Diabetes Discussions: World Diabetes Day Research Special

Jack [00:00:10]: Welcome to Diabetes Discussions, a podcast from Diabetes UK. In this special World Diabetes Day episode, we'll be talking about the vital research that Diabetes UK funds and fuels. 

[00:00:22]: Research is our hope for a better future for everyone affected by diabetes, and we'll discuss the impact of this research in our bid one day to stop diabetes forever. 

[00:00:32]: Also in this episode, we're excited to announce the launch of a brand-new screening programme for type 1 diabetes in adults, and we'll explain why this development is so significant.  

[00:00:43]: I'm Jack Woodfield from Diabetes UK and this World Diabetes Day I'll be guiding you through the past, present and future of diabetes research and how it is changing the lives of people affected by diabetes. 

Claire [00:00:56]: If it did come back even that it was a positive test to say that they're higher risk at least then I could work with the diabetes teams and put a plan in place. 

Lucy [00:01:06]: The first two areas for me are so exciting because combined, hopefully this will lead to a cure one day. 

Jack [00:01:16]: World Diabetes Day is on the 14th of November every year and this World Diabetes Day we're celebrating the 100-year anniversary of when Frederick Banting and John McLeod won a Nobel Prize for discovering insulin, the treatment which has gone on to save millions of lives around the world.  

[00:01:33]: Since then, our scientists have made incredible breakthroughs from helping people with type 1 diabetes to make their own insulin, to putting type 2 diabetes into remission. And all of this has only been possible because of you, the listeners, and your vitally important fundraising.  

[00:01:49]: To help guide us through the world of diabetes research in this episode, I'm joined by Dr. Lucy Chambers, Head of Research Communications at Diabetes UK, who herself lives with type 1 diabetes.  

[00:02:00]: I'm also joined by Claire Gallagher, who lives in Northern Ireland with her husband and three sons. Claire was diagnosed with type 1 diabetes age 3, and one of her sons has also been diagnosed with type 1. Lucy, Claire, a huge welcome to you both, and thank you so much for being here.  

Claire [00:02:15]: Hiya.

Lucy [00:02:16]: Hi Jack. 

Jack: So, later on in this episode, we're going to showcase some of the fantastic research breakthroughs which have been made in the past 100 years, and how Diabetes UK has been at the forefront of ensuring people living with diabetes benefit from these developments. 

[00:02:31]: But first, we're very excited to discuss a brand-new, world-first screening program for adults at risk of type one diabetes called T1DRA, which is spelt T 1 D R A, and this stands for the type one diabetes risk in adults study. And as of today, World Diabetes Day 2023, the study is now open for recruitment. 

[00:02:50]: Now Diabetes UK is not the main funder of this study, although we do fund ELSA, and this is short for the Early Surveillance for Autoimmune Diabetes study, and this is a type 1 screening trial for children, which is currently running nationwide, which opened on World Diabetes Day last year, which we'll come to.
 
[00:03:06]: But Lucy, first of all, could you tell us about T1DRA and why is this such a significant study? 

Lucy [00:03:12]: Thanks, Jack. Yeah, well, this is a really hugely important study. First off to say it's run by Professor Kathleen Gillespie at the University of Bristol. And it's a study to find adults who are at high risk of type 1 diabetes. I think the first thing to say is that type 1 diabetes obviously does develop in children, but there's maybe a misconception out there that it only develops in children, that adults don't develop it, but we know that over 50% of diagnoses are actually in adults. But what we don't know much about is how it develops in adults, because most of the research, previous to this study, has studied children.
 
[00:03:51]: So, I was diagnosed as an adult when I was 27. I know a former participant on this show, Roxy Horner, she was also diagnosed as an adult. People can be diagnosed in any decade of life. I mean, I think Theresa May was diagnosed with type 1 diabetes in her fifties. So, it can happen to anyone at any time. 

[00:04:10]: So, this study is about looking at the general population. So, Professor Kathleen Gillespie is looking to recruit 20,000 people from across the country to find those people who are at high risk of developing type 1 diabetes. And then when she's found those people who are at high risk, she wants to follow them and look to see how type 1 diabetes develops, how quickly it develops, what factors can influence how quickly it develops. 

