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Inside the lab: Ethnicity and type 2 diabetes

Our vision of world where diabetes can do no harm can only be reached by investing in ground-breaking research. This Type 2 Diabetes Prevention Week, we’re hearing from one of our scientists who’s looking at why some people are more at risk of developing type 2 diabetes.

Professor Dan Cuthbertson is a Professor of Medicine and an Honorary Consultant Physician at the University of Liverpool. With our funding he’s investigating ethnicity as one of the many factors that influence risk of type 2 diabetes

Prof Cuthbertson said:

"I was always interested in hormones and human metabolism; how different organs talk to and relay signals to each other. For instance, how does the body communicate to the different tissues (like your liver, fat tissue and heart) when you exercise or when your weight goes up or down, what happens across the different organs. Understanding how energy is partitioned amongst the various organs is so critical to understanding the impact of weight loss or weight gain on your metabolic and cardiovascular health.

"That’s why I started doing a PhD. I was looking at insulin resistance in skeletal muscle, and then in fat tissue across a spectrum of people living with overweight or obesity. I think what I enjoyed was understanding the mechanisms by which different diseases arose. And how different treatments had an impact."

Diversity in research and treatment

We know that people from Black African, African Caribbean and South Asian backgrounds are more likely to develop type 2 diabetes. They’re also more likely to develop the condition from a younger age, and to develop more severe diabetes complications, such as liver or heart conditions.

Risk of type 2 diabetes is different for everyone. Social and environmental factors play a part in why our ethnicity can influence the risk of type 2 diabetes, along with biological differences.

"Everyone’s biology is different. Their physical, social, and psychological circumstances are different. And so are their preferences for what can be effective to improve their health and barriers in accessing diabetes care. To think that you can apply a standardised, 'one-size-fits-all' approach to type 2 diabetes prevention or management isn't going to work."

With our funding, Prof Cuthbertson is delving deeper into the biological nuances that drives the development of type 2 diabetes in different ethnic groups. He explained:

"In terms of what contributes to type 2 diabetes risk, when you look into the biological mechanisms in different populations, it is clearly different. In South Asian people, it appears body fat can be stored differently, with more building up in and around important organs like the liver, pancreas, and heart. This makes it more difficult for insulin to work properly to lower blood sugar levels, while also increasing blood fat levels.

"In Black African people, the same may not be true as often organ fat accumulation is much less and it may be driven first of all by the way the liver handles insulin then leading to higher insulin levels ."

Prof Cuthbertson’s research hopes to help us better understand the biological reasons why people from some ethnicities have a higher risk of developing type 2. This can help to tackle inequalities and provide the tailored, most optimal type 2 diabetes prevention strategies and treatments.

Challenging stigma

Prof Cuthbertson also called for attention in tackling stigma around obesity and type 2 diabetes:

"What we know about obesity is that it is a complex chronic disease. There are so many factors that drive obesity, perpetuate obesity and cause weight regain after weight loss. And we need to move away from blaming people. To actually put in place clinical pathways, consider more innovative approaches to support patients and be more empathic when tackling this serious clinical problem."

When asked to picture the future of type 2 diabetes prevention and care, he said:

"We’ve now got a highly successful Diabetes Prevention Programme, and within the NHS a low-calorie diet scheme being rolled out to 10,000 people. These are very effective in both type 2 diabetes prevention and remission. But these approaches might not work for everyone. There needs to be other dietary interventions and support for increasing physical activity. We have just launched a cookbook, co-designed with our patients to help people make affordable and nutritious food and that has been so popular.

"I would like to see more community hubs around the country where people could go and access practical advice, education and support about nutrition and exercise. And maybe even moving towards better availability of community diagnostic centres. So people with higher health risks, such as with higher body index or long duration of diabetes, can access advice, support and care and have more personalised management for their conditions and complications."

Outside of the lab

In his free time, Prof Cuthbertson enjoys long-distance running and cycling.

"I think for me, because I'm a keen long distance runner and cyclist, I now understand the benefits of exercise and physical activity for my own physical and mental health. It's also one of my passions to integrate my personal and professional activities, by  trying to encourage the wider public to enjoy the benefits of being more physically active."

This motivation to bring real impact to people’s life drives Prof Cuthbertson’s research. And it echoes with how his gratitude to all the supporters of Diabetes UK, whose generosity has truly made research happen.

"I want to thank all of our supporters because what you do for diabetes is absolutely amazing. I've raised a small amount for Diabetes UK through running, and I know how much sacrifice and time and effort that took. I think what our supporters are doing is phenomenal. The research you enable makes a huge difference to our understanding of all types of diabetes and their treatment. And to how we could have an impact on the lives of people living up and down the country. Without you, we wouldn't be doing any of this."

Find out more about the research projects we’re funding here. And read more about what we are doing to commemorate this year's Type 2 Diabetes Prevention Week

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