Vol. 6 No. 3: Fall Equinox, 2004
There is a large amount of research being conducted with respect to type 2 diabetes. Some of it is focused on key aspects of the cause of diabetes while other research is geared towards determining what is the best therapeutic approach for managing diabetes and reducing heart attacks and strokes as well as the long-term complications associated with diabetes.
The Causes of Diabetes
The fundamental aspects of the cause of diabetes appear to be increasing insulin resistance combined with a pancreas that eventually fails to produce sufficient insulin. When insulin supply can no longer overcome insulin resistance then blood glucose homeostasis is compromised and diabetes results. There appears to be a number of genes involved in the tendency to acquire diabetes yet typically this represents only the potential to acquire diabetes since environmental conditions must be such that the genetic potential is expressed and diabetes results. Therefore insulin resistance and pancreatic insulin production are both areas of interest.
Insulin Resistance. Research suggests that obesity is a key element in the development of insulin resistance yet obesity is complex as well and also has a genetic component. Researchers continue to try and determine the mechanisms whereby obesity leads to insulin resistance since this may provide insight into therapeutic options and possibly the prevention of diabetes. Even the subtleties of how fat is distributed on the body appears to play a role in the progression of insulin resistance.
Beta Cell Function. The cells in the pancreas that produce insulin are called beta cells. The mechanism behind the failure of the beta cells to produce sufficient insulin is one key area of research. While the function of beta cells is reasonably well understood it is not clear why these cells eventually fail to produce sufficient insulin in some people.
The Canadian Diabetes Association recently announced its updated guidelines for the treatment of diabetes. This of course means the treatment of blood pressure and blood cholesterol as well. Periodically these guidelines undergo revision based on research being done all over the world. The research is geared towards answering numerous questions that still exist regarding how diabetes is best managed and as answers are found the guidelines are adjusted to reflect the new information. Often these studies will focus on blood sugar management, blood pressure management and blood cholesterol management. One very important long-term study being conducted right now is looking at all three of these risk factors and trying to determine the optimal therapeutic approach for each. This North America wide study is called ACCORD, which stands for Action to Control Cardiovascular Risk in Diabetes (www.accordtrial.org) and is in the process of recruiting 10,000 volunteers in 70 centres throughout Canada and the United States. Key aspects of the study will involve an assessment of the benefits/risks associated with aggressive lowering of blood sugars, blood pressure and blood cholesterol in people with type 2 diabetes. This study will finish in 2009 and the results will be very exciting indeed.
Another interesting study is looking at heart disease in type 2 diabetes. In people who have major progression of heart disease and who are potential candidates for heart by-pass surgery it is not clear whether early intervention is beneficial. A major North America wide study is trying to answer this question. Bari 2D (www.diabetesheartstudy.org1) is investigating the outcomes in diabetes patients who receive by-pass surgery versus those who receive medical therapy as the first line of treatment. Patients are randomized to one group or the other and then followed for a number of years while treating their diabetes as effectively as possible.
There are many other areas of diabetes research so keep tuned into our website for more information and more updates.
1Note — www.diabetesheartstudy.org is no longer operational