[00:04:38]: And I can talk about this in a bit, but she-it's also about supporting people who have that high-risk status as well. I guess the question that probably is coming to lots of people's minds is how can you work out if someone is at high risk of type 1 diabetes? 

[00:04:54]: So, type 1 diabetes is an autoimmune condition. So, this is when the immune system turns on the pancreas and kills off those cells that make insulin, which are called beta cells. Now this doesn't happen all of a sudden, that destruction of the beta cells can happen months and sometimes years before people get a diagnosis of type 1 diabetes. So, what scientists can do now is look at people's blood and they can look for markers in the blood, and these are called autoantibodies, and these markers can tell us who is likely to develop type 1 diabetes in the future. 

[00:05:30]: And it's by finding those people with these markers in their blood that we can say that these people are at high risk of developing type 1 diabetes and then make sure that they're getting the support and information and care that they need as well.
  
Jack [00:05:43]: And so in terms of the care and support that someone might receive, how does that work? So, if someone does find out through the study that they are at high risk of type 1, what happens then? 

Lucy [00:05:52]: So, in the study, I think the first thing to say is that most people, we don't quite know how many people, but the majority, probably at least 97 to 98% of people, will be told they are negative. So, they have a low risk of developing type 1 diabetes in the future. 

[00:06:09]: And they'll be told that through a text message. There'll be a small handful of people who have these markers in their blood that show the scientists that their immune system is planning attack on the beta cells that make insulin. And those people will be called by the research team to let them know that they've got these markers in their blood.
 
[00:06:27]: And then they'll be sent a letter which they can take to their GP so the GP also knows. And then these people will be offered information about type 1 diabetes and what the symptoms look like. And they'll be followed up and monitored so they'll have their bloods checked as well to see if type 1 diabetes is developing. 

[00:06:45]: So, knowing you're at risk and getting the information about type 1 diabetes can really avoid you having a sudden diagnosis. You can be prepared, you can look out for the symptoms and you can learn about the condition. And also, as part of this study, people who are identified as high risk will have the chance, if they're running, to be able to enrol on clinical trials that are testing new therapies that can hopefully one day prevent type 1 diabetes developing in people who are at high risk. So, lots of benefits of knowing that you are at high risk.  

Jack [00:07:20]: It certainly sounds like a really important milestone in type 1 screening, and so T1DRA joins the ELSA study as a screening test for type 1, and as I mentioned earlier, ourselves, Diabetes UK, as well as the charity JDRF, are funding ELSA, which is aiming to screen 20,000 children aged between 3 and 13 years, and Claire, finding out about type 1 diabetes risk has particular pertinence to your story. 

[00:07:44]: So, screening children for type 1 diabetes only became available in Northern Ireland in October 2023, but you've known for some time that you want to have your other two sons screened for type 1 diabetes. So, can you tell us about yourself and the history of diabetes within your family and why you want your other children to be screened? 

Claire [00:08:03]: Yeah, so, um, yep, I'm Claire and I'm 36 and I live in just a wee, rural community outside Lurgan. I grew up in a family of six with my mum and dad and my two sisters and brother. So, one of my sisters is type 1 diabetic and she was diagnosed at age 4 and my brother was diagnosed at age 20 so he was that wee bit later and then myself I was diagnosed at age 3. 

[00:08:28]: So, we have a big family history, like within my immediate family with my sister and brother, but as far as like my mum and dad, we have absolutely no family history. So, diabetes coming into our family was like a massive shock and it was a big shock even for like my mum and, you know, back 33 years ago, there wasn't the same support networks that we have nowadays with all the specialized clinics and multidisciplinary working teams. 

[00:08:52]: And my mum, she did find it, like, quite difficult. She was a nurse. And because of that, um, she actually went on and did more studying and became a diabetic specialist nurse. So, I have that history in my family as well. So, then later on, obviously I've got married, I always knew the risk of, like, you know, my children might develop type 1 diabetes, but it was still a massive shock when my son Enda at age three, uh, was diagnosed with type one diabetes. 

[00:09:19]: I was still so emotional, even though I sort of probably should have been more prepared for it. Um, it still came like a bolt of lightning and in the middle of the night and the blood sugar check and his blood sugars up at 20, um, and then because we knew the symptoms, we got him very early. So, there was very little ketones. 

