaning that inhibiting it can potentially prevent beta cell decline.
Professor Ashcroft concludes, “But there is a very long way to go before we can tell if this approach would be useful for treating beta-cell decline in T2D. In the meantime, the key message from our study if you have type 2 diabetes is that it is important to keep your blood glucose well controlled.”
Conversion of cells may help type 2 diabetes patients with insulin resistant beta cells
In a non-diabetic body, different types of pancreatic cells work together to maintain a healthy blood glucose level. For example, pancreatic alpha cells secrete glucagon when low blood glucose levels are detected. This idea that beta cells could only function normally in the presence of other pancreatic cells was widely accepted.
However, a study from the University of Geneva proves that in mice, only beta cells are needed to manage blood sugar levels effectively. All pancreatic cells had served the same function – to produce insulin. “But what happens if all the cells of the endocrine pancreas abandon their original function to start producing insulin? It is what we wanted to find out in our new study.” Professor Herrera says. In the study, researchers produced mice that would selectively eliminate non-beta cells when they reached adulthood. The results were surprising – these mice could regulate blood glucose levels even better than the mice with a normal pancreas.
When there is insulin deficiency in the body, 2% of pancreatic cells naturally convert into insulin-producing cells. Researchers hope to identify a molecule that can initiate and amplify the conversion, or to implant differentiated stem cells to produce beta cells into patients. Insulin resistance is when body cells such as fat cells and liver cells cannot efficiently take up glucose and store it. Therefore, the conversion of non-beta cells to beta cells can be especially helpful in patients whose cells are more insulin-resistant.
Conclusion
Type 2 diabetes affects 415 million people worldwide and it is costly to manage. The ongoing research on type 2 diabetes is advancing steadily and is supported by governments from many countries. There is certainly hope for a more efficient and accessible treatment, but we must play our part. We should keep our bodies healthy by doing regular exercise and having balanced diets. Further reading or even involvement in diabetes advocacy can also go a long way.
Written By: Amy Lok
References
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Side Effects of Metformin. (n.d.). Healthline. https://www.healthline.com/health/diabetes/metformin-side-effects#serious-side-effects
University of Oxford. (2022, November 14). Key cause of type 2 diabetes uncovered | University of Oxford. Www.ox.ac.uk. https://www.ox.ac.uk/news/2022-11-14-key-cause-type-2-diabetes-uncovered
World Health Organization. (2023, April 5). Diabetes. World Health Organisation; WHO. https://www.who.int/news-room/fact-sheets/detail/diabetes
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