On day two of our professional conference (DUKPC), fibre was in the spotlight and we heard about new research on type 2 diabetes remission and treatments to help people with type 1 diabetes and eating disorders.
The perks of fibre
One of the day’s most anticipated lectures was given by our researcher Dr Denise Robertson, from the University of Surrey. Her talk was dedicated to fibre. Dietary fibre is a type of carbohydrate that’s found in plant-based foods. It’s not absorbed or digested by the body.
Scientists have been interested in whether high fibre diets could help to prevent or manage type 2 diabetes. There’s now a lot of of evidence that shows fibre can improve factors that are important in managing diabetes and avoiding its complications, like HbA1c and blood fats. And eating a high-fibre diet has been linked to lower mortality in people with all types of diabetes. Dr Robertson said we should aim to get at least 15g of fibre a day, but the more the better.
In recent years, scientists have also learnt more about what fibre does inside our bodies, and how this could potentially be linked to the development of type 2 diabetes. The bacteria living in our gut break down fibre, in an important process that produces short chain fatty acids. Short chain fatty acids can improve insulin sensitivity and reduce internal fat build up.
But if our gut bacteria don’t have access to fibre, it will break down protein instead. Byproducts of this process can cause a ‘leaky’ gut, which in turn can lead to insulin resistance and type 2 diabetes. In this way, scientists think fibre could help to protect against the condition.
Getting enough fibre in our diets is clearly important, but it can be hard to do. Dr Robertson talked about "health by stealth", using resistant starch. Resistant starch is a carbohydrate that acts like fibre. It isn’t broken down by the gut and so doesn’t affect blood sugar levels. It’s found naturally in some foods, like bananas and pulses, and it can also be added to food.
With our funding, Dr Robertson is now investigating if swopping normal starch with resistant starch can reduce blood sugar levels and help people with type 2 diabetes to manage their condition. The data so far is looking promising, but the study’s still underway and we’ll have to wait for the full results. You can read more about this project.
Now that we better understand how fibre could help people with diabetes or at risk of type 2, Dr Robertson concluded that the next challenge is to find simple ways to help people eat more of it. We need to make sure high-fibre food is acceptable and affordable for everyone.
Remission could improve heart health
We’ve been funding the groundbreaking work of Professor Roy Taylor for over a decade. His research has transformed our understanding of type 2 diabetes and shown its possible for some people to put the condition into remission with a low-calorie diet weight management programme.
Remission means that your blood sugar levels are in a healthy range. Losing weight can also help to keep your blood pressure and cholesterol down. All of this is usually linked to a lower risk of diabetes-related complications, but research is still ongoing to see if remission does protect against complications.
At DUKPC, Professor Taylor and his team shared new findings that suggest that losing weight and being in remission can improve heart health.
They looked at 29 people with type 2 diabetes to explore how losing weight and going into remission affects risk of heart disease. The researcher used a risk calculator, which combines information on a range of different factors linked with heart disease to predict the risk of having a heart attack or stroke.
Six months after going on the low-calorie diet everyone had lost weight and had less internal body fat, and this lowered their risk of heart disease. But the reduction in risk was bigger for people who had put their type 2 diabetes in remission compared to those who weren’t in remission. This gives us early evidence that being in remission could help to protect against heart attacks and strokes later in life. The findings also show that weight loss on its own can benefit health, even if you don’t go into remission.
This research is really encouraging and builds a picture of how remission can offer people with type 2 diabetes a chance of a better quality of life, without the complications of diabetes. But there’s still more we need to find out about how much remission can protect people against diabetes complications. That’s why it’s important to keep on getting regular health checks even when you are in remission to make sure that any new, or existing complications, can be monitored and treated.
Eating disorders and type 1 diabetes
Having diabetes doubles your risk of having an eating disorder. This could be because people with diabetes need to give a lot of attention to what they eat and their weight to manage their condition. But there’s still so much we don’t know about how and why people with diabetes develop eating disorders, and importantly, how to best care for them if they do.
Dr Marietta Stadler, at King’s College London, is helping to fill this research gap by developing an urgently needed intervention for people with type 1 diabetes and eating disorders. It aims to support people to reduce dangerous eating behaviours, including skipping or reducing insulin to try to lose weight, and the distress associated with living with an eating disorder.
People with type 1 diabetes, doctors, nurses, psychologists and dieticians are working together to design this new intervention, called STEADY(Safe management of people with Type 1 diabetes and EAting Disorder StudY). Over six workshops they collaboratively developed a toolkit that draws on cognitive behavioural therapy and diabetes education, and which can be tailored to individual needs.
The researchers now plan to test it with a small group of people with type 1 who have eating disorders and compare how effective this is to usual care. They'll develop and refine STEADY with the help of feedback from those in the trial. If STEADY is successful, it will be tested in a larger study, with the eventual hope that it will be offered across the NHS in the future.
You can read more about research we’re funding to improve care for people with diabetes and eating disorders.