[00:09:37]: Um, so it was a very short stay in the hospital. Um, and I got a lot of support then from the Southern Health, uh, Social Care Trust, the diabetes team there, got him home and had diabetic nurses coming out to the house then to give a lot of support, which was really, really helpful. 
 
[00:09:53]: But, uh, I suppose the other thing I would say is that I used support around me, um, likes of, um, the T1DCAT support groups. Although I'd lived with it all my life, I'd never been a parent with a child with type 1 diabetes and having a child with type one diabetes is completely different to you controlling and managing your own diabetes. There's so many things with children that you can't control, you know, like, so he'd be going to school and he had an assistant, but there's a lot of organizing to do with, um, medical kits and just making sure that his assistant is trained and the diabetes nurses are really good at getting the training put into the schools. 

[00:10:29]: But things like, you know, taking him to sports and how much do you be that helicopter mum? Do you sit and watch him? Do you not sit and watch him? Um, and trying to give him, as he's got older now, he's eight, that wee bit of responsibility. 

[00:10:43]: And like he can count his own carbohydrates now. So, I've been trying to teach him and be really proactive that he's taken responsibility and independence with his diagnosis. So, like trying to leave him for like, you know, like a half an hour and then going back to him to check on him just so that he feels he has that independence and is able to, you know, manage symptoms and signs of hypos and all that stuff that he's going to have to do in the future for himself. Just trying to empower him, I suppose, as a child. 

Jack [00:11:11]: Pretty amazing that he's taking that responsibility on because it's not an easy responsibility to take on. And something you said earlier about how you felt like you could have been more prepared for Enda's diagnosis. And I don't think as a parent you possibly can be prepared for that. I don’t think there’s anything you can do. But I wonder, is that a driving factor for you that you would like your other two sons to be screened for type one, so you feel that you perhaps have a bit more of, kind of, an idea that it could happen? 

Claire [00:11:36]: Yeah. So, like, with Aidan and Kilian, I would love to get that result back either to say that hopefully that they're at a low risk, which would be amazing and maybe I could relax a little bit. Cause I do check their blood sugars if they're running to the toilet or if they're like asking for an extra drink that day and I'm overthinking it, but I suppose it would be good for if it did come back, even that it was a positive test to say that they're higher risk.
 
[00:11:59]: At least then I could work with the diabetes teams and they could maybe have, you know, regular like blood sugar checks and put a plan in place that I'm not panicking or I'm not, you know, I do, I do know that maybe it is kind of definitely going to come, but at least I can be more prepared and prepare the family and the school and get that information there, you know, and symptoms to look out for and educate. I think that would be a really good benefit.  

Jack [00:12:24]: Yeah, absolutely. And as someone with type 1 diabetes myself and a father of two, I can see how valuable screening is for, not just potentially giving that peace of mind, but also providing potentially the earliest, safest diagnosis for children as well. And Lucy, for someone like Claire, who actively wants to understand her children's type 1 diabetes risk, how pivotal is the ELSA research for parents? 

Lucy [00:12:44]: I think the, how the, um, the research team describe it is the sooner we screen, the sooner we can intervene and that's what ELSA is all about. It's about knowing, as Claire was saying, having that information if your child is at high risk, being able to do everything that you can to make sure that their diagnosis when it comes is safe and not an emergency situation because no one wants to be in hospital with their child, you know, with DKA, which is a life-threatening situation. 

[00:13:15]: And we know far too many diagnoses happen that way at the moment. And with screening, that is something we can do to avoid that situation happening. So that really is, you know, so important. And also, you know, life with type 1. All of us here today live with type 1. We know how much we had to learn when we were first diagnosed, and we understand how much parents have to learn when they get a diagnosis for their kids and it's not information that you just read a leaflet and you get it in a day.
 
[00:13:44]: It literally takes years to really get to grips with everything. The tech, you know, how personally or how your child responds to different situations. It's a steep learning curve. So, you know. If you get a diagnosis and have to do all that learning immediately, it's quite overwhelming. So, if you've got that space of time to do that learning and prepare, it really can be helpful to parents and obviously the children. 

[00:14:07]: So that's, yeah, that's really a massive benefit. And then the other benefit, which, um, I touched on with T1DRA, which is also available for children, is these clinical trials that are testing these drugs called immunotherapies. So immunotherapies and screening kind of go hand in hand really, because there's an immunotherapy in America that's been licensed called Teplizumab. 

