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DUKPC Digest Day 1: Health inequalities, the pandemic and causes of type 2 diabetes

A heavily pregnant woman in a green dress holding her bump against a sunset background

We’ve just kicked off Diabetes UK's annual professional conference (DUKPC). It sees hundreds of healthcare professionals and scientists come together to discuss what’s new in diabetes research and care. 

Day one has been off to an action-packed start. Here are some of the research highlights that were top of today’s agenda:

  • health inequalities in gestational diabetes
  • the impact of the pandemic and
  • the causes of type 2 diabetes. 

Health inequalities revealed for Black and South Asian women following gestational diabetes

A new study revealed that Black and South Asian women are up to three times more likely to develop certain long-term health conditions following a diagnosis of gestational diabetes than white women.

The research, led by Dr Elpida Vounzoulaki at University of Leicester and funded by NIHR ARC East Midlands, shows clear health inequalities when it comes to long-term health outcomes for Black and South Asian women previously diagnosed with gestational diabetes.  

Gestational diabetes affects around 4-5% of pregnancies in the UK. Although it nearly always goes away once the baby has been born, having gestational diabetes increases the risk of pregnancy complications. These include premature birth, pre-eclampsia, which causes high blood pressure during pregnancy, and stillbirth, although this is very rare. 

It also increases the mother’s risk of developing serious, long-term conditions such as type 2 diabetes and cardiovascular disease. In the UK, around half of women who have had gestational diabetes go on to develop type 2 diabetes.   

Following future health

The researchers looked at the health records of nearly 11,000 women who had experienced gestational diabetes during their pregnancy. They wanted to see how many went on to develop type 2 diabetes, high blood pressure or depression, or had gestational diabetes again. 

They looked at the data to find out if the women’s ethnicity or level of deprivation was linked to the likelihood of these conditions occurring. 

They found that during an average five-year follow-up period after a diagnosis of gestational diabetes: 

  • South Asian women were nearly twice as likely to develop type 2 diabetes when compared to white women
  • Black women were nearly 1.5 times more likely to develop gestational diabetes again when compared to white women
  • Black women were nearly three times more likely to have high blood pressure when compared to white women. 

We already know that Black and South Asian women have an increased risk of developing gestational diabetes. This new research shows that they also have a higher risk of poor longer-term health outcomes after having gestational diabetes.

Dr Elizabeth Robertson, Director of Research at Diabetes UK, said:

These findings add to the body of evidence showing that, too often, people from ethnic minority backgrounds have poor diabetes outcomes, with pregnant women being no exception. 

“Gestational diabetes, and long-term ill-health following it, aren’t inevitable outcomes of pregnancy for Black and South Asian women. Health inequalities that persist in diabetes care must be addressed by the research and healthcare community.  

“Pregnancy can be a vulnerable time for women, and gestational diabetes can take its toll on health and wellbeing. We need to provide reassurance, care and support, and we must urgently see efforts to improve health outcomes among women from ethnic minority groups.

Elpida Vounzoulaki, Epidemiologist and PhD Researcher at the University of Leicester, said:

Our research highlights the importance of reconsidering perceptions around gestational diabetes, which people normally see as a temporary condition, by acknowledging and understanding its long-term impact on health. 

“We need to transform health systems to reduce health inequalities, and both healthcare professionals and researchers need to work collaboratively and take action by developing and incorporating strategies that address health inequalities in diabetes care. We hope that these findings may inform future guidelines on screening for health outcomes in women diagnosed with gestational diabetes in pregnancy.

The effects of the pandemic on risk of diabetes complications

The coronavirus pandemic caused huge upheaval to routine diabetes care and brought about changes to our ways of living, which could have affected how people manage their diabetes. For example, some people found during lockdowns that they were less active than usual or their eating habits changed. These changes could have an impact on blood sugar levels and other factors that affect the risk of longer-term diabetes complications.

At DUKPC, Professor Naveed Sattar and his team at the University of Glasgow revealed findings from their Diabetes UK-funded research that explored the link between the pandemic and changes in risk factors for diabetes complications.  

They used health records from a large group of people living with type 1 and type 2 diabetes in England and Wales to compare people's HbA1c, BMI, blood pressure and cholesterol in the three years before the pandemic with their levels in 2020 and 2021.

Changes over time

So far the researchers have found that for people with type 1 diabetes, HbA1c levels appeared to have improved slightly from 2019 to 2020/21. This researchers note that this period coincided with when more people living with type 1 were able to access Flash or CGM, and we don't yet know the impact this blood sugar monitoring technology could have on overall patterns in HbA1c levels. There weren't any changes for BMI, blood pressure or cholesterol seen in people with type 1. 

People living with type 2 diabetes had a small increase in HbA1c, BMI and cholesterol levels, and there was a steeper increase in their blood pressure over the pandemic.

The researchers are continuing their analysis and as a next step they also plan to find out if the pandemic had a bigger impact on certain groups of people with diabetes, based on age, sex, ethnicity, where people live and their type of diabetes.

This research is helping us to understand the indirect effects of coronavirus on the health of people with diabetes and their risk of complications. This can help us work out what needs to be done to improve diabetes care and reduce health inequalities, as well what support people need to manage their diabetes well as we adjust to living with coronavirus.

How is the immune system linked to insulin resistance?

Professor Hari Hundal shared his Diabetes UK-funded work to better understand the immune system’s role in the development of type 2 diabetes.

We have a set of proteins circulating in our blood that help to fight infection and destroy harmful bacteria and viruses. It’s a part of the immune system, called the complement system. There’s evidence to suggest that obesity can cause this system to become overactive, and this might lead to insulin resistance – a key feature of type 2 diabetes.

With our funding, Professor Hundal, from the University of Dundee, has been studying the proteins in the complement system and investigating how they are linked to obesity and insulin resistance.

Fishing for complements

These proteins, called complement receptors, sit on the surface of cells. Professor Hundal previously found that one particular complement receptor (called C5aR1) affects the way muscle cells respond to insulin and take up glucose from the blood.

In his latest study presented at DUKPC, Professor Hundal and his team studied muscle cells in the lab, which they exposed to fatty acids. This helps scientists to mimic conditions inside the bodies of people living with obesity.

We know from past research that obesity can trigger inflammation in muscle, which in turn can lead to insulin resistance. Fat can also affect mitochondria. Mitochondria are found inside cells. They’re like batteries, making energy and powering our cells. We need this energy to help move insulin in and out of cells to control blood sugar levels. But if cells are exposed to high levels of fat, it can drain their battery.

Professor Hundal wanted to see if he could improve how muscle responds to insulin and reduce the draining effects of fat on mitochondria by blocking the activity of C5aR1. His results showed that targeting C5aRI in this way reduced inflammation and helped mitochondria to continue to work properly.

The findings suggest that C5aR1 is a key player in causing inflammation and mitochondria problems in muscles cells. And that the protein is likely to be important in explaining the link between obesity, insulin resistance and the development of type 2 diabetes.  

Knowing more about the immune system’s role in obesity and type 2 diabetes on a molecular level could lead to new treatments in the future designed to help prevent people living with obesity from developing type 2 diabetes, and to treat insulin resistance in those with type 2.

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