An urgent need to do more for diabetes
Basic science has revolutionised treatments, but here’s why a more coordinated and concerted approach to confronting this deadly disease is needed, fast.
Living a healthy lifestyle. From construction sites to the top end of town, the school gate to GP clinics – the general public gets it. People know that physical activity is important for weight management and healthy eating can reduce the risk of chronic illnesses such as obesity and type 2 diabetes.
Yet, the simple fact is, obesity rates have been increasing for the past 20 years, which means that diabetes incidence are also on the rise.
It’s reported more than two billion people worldwide are obese or overweight, and diabetes affects more than 400 million people across the globe. In Australia alone, almost one million people are living with diabetes.
Furthermore, type 2 diabetes is generally known as ‘mature onset diabetes’ for good reason. It usually develops in adults over the age of 45, but it’s increasingly occurring in younger age groups, including children.
Saturday 14 November marks the 29th World Diabetes Day – a global driver to promote the importance of taking coordinated and concerted actions to confront diabetes as a critical global health issue.
There has never been a better time for scientists to make their work more accessible to the public and for pharmaceutical companies and industry partners to increase their role in the fight against this deadly disease.
BIOMEDICAL RESEARCH RECAP
Before the discovery and purification of insulin almost 100 years ago, patients were typically treated with a low energy high-fat, high-protein diet. Since then, a variety of treatments have been discovered and clinicians now have a range of drugs at their disposal, those that:
- Improve a patients sensitivity to insulin;
- Increase secretion of insulin from the pancreas; and
- Increase the excretion of glucose in urine.
These are generally effective at reducing blood glucose levels for a period of time and are often used before insulin therapy.
Understanding this basic science is necessary and important to the improvement of medical care because, despite centuries of intense investigation, we still don’t fully understand exactly how certain diseases develop and how best to treat them.
The thing is, governments don’t have an unlimited budget to spend on the health and wellbeing of Australians – and research is just one cog in this wheel. This means, as basic scientists we need to continually reinforce why our work is important.
It is critical for scientists to make their work palatable to the general public, to place it in a context that is easily digested. Everyone, including governments, needs to understand why science is important and how it will help all of humanity.
TODAY’S TWO BIGGEST CHALLENGES
So, what’s needed to get us ready for an ageing population and a global forecast of 578 million adults having diabetes by 2030? There are two key focus points.
1. Minimising the number of individuals who will develop diabetes
Given type 2 diabetes is so closely associated with obesity we need to reduce the obesity burden, which is a highly complex issue and is being vigorously pursued from basic scientists looking for new therapies to public health officials striving to make communities healthier.
2. Devising better treatments for patients with existing type 2 diabetes
We need to continually seek to refine the effectiveness of current medications through dosing strategies and delivery systems, for example through automated glucose monitoring systems and insulin pumps. This would take away much of the hour-by-hour stress patients experience when managing their blood glucose levels.
The aim of diabetes treatments is to lower blood glucose. One of the more interesting recent developments relates to the discovery that a protein called SGLT2 is responsible for the reabsorption of glucose in the kidney, thereby maintaining glucose in the body rather than allowing for its excretion in urine.
Scientists surmised that blocking the action of SGLT2 could lead to more glucose excretion and lowering blood glucose levels as a result. This led to the development of a novel class of drugs known as gliflozins, which act independently of insulin. These drugs are now a mainstay for the treatment type 2 diabetes.
In September research led by the University of Melbourne, published in Science Translational Medicine, also found a newly discovered protein produced by the liver helps to control blood sugar levels. We engineered a long-lasting form of this protein called SMOC1 which, if it works the same way in humans as in mice, would only need to be injected once a week – rather than given daily as is the case for many current diabetes medications.
CALL FOR COLLABORATION
To take these efforts from bench side to bed side, more co-funding from pharmaceutical companies and industry partners is needed. In many ways they are the end beneficiaries of basic science discoveries and some input at the early stages might move good ideas towards drug development at a much faster pace.
Representatives in the pharmaceutical industry often use the term ‘glucose-plus’. They want to see a compound that does more than ‘just’ reduce blood glucose – perhaps it also reduces body weight, improves kidney function or reverses fatty liver.
In many ways there is a misalignment of the desires of industry and what basic scientists think is possible in terms of treating multiple aspects of this disease.
These companies need to invest millions of dollars to get a drug to market, so one can understand their desire for the wonder pill. In reality, it’s more likely that smart combinations of drugs will be required to treat diabetes and its complications. We look forward to meeting that challenge together to not only reduce the burden of this disease, but also help millions more realise a healthy lifestyle.
Head, Department of Physiology, School of Biomedical Sciences, University of Melbourne
Disclosure statement: Matthew Watt receives funding from the National Health and Medical Research Council of Australia and the Diabetes Australia Research Trust for this work.
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