[00:14:32]: So, it was licensed last year. It's the first immunotherapy for type 1 diabetes. And it's licensed to give to people who are at high risk of developing type 1. So, through research, we know that that drug can delay a diagnosis in someone at high risk by at least 3 years. Which is really, you know, quite incredible if you're a child of 12 and you can put it off until you're 15, that's, you know, a big chunk of your childhood where you're not living with type 1. 

[00:15:00]: So that drug, teplizumab, is now being looked at in the UK, is going under review. So hopefully it'll be approved for use in the UK soon. We don't know when, but it's going through that process. And there's more of these immunotherapy drugs in clinical trials at different stages. 

[00:15:15]: So why we need screening alongside these clinical trials is we need a way. to look across the population and pinpoint and find those children that are at high risk so we can get these new drugs to them. At the moment, they can only get these drugs in clinical trials, but we're really hopeful for a future where these drugs are on the NHS. 

[00:15:34]: So, at the moment, screening is about having a safe and gentle diagnosis, giving, making sure people are supported, have the information, monitoring so they can avoid that emergency situation. And we're working towards hopefully a future where we've got medications to give to people which can delay the diagnosis and maybe hopefully one day put it off forever because what these drugs do is reprogram the immune system so it no longer attacks those cells that make insulin.
 
[00:16:00]: So, Elsa and uh, T1DRA, although they're similar in that they're screening people for their risk of type 1 diabetes, ELSA, because we know a lot about risk in children, there's been lots of research previously, this study is set up to test whether a nationwide screening program would work in the UK and could be rolled out in the NHS. This is the data we need to be able to see if that would be possible.  
[00:16:27]: T1DRA is screening adults, but it's not working towards a screening study yet. What that study's doing is trying to find more about risk in adults because we just don't know enough at the moment. So, it's kind of the step before the ELSA study.
 
Jack [00:16:43]: Yeah, absolutely. I think it's a real testament to the work that scientists are doing on this and building up these screening trials and hopefully outcomes in 10 years’ time will just be just so much more developed than they are now. And Claire, I'd also like to ask you, you've touched on this already about the challenges of being a parent with diabetes to a child with diabetes.
 
[00:17:04]: Because I know from my own experiences of if I have a hypo and I'm with my children or we're out and about with my children, I have to stop and treat the hypo and sometimes, because they're quite young, they don't always understand this. But on top of that, as a parent with type one, you also have a child with type one who you've had to look after all these years.
 
[00:17:20]: And I was wondering, is there any advice or tips, things that have worked for you over the years or that work for you now that you would offer to parents who might be in similar situations?  

Claire [00:17:31]: I would just say to parents that whenever you have a child with type 1 diabetes, you can't be too hard on yourself. Every day is so different. You can have a really good day, a really good week, and then you could have a week where you're-the blood sugar's maybe up and down and you know, children are growing. The, the rates of the insulin are changing from day to day. Whether he's having a really busy day with sport, it can be also very different. 

[00:17:56]: And even just like you're trying to count their carbohydrates for their dinner and with the child, are they going to eat all that dinner? You know, so everything is just, you have to be very flexible, just, you know, um, just not be too hard on yourself and not be too hard on, you know, the wee man too, cause he's trying his best and-and try and work around it, but I did say about the, um, the type one-the T1DCAT group, it's like a, uh, like a wee support group that I joined.

[00:18:24]: It's part of the Southern Trust, and it has been a really good thing, um, to join that support group. Um, just to be able to see what other parents with children with type one are going through. And you've somewhere to go to that you can relate and say, do you know what? Yeah, that's exactly what's been happening for me. 

[00:18:39]: And you might get a wee tip about how to do something maybe just slightly differently. And then on the other hand too, whenever somebody comes in to that group who's got a newly diagnosed child, it lets you see how far you've come because you're actually the person then that's giving advice to the person with the newly diagnosed child and that can give you even a bit of a boost to know that you know you are coping well and you're doing well. 

[00:19:03]: But I think the other thing too is not to hold back on anything, like I take my child on holidays everywhere. He does every sport that-that's going, I encourage him to go to swimming and he does soccer and Gaelic. And, um, I encourage him to go to all the parties and, um, we count his carbohydrates so that he can eat everything, and I don't restrict anything. 

