Week one of our professional conference (DUKPC) wrapped up with important research highlighting inequalities in diabetes care, we learnt more about what’s going on in our brain after weight loss and how antibodies could help us diagnose diabetes type.
Social deprivation in Scotland linked to DKA
A nationwide study we funded has revealed widening inequalities in type 1 diabetes care across Scotland. Research led by Dr Joe O’Reilly at the University of Edinburgh found that cases of diabetic ketoacidosis (DKA) have been steadily increasing since 2004, with those from socially deprived areas most likely to be hospitalised or die as a result.
DKA is a serious complication of type 1 diabetes that happens when there is a severe lack of insulin in the body. This means the body can’t use sugar for energy, and starts to use fat instead. When this happens, chemicals called ketones are released, which cause the blood to become dangerously acidic, leading to DKA. DKA is a medical emergency needing hospital treatment, and if not treated quickly it can be life-threatening. People living with type 1 diabetes must carefully monitor their blood sugars, keeping them in a target range as much as possible, to reduce their risk of DKA.
Dr O’Reilly used National Records of Scotland data to track people with a diagnosis of type 1 diabetes in 2004 until 2018. They investigated how many were admitted to hospital or died as a result of DKA over the 14-year period.
The team found that in the 37,939 people with type 1 diabetes identified, over a quarter (27%) experienced DKA, with over of 30,000 DKA hospital admissions and 472 deaths from 2004 to 2018. Rates of DKA deaths were found to be more than twice as high in 2018 compared to 2004.
People living in more socially deprived areas had higher rates of DKA hospitalisation and death throughout the study period than those from less socially deprived areas. Women were found to have higher rates of hospitalisations than men.
Rates of DKA admissions and deaths were lower in those who used an insulin pump or had completed a structured diabetes education course. The researchers think that wider access to these tools may be important in preventing DKA in the future. This work reinforces the need to address inequalities that exist in diabetes care and improve health for everyone living with diabetes.
Low-calorie diets and weight loss surgery linked to different brain responses
Dr Vicky Salem, our research fellow at Imperial College London, shared new findings that revealed different patterns of brain activity in response to food in people with type 2 diabetes, depending on whether they reduced their weight through diet or weight loss surgery.
People who have put their type 2 diabetes into remission have healthy blood sugar levels without needing to take any diabetes medication. Losing weight and maintaining weight loss is key to going into remission and staying there and we know low-calorie diets or weight loss surgery are routes to remission for some people.
After weight loss surgery, evidence shows that many people can keep weight off and stay in remission for the long term. But it can be more difficult to maintain weight loss through diet.
To understand more, Dr Vicky Salem studied 16 people with or at risk of type 2 diabetes who had gastric bypass surgery and compared them to 19 people who’d been on a four-week low calorie diet. The participants had MRI scans before and after their surgery or diet and Dr Salem’s team examined which parts of the brain responded when they were shown images of food.
She found that there were different brain responses in the two groups. After people had been on a low-calorie diet they had more activity in the reward areas of their brain when they were shown food cues, compared to before their diet. After surgery, this type of brain response was reduced.
Dr Salem also found that the system where the brain controls appetite in response to how much energy it needs was better engaged after people had lost weight through surgery compared to dieting.
This research helps us start to build of picture of what happens inside in brain after weight loss, which could explain why people might find it harder to keep weight off after dieting compared to weight loss surgery.
The NHS is now piloting remission programmes using a low-calorie diet approach, inspired by our DiRECT trial, and it’s vital we understand as much as possible about what could help people to maintain weight loss and stay in remission for the long term.
Getting the diagnosis right
Getting the right diagnosis of diabetes is so important. It means people will receive the right treatment for them and could avoid serious complications. But different forms of diabetes can be difficult to accurately diagnose, and thousands of people every year in the UK can get misdiagnosed with the wrong type of diabetes.
At DUKPC, our researcher at the University of Exeter, Dr Angus Jones, explained that spotting type 1 diabetes in older adults can be particularly hard because type 2 diabetes is so common in this age group. Adults diagnosed with type 2 diabetes who need insulin within three years have a 50% chance of actually having type 1 diabetes.
Dr Jones updated us on how autoantibodies can help to avoid this. Antibodies are made by our immune system to protect us from intruders. Antibodies stick to the surface of harmful bacteria or viruses to alert the immune system that they need to be destroyed. But in type 1 diabetes, the immune system mistakenly thinks our insulin-producing beta cells are the enemy and it produces a type of antibody that recognises beta cells, instead of germs, called islet autoantibodies.
We can see if someone has islet autoantibodies with a simple blood test. Type 2 diabetes and other forms of rarer, genetic diabetes aren’t caused by an immune attack and so people with these types of diabetes are much less likely to test positive for autoantibodies. In this way, doctors can test for autoantibodies to help get the diabetes diagnosis right.
But Dr Jones pointed out this method isn’t perfect. About 7% of people with type 1 diabetes will test negative for autoantibodies, and there will be people with other forms of diabetes who will test positive. With our funding, Dr Jones is now assessing a range of different features and tests to find out which, and in what combination, are best able to help doctors diagnose type 1 diabetes in later life. Read more about this project.