Why the ordeal of daily jabs is coming to an end
THE key to eradicating Britain’s diabetes epidemic, most experts agree, lies in prevention. Halting the rise of this insidious illness is vital to protect the health of future generations. But there have also been huge strides in treatment – meaning even those unlucky enough to develop the condition still have more than a fighting chance of defeating it.
Anti-diabetes diets, therapies to boost gut hormones and ‘wake up’ sleeping hormonereleasing cells in the body are just some of the revolutionary new methods that could potentially help win the war against this modern plague.
And, thanks to these advances, many may be able to beat type 2 diabetes without drugs. Others will be able to harness the power of these scientific advances and prevent the hidden damage the disease does, which can include heart disease, blindness and amputations.
WONDER DIET THAT PUTS DIABETES INTO REMISSION
EXACTLY one century has passed since American physician Frederick Madison Allen wrote a book recommending a ‘starvation diet’ for diabetes.
The 1919 publication reported how dogs with diabetes remained well on an extreme calorie-restricted, low-carb plan.
When Dr Allen tried it on humans, the approach was undoubtedly radical. But with some patients dying of malnutrition, the therapy failed to become mainstream.
In recent years, however, it has been revived thanks to ground-breaking research showing it has the potential to extend the lives of those with diabetes, and reduce complications.
No pills, no injections – instead, the evidence suggests, the secret lies in a combination of extreme dieting and exercise.
At the forefront of this drive has been the Diabetes UK-funded Diabetes Remission Clinical Trial (DiRECT), run by a team led by Professor Roy Taylor at Newcastle University.
The three-year study found consuming a strict diet of just 800 calories a day for 12 weeks led to half of participants putting their diabetes into remission, meaning they no longer needed medication and did not have high sugar levels. It is still early days but the most recent data show the majority of those who lost the most – 22 lb or more – are still in remission two years later.
Even more astounding are the tantalising early signs that those people are experiencing fewer complications, such as heart problems and cancer.
This is critical if the programme is to be rolled out by the NHS: studies involving those with even well-managed type 2 diabetes suggest the complication rates remain high because microscopic damage to nerves and blood vessels has already developed over time.
Patients in Prof Taylor’s study were followed closely to ensure there were no adverse effects from the extreme diet. In fact, they had fewer heart attacks, strokes and amputations. ‘But what was even more eye-opening was the difference emerging in cancer cases,’ says Prof Taylor. ‘What we’re seeing is not the cause of cancer being taken away – it’s a matter of changing the speed at which cancer will grow. If you reduce that to very slow, you may be lucky enough to die in your bed at the age of 99 without it ever having been noticed. The numbers are very small but it’s an interesting preliminary finding.’
But how can an extreme diet halt diabetes? The theory is that losing excess weight initially strips away dangerous fat that has accumulated around internal organs such as the liver and pancreas.
Known as visceral fat, it forces sugar to remain in the bloodstream and leads to the development of type 2 diabetes, heart disease and high blood pressure.
GUT HORMONES COULD PLAY A CRUCIAL ROLE
FOR some obese patients with type 2 diabetes, surgery is now a recommended treatment – and a life-saver. Options include a radical operation that reduces the size of the stomach or bypasses part of the upper intestine, which leads to significant weight loss.
But one of the most puzzling things about surgery is it often puts diabetes into remission within days – long before any weight loss even occurs. Now researchers say the speed with which it works means something else must be prompting the dramatic results – most probably hormones in the gut.
Prof Francesco Rubino, chair of the department of metabolic and bariatric surgery at King’s College London and a consultant surgeon at King’s College Hospital, says: ‘I’ve had insulindependent type 2 patients who had surgery on a Friday and by Monday they no longer needed insulin and had normal glucose levels.
‘This happens in a significant number of patients. Remission is durable and can continue for 15 to 20 years after surgery, which is the most fascinating part.
‘We don’t know yet why but we know the gut is a sophisticated computer that controls sugar metabolism in the body, how much insulin is made in the pancreas and how the brain responds to food or fasting.’
One theory is that gut hormones, especially GLP-1 and peptide YY (PYY) may contribute to surgery’s success.
People who are obese and have type 2 diabetes make less GLP-1 and PYY after meals. These hormones control the release of insulin by the pancreas that helps to control blood sugar levels.
Studies suggest that surgery significantly increases both
Any form of stress or trauma – even sunburn – can raise your blood sugar level
GLP-1 and PYY. Now scientists at Oxford University, who are researching the role of PYY, hope a drug that stimulates its release could eventually do away with the need for surgery.
Meanwhile, Dundee University’s Prof Calum Sutherland, an expert in molecular medicine, is investigating the role of another gut protein – glut2 – in diabetes reversal. Too much glut2 seems to stop patients responding to metformin, a cheap and readily available drug that’s been around for decades and reduces blood sugar levels.
Prof Sutherland and his team hope to develop a drug that can improve the response to metformin. He says: ‘If we could find a way to reduce glut2 we could also help them respond better to metformin.’
WAKING UP SLEEPING CELLS
ALTHOUGH most type 2 diabetes patients take tablets to control their blood sugar, some need injections of the hormone insulin as their bodies no longer produce it. Insulin is vital for moving sugar from digested food out of the blood and into cells where it can be used as energy.
The hormone is secreted by specialised beta cells in the leafshaped pancreas gland, which sits below the liver in the abdomen.
For years, doctors thought diabetes patients who needed insulin jabs had no functioning beta cells left. Now the theory is that these cells are simply hibernating and can, in fact, be woken up by reducing the stress they are under from, for example, excess weight.
This would then allow them to start producing insulin again, getting blood sugar under control and effectively curing the patient’s type 2 diabetes.
Prof James Shaw, an expert in regenerative medicine at Newcastle University, says the 800-calorie-a-day diet ‘shows beta cells can spring back into life’. He adds: ‘We’ve assumed that having no natural insulin circulating means patients have no beta cells left. But they may well be in there, just not producing insulin.’
Several studies show drugs used to counter TNF (tumour necrosis factor – a protein that causes inflammation) could hold the key to bringing these insulinproducing cells back to life.
The drugs are usually used to dampen down pain in certain types of arthritis.
THE SMART PILL THAT COULD BANISH JABS
FOR the one in four people with type 2 diabetes who have to take insulin, daily blood tests and injections can be an exhausting routine. But research by diabetes drugs giant Novo Nordisk could do away with the need for injections completely.
The Danish multinational company 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 to the stomach wall, penetrating it with a tiny needle that delivers insulin directly into the tissue.
Meanwhile, a team at Birmingham University is pioneering a special insulin-containing gel which may need to be injected only once a week.
The gel releases insulin when it comes into contact with sugar in the blood, but not when sugar levels are low, and insulin is therefore not needed.
The gel is at a very early stage but could one day transform the lives of insulin-dependent diabetics.