[00:19:26]: And I just try to make life as normal for him as we can. And just, I suppose the other thing is too, just keeping that really good link with your-your health team as well. You know, they're really good support and the diabetic nurses, they're only ever at the end of the phone for me or an email or, you know, anything you need. Um, they're always there to help you and support you. 

Jack [00:19:44]: Uh, Claire, it sounds like you're absolutely smashing it, to be honest. I mean, it sounds like you're just on top of everything and wish you all the best with ELSA and the entire process and I hope that it's as comfortable an experience as it can be for you. 

[00:19:59]: And if you're listening to this and you do want to learn more about signing up to take part in the screening studies that we've mentioned, you can find out more in our episode notes. 

[00:20:07]: So, we've reached the end of part one of this episode, which means Claire, we're going to say goodbye to you, but not without a huge thank you for coming on the podcast today and for sharing your story with us. Thank you so much. 

Claire [00:20:17]: Thanks very much for having me.  

Jack [00:20:18]: You're absolutely welcome. And in the second part of this episode, Lucy is going to talk about some of the incredible research that has happened and is happening within diabetes and the exciting research coming up in 2024. 

[00:20:29]: [break] 

Jack [00:20:43]: Lucy, there have been so many milestone developments in diabetes research over the years, which we've helped to fund, such as the world's first blood glucose meter, discovering how to put type 2 diabetes into remission and helping people to avoid complications of diabetes. And this research is hugely dependent on donations. 

[00:21:00]: So, can you tell us about some of the really exciting work that we're doing and how we use these donations and how it makes a massive difference?
  
Lucy [00:21:07]: I think, first of all, just to say massive thank you to our supporters, because, you know, we can't fund research without their incredible generosity, and in my mind, obviously, I'm a scientist at heart, there is no progress for people with diabetes without research, so we really can't do it without our supporters.
 
[00:21:26]: And pretty much every penny Diabetes UK spends on research is very kindly given to us, so, um, so important, and we know research is really expensive business, you know, I've been to labs and seen microscopes that cost half a million pounds, you know, it costs a lot, it takes time. 

[00:21:47]: It involves lots of people but, you know, every donation even if it's just a couple of pounds it all adds up and it's combined that these donations are allowing us to, you know, step by step get closer to those big breakthroughs. So, you know, every penny counts. 

[00:22:04]: So, you know, putting together our revamped Research Impact Report that looks back over 85 years of us funding research was really quite an emotional experience for me because I work for the charity, I understand our research but, you know, really getting a clear picture on how Diabetes UK has pretty much played a part in all the big developments that have happened for people with diabetes, our research has played a role. 

[00:22:30]: Um, so it was, you know, really quite emotional to hear those stories from our researchers. But also, you know, we have lots of people with diabetes in our report talking about how research has benefited them. So, you mentioned, Jack, you know, we funded the first insulin pen, we funded the first blood sugar monitor. We actually funded the first artificial pancreas in the UK. 

[00:22:52]: We funded the first eye screening program. We funded the first diabetic foot clinic. Uh, we funded the first studies into remission. You know, when you read the report, you're like, ‘oh, another first. Oh, it's another world first. Oh, another one’. So, you know, really incredible stuff. And it all started, you know, 85 years ago. 

[00:23:12]: One of our founders, R. D. Lawrence, he was one of the first people in the UK to receive insulin. And because that saved his life, he went on to establish Diabetes UK because he wanted to further research and education into diabetes. And that's what we've been doing ever since.
  
[00:23:30]: We funded our first grant, just over 85 years ago, cost us £50 and since then we've invested millions and millions and millions of pounds and it's been really transformational. So, I hope people enjoy. It's on our website, there's lots of stories to see what we've been up to and-and how it's really changed lives.  

[00:23:49]: I guess for me, in sort of recent history, something that I've been very close to and seen really shift thinking about type 2 diabetes and really shift what's possible for people with a new diagnosis of type 2 diabetes is remission. So, we've been funding research into remission since 2008, um, we've invested well over 3 million pounds into this area since then. 

[00:24:15]: So, before 2008, you know, you've got a diagnosis of type two diabetes and that was kind of it, you had it, you knew it was a lifelong condition. And you're probably told it was going to get progressively worse and worse. And what our research on remission has done is really kind of turn the tables on-on that diagnosis. 

