The key to eradicating the British diabetes epidemic, most experts say, is prevention. Stopping the emergence of this insidious disease is essential to protect the health of future generations.
But there have also been huge advances in treatment – meaning that even those who are unlucky to develop the condition still have more than a chance of beating it.
Diets against diabetes, therapies to stimulate intestinal hormones and & # 39; waking up & # 39; cells that release the sleep hormone are just some of the revolutionary new methods that may help win the war against this modern plague.
The key to beating the British diabetes epidemic is prevention and sticking to medical advice. But there have also been huge advances in treatment – meaning that even those who are unlucky to develop the condition still have more than a chance of beating it.
And thanks to this progress, many can beat type 2 diabetes without medication. Others can harness the power of this scientific advancement and prevent the hidden damage that the disease can cause, such as heart disease, blindness and amputations.
Wonder diet that brings diabetes into remission
Exactly a century has passed since American physician Frederick Madison Allen wrote a book in which a & # 39; starvation diet & # 39; for diabetes was recommended.
The 1919 publication reported how dogs with diabetes remained well on an extremely calorie-restricted, low-carbohydrate plan.
When Dr. All it tried on people, the approach was undoubtedly radical. But with some patients who died from malnutrition, the therapy could not become mainstream.
In recent years, however, it has been revived thanks to pioneering research that shows that it has the potential to extend the lives of people with diabetes and reduce complications.
No pills, no injections – instead, the evidence suggests, the secret lies in a combination of extreme diet and exercise.
At the forefront of this drive was Diabetes UK-funded Diabetes Remission Clinical Trial (DiRECT), run by a team led by Professor Roy Taylor at the University of Newcastle.
The three-year study found that eating a strict diet of only 800 calories per day for 12 weeks led to half of the participants giving their diabetes remission, meaning they no longer needed medication and did not have high sugar levels . It is still early, but the latest data shows that the majority of those who have lost the most – 22 pounds or more – are still in remission two years later.
Sarah Dunkley, pictured, from Dartford developed gestational diabetes while carrying her first child. She had to inject insulin eight times a day to protect her daughter Eleanor. After the birth, Sarah lost eight stones in the next ten months, which means that her second pregnancy (she is currently 31 weeks) is progressing well
Even more stunning are the provocative early signs that those people experience fewer complications, such as heart problems and cancer.
This is crucial if the program is to be rolled out by the NHS: studies with people with even well-managed type 2 diabetes suggest that complications remain high because microscopic damage to nerves and blood vessels has already developed over time.
Patients in Prof Taylor's study were closely monitored to ensure that there were no adverse effects of the extreme diet. In fact, they had fewer heart attacks, strokes, and amputations. & # 39; But what was even more striking was the difference in cancer cases & # 39 ;, says Prof Taylor. & # 39; What we are seeing is not the cause of canceling cancer – it's a matter of changing the rate at which cancer will grow. If you reduce that to very slowly, you may be lucky enough to die in your bed at the age of 99 without ever being noticed. The figures are very small, but it is an interesting preliminary finding. & # 39;
But how can an extreme diet stop diabetes? The theory is that losing excess weight initially removes dangerous fat that has accumulated around internal organs such as the liver and pancreas.
Known as visceral fat, it forces sugar to stay in the bloodstream and leads to the development of type 2 diabetes, heart disease and high blood pressure.
Intestinal hormones could play a crucial role
For some obese patients with type 2 diabetes, surgery is now a recommended treatment – and a life-saving remedy. Options include major surgery that reduces the size of the stomach or bypasses part of the upper intestine, leading to significant weight loss.
But one of the most puzzling things about surgery is that diabetes is often remixed within days – long before even weight loss occurs. Now researchers say that the speed with which it works means that something else should evoke the drastic results, most likely hormones in the intestines.
Prof Francesco Rubino, president of the metabolic and bariatric surgery department at King's College in London and a consultant surgeon at King's College Hospital, says: “I have insulin-dependent type 2 patients who had undergone surgery on Friday and no longer needed insulin on Monday and had normal glucose levels.
& # 39; This happens with a significant number of patients. The remission is durable and can be continued 15 to 20 years after the operation, which is the most fascinating part.
& # 39; We don't know why yet, but we know that the gut is an advanced computer that controls the body's sugar metabolism, how much insulin is made in the pancreas, and how the brain responds to food or fasting. & # 39;
One theory is that intestinal hormones, especially GLP-1 and peptide YY (PYY), can contribute to the success of an operation.