[00:24:34]: And now people can get a diagnosis and know that remission for some people, not all, but for some people going into remission is possible. And our research showed that people can do this, some people can do this, not everyone, by following a low-calorie weight loss program. 

[00:24:50]: Basically, what that does is, as people lose weight, they're losing fat from inside their liver and pancreas and these are key organs that help to manage blood sugar levels. 

[00:25:02]: So, by kind of stripping away that internal fat you're allowing these organs to work properly again and people's blood sugar levels to come back into a target range. So really transformational, we funded the DiRECT trial, which showed that the remission from type two can be supported in a kind of primary care setting. 

[00:25:22]: And because of our research, and the research of others all around the world, and our research led by Professor Roy Taylor and Professor Mike Lean, the NHS this year rolled out a new service for people with a new diagnosis of type 2 diabetes called the Type 2 Diabetes Path to Remission. 

[00:25:42]: So, this is being rolled out across the UK and it's based on the DiRECT kind of protocol and it's a weight loss diet to help people lose weight and put their type 2 diabetes into remission.  
[00:25:55]: I think it's really important to say that it's not possible for everyone, we know that, and this DiRECT kind of approach, this calorie weight loss approach, um, doesn't suit everyone and that-and we know that we've got evidence to show that, and we've heard it from many people as well. 

[00:26:10]: So, we're not stopping here. We know we want more people to have a chance of going into remission, so we're carrying on funding research to find out different ways and different dietary approaches that can suit different people. So, we've recently funded a big study called New Dawn, led by Professor Susan Jebb, which is testing lots of different weight loss approaches for people with type 2 diabetes. 

[00:26:32]: We want basically people to get a diagnosis of type two and then to be able to find an approach that suits them, suits their lifestyle, and gives everyone the best chance of going into remission. 
 
[00:26:44]: So, for me, that's really exciting, you know, we've been investing in this area for, you know, 15 odd years. And not often do you start with an idea. Professor Roy Taylor and Mike Lean had this idea 15 years ago, and now we've got a service in the NHS based on their idea. So, it doesn't happen that quickly usually. Um, so, you know, really just amazing example of having a really brilliant idea and showing that it works and getting it out there and then working with the NHS to make sure, um, people have access to it. 

Jack [00:27:20]: Yeah, absolutely. And just to follow up on what Lucy was saying, if you're interested in learning more about the DiRECT study and the New Dawn study, we have links on the website and there'll be links in the episode notes where you can find them. And you can also find the link to the Research Impact Report, which Lucy mentioned to highlight all our amazing achievements over the past 85 years.  

[00:27:39]: And Lucy, looking to the future, which research projects heading into the new year, are you particularly excited about? 

Lucy [00:27:46]: Can I be really selfish here, Jack?  

Jack [00:27:48]: Of course, yeah! 

Lucy [00:27:50]: As a person with type 1 diabetes, the one that gets me, you know, really excited for the future is our Type 1 Diabetes Grand Challenge, which is a new program of work we are running in collaboration with JDRF and the Steve Morgan Foundation, who have been incredible and donated £50 million into this program of research. 

[00:28:30]: And this program of research, you know, is so exciting because it's new, it's bringing together the UK's, you know, best and leading diabetes charities. We've got backing from the Steve Morgan Foundation, and we've got the whole kind of type 1 diabetes research community excited and rallying around and coming together and collaborating. 

[00:28:50]: And we're all working together to this goal where we need a new treatment for type 1 or treatments, you know, we're all relying on insulin, we've been relying on insulin for 100 years. So, the potential of this program is massively exciting for me on a personal level and professionally.  

[00:29:05]: So, there's three areas that the Type 1 Diabetes Grand Challenge is funding, three research areas. So, the reason we picked these three areas is because we had scientific experts from all around the world telling us these are the areas with most potential, with most promise to get us closer to new treatments and hopefully one day a cure for type 1. 

[00:29:26]: Um, and we also obviously, what we always do with our research is talk to people with type 1 diabetes and say, what do you want? What's important for you? So, all those things came together to help us land on these three areas.

[00:29:38]: So, the first two areas for me are so exciting because combined, hopefully this will lead to a cure one day. So, take a step back. The first stream of research we're funding is to find ways to make new beta cells in the lab. Um, at the moment we can do that, but they're not brilliant. They don't function so well. 

[00:30:01]: The reason we want to make new beta cells in the lab is because ultimately we want to have an unlimited supply so that everyone with type 1 diabetes in the world has access to new beta cells so they can be transplanted into them and they can make their own insulin again. Fantastic.
 
[00:30:18]: We can do that at the moment with, um, pancreases, um, like donor cells when people have died, but obviously there's not many of those to go around. Um, and that's not going to be the answer for the majority of people with type one diabetes. So, we need a way to kind of basically set up a beta cell factory and produce lots of them. 

[00:30:34]: Um, so you've got type one diabetes, you've got these factory-made beta cells transplanted into you, they're making insulin, but we all know our immune systems are programmed to eventually kill these off. So that's not, on its own, the kind of answer. That's not going to be a cure on its own. What we need is a way to protect these cells either by reprogramming the immune system, so it no longer attacks them, or by kind of shielding these cells. 

[00:31:02]: So, the second area of work that we're funding is looking into the root causes of type 1 diabetes and working out how we can stop that immune system attack. And once we've got treatments to do that, and once we've got lots of beta cells to give people combined, we hope that one day that will be a cure.  

[00:31:22]: So, you've got new beta cells and your immune system is behaving itself and you're making your own insulin again. Um, and then the third area, which is really innovative and really exciting. So, while we're waiting for a cure, we want people to be able to live much better with their type one diabetes. 

[00:31:37]: Um, so we're investing in next generation insulins, which we hope one day insulin will be a lot faster and a lot smarter. So, we know dosing with insulin at the moment is really tricky to get right. Um, we know there's a lag from when you inject to when it starts working. So, if we can get better insulins that will really transform people's lives and just make type 1 diabetes management a lot easier. So, three really exciting areas, um, with massive potential.  

Jack [00:32:07]: The massive potential you mentioned is certainly very inspiring and it is hopefully quite an exciting future for the world of diabetes research. 

Lucy [00:32:18]: Another research area that really means a lot to me personally, and I know it means a lot to pretty much everyone who lives with diabetes, because we all experience this going about our business to different degrees, is diabetes stigma.
  
Jack [00:32:34]: Yeah, absolutely. 
 
Lucy [00:32:35]: So, as an organization, you know, we know, we've done research to show that the majority of people who have diabetes have to deal with misconceptions about diabetes, have to deal with people asking them questions about, you know, is it about eating too much sugar? 

[00:32:54]: Um, it's a really misunderstood condition and people can feel quite stigmatized and quite judged, unfairly so, absolutely unfairly so. So, as an organization stigma is really important to us. And we also know that, you know, people who feel stigmatized because of their condition, um, sometimes it's stopping people accessing the healthcare they need. 

[00:33:17]: So it's a, you know, really important issue because not only does it affect people's mental, sort of, psychological wellbeing, but it also can have a
really significant effect on their physical health because it's stopping them accessing the care they need. So, it needs to end. We need to work out why it's happening and how to stop it happening. 

[00:33:36]: So, we're funding research now. To do exactly that, to understand stigma better, understand why it develops and work out ways that we can, um, put in place to really address it and challenge it.  

Jack [00:33:50]: I think it's a really important point, Lucy. And for anybody listening that is interested in learning more about stigma, you can check out episode seven of our podcast, where we talk exclusively about stigma.
 
[00:34:00]: Thank you, Lucy, for taking us through that and thank you to everyone for listening and thank you to everyone who has donated to us and has helped to be able to fund the research that we do.
 
[00:34:10]: Lucy, thank you so much for coming on the episode today and discussing the research that we fund and fuel in our bid one day to stop diabetes forever. Thank you so much.  

Lucy [00:34:19]: Thanks for having me, Jack. 

Jack [00:34:25]: That's all for this episode of Diabetes Discussions. Thank you for listening. And to find out more about what we're doing to celebrate World Diabetes Day 2023, you can follow our activity on our socials or visit our website at diabetes.org.uk  

[00:34:42]: For more information on the research discussed in this episode, you can search Diabetes UK online, or check out the information and links in our episode notes. 

[00:34:50]: Don't forget to hit subscribe so you never miss an episode, and if you like what you've heard, please rate and review to help others discover the podcast. Thanks for listening, see you next time.