People who are obese and have type 2 diabetes make less GLP-1 and PYY after meals. These hormones control the release of insulin through the pancreas that helps control blood sugar levels.
Studies suggest that surgery significantly increases both GLP-1 and PYY. Now scientists from the University of Oxford, who are researching the role of PYY, hope that a drug that stimulates its release might eventually eliminate the need for surgery.
Meanwhile, Prof. Calum Sutherland of Dundee University, an expert in molecular medicine, is investigating the role of another gut protein – glut2 – in diabetes reversal. Much glut2 seems to stop patients responding to metformin, an inexpensive and readily available drug that has been around for decades and lowers blood sugar levels.
Prof. Sutherland and his team hope to develop a drug that can improve the response to metformin. He says: & # 39; If we could find a way to reduce glut2, we could also help them respond better to metformin. & # 39;
Wake up sleeping cells
Although most patients with type 2 diabetes use tablets to control their blood sugar levels, some people need injections of the hormone insulin because their bodies no longer produce it. Insulin is vital for moving sugar from digested food from the blood and into cells where it can be used as energy.
The hormone is secreted by specialized beta cells in the leaf-shaped pancreas gland, which is located under the liver in the abdomen.
For years, doctors thought of diabetic patients who needed insulin injections, but no longer had working beta cells. Now the theory is that these cells are simply in hibernation and can actually be awakened by reducing the stress they are experiencing, for example overweight.
This would then enable them to make insulin again, to control blood sugar and effectively cure the patient's type 2 diabetes.
Prof James Shaw, an expert in regenerative medicine at the University of Newcastle, says the 800-calorie-per-day diet shows that beta cells can jump back into life. He adds: & # 39; We have assumed that having no natural insulin circulation means that patients no longer have beta cells. But they might be there, but they don't produce insulin. & # 39;
Several studies show that drugs used to fight TNF (tumor necrosis factor – a protein that causes inflammation) can be the key to reviving these insulin-producing cells.
The drugs are usually used to moderate pain in certain types of arthritis.
The smart pill that could ban daily jabs
For one in four people with type 2 diabetes who have to take insulin, daily blood tests and injections can be a tiring routine.
But research by diabetes doctor Novo Nordisk could completely abolish the need for injections.
The high-tech pill attaches itself to the stomach wall and penetrates it with a small needle that delivers insulin directly into the tissue
The Danish multinational is developing an insulin pill, something that was once considered impossible because the stomach breaks down the hormone before it gets a chance to enter the bloodstream.
The high-tech pill attaches itself to the stomach wall and penetrates it with a small needle that delivers insulin directly into the tissue.
Meanwhile, a team from the University of Birmingham is pioneering a special insulin-containing gel that may only need to be injected once a week.
The gel releases insulin when it comes in contact with sugar in the blood, but not when the sugar levels are low and insulin is therefore not needed.
The gel is at a very early stage but could one day change the lives of insulin-dependent diabetics.
Three more high-tech solutions
1 Diabetes treatment uses a & # 39; one-size-fits-all & # 39; approach. But would it be better to treat patients differently? Studies suggest that there may be five subtypes of type 2 diabetes. Currently, all patients are receiving medication to lower their blood sugar levels, but in fact some may benefit from insulin shortly after diagnosis, while others are more likely to experience diabetes complications earlier.
Professor Calum Sutherland of the University of Dundee says: & # 39; If we can pick up subtypes earlier and we can figure out which interventions work best in each case, we have a better chance that people have a better quality of life and fewer complications. & # 39;
2 Known as the building blocks of nature, stem cells were long thought to have the capacity to replace most types of damaged cells in the body. Scientists at Kingston University in southwest London are investigating how the number of beta cells that can be produced from transplanted stem cells can be increased. It is still early and a & # 39; cure & # 39; is probably ten years or older.
3 There is no specific diabetes gene that predicts an individual's risk of disease, but Silicon Valley's 23andMe DNA testing company has developed a type 2 risk assessment that looks for common factors in the DNA of people with the condition. The £ 149 Health Predispositions test cannot diagnose diabetes, but those taking the test can be told if they are at risk for the disease. It is controversial because most of those in his database, on which the test is based, are white Europeans, so the test is less effective for ethnic minorities who are most at risk for the condition.
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