Funded Research

Vitamin D is an important hormone which performs a number of vital functions in the body, and lack of it for a period can cause a variety of health problems, many of which relate to bone damage. However, it is common for obese individuals to have a low level of vitamin D in their blood. Research work suggests that low blood levels of vitamin D might make individuals more likely to develop type 2 diabetes, a condition in which the body’s cells become less responsive to insulin, the hormone which tells these cells to take sugar out of the blood for storage. This is why people with untreated diabetes can have dangerously high levels of sugar in their blood. Obese individuals tend to have bigger fat cells. These bigger fat cells are less responsive to insulin than normal sized cells, and also release ‘messengers’ that cause inflammation. This inflammation also makes it more difficult for insulin to work properly. We have done some research in this area already and our work has shown that vitamin D may reduce this inflammation in fat, which could ultimately make the body more sensitive to insulin, thus reducing the risk of type 2 diabetes. We also want to know if obese people have high levels in their bodies of a substance which might block vitamin D from reducing this inflammation. In this study, we shall take samples of fat from the abdomens of people who are having planned abdominal surgery, and use these fat biopsies to measure how much inflammation there is. We would also measure vitamin D levels in their blood and perform a number of non-invasive tests to determine the total body fat mass and where that fat is being stored. We would then analyse these results and be in a better position to say whether people with low vitamin D levels have more inflammation in their fat and therefore don’t respond to insulin as they should.

Many people with diabetes are affected by some form of bladder dysfunction, where the bladder muscle becomes overactive and can cause urinary urgency (a sudden and intense urge to use the toilet), nocturia (waking from sleep to urinate multiple times in a night) and urinary incontinence (leakage of urine). Together, these symptoms can dramatically reduce quality of life. Recent studies in patients with overactive bladder muscles (which can also occur without the presence of diabetes) and animal models of diabetic bladder dysfunction have identified altered levels of cytokines in urine and bladder tissue samples. These are a group of chemicals with important roles in regulating the immune system, which can also affect the behaviour of other organs, so they may cause the changes in bladder muscle activity. In this study we plan to collect samples of bladder tissue from patients with normal bladders and from patients with diabetes, in both cases with or without overactive bladders. By quantifying the amounts of cytokines in these tissue samples and comparing them to measurements of bladder function, we hope to further our understanding of the changes that occur in the bladder to cause the debilitating symptoms of diabetic bladder dysfunction.

Deaths from liver disease are rising more rapidly than any other cause of death in the UK. The most common cause of chronic liver injury in the developed world is non-alcoholic fatty liver disease (NAFLD), which is found in up to 75% of patients with diabetes. NAFLD is a spectrum of disease that includes simple fat deposition to the more aggressive form involving inflammation and scarring in the liver (non-alcoholic steatohepatitis (NASH) that can progress to cirrhosis, liver failure and liver cancer. The factors that determine whether an individual patient will develop the more aggressive NASH are not fully understood although a combination of genetic, environmental and lifestyle factors are likely to play a role. There has been recent interest in the effect of ethnicity in the progression of NAFLD and our group has recently reported that NAFLD is three times more common among patients of Bangladeshi origin compared to other ethnic groups – including other South Asian groups. Our aim is to study the degree to which NAFLD and NASH affect patients with diabetes from different ethnicities and to develop guidelines to help doctors manage patients with NAFLD in an ethnically diverse population, such as ours.

Young people with type 1 diabetes find it difficult to adjust to and deal effectively with their illness as evidenced by poor blood sugar control, serious complications and high mortality. The problem is particularly pronounced in England in the 16 – 25 age group. Our understanding of this national failure is very limited, particularly as scant recent research is available for the UK. Instead of focusing on the negative aspects of diabetes, we want to find out how young people successfully adjust to and integrate the condition into their day-to-day life. They are living through an important transitional period where crucial developments are taking place, which impact on partner, career and other life-style choices. We adopt a novel approach focusing on resilience, which others and ourselves have successfully researched in groups without diabetes. Resilience is the ability to deal effectively with adversity and bounce back from poor wellbeing/mental health and this will be explored in our study. We will use questionnaire data to assess resilience and associated factors such as attachment, social support, self-esteem and recent life events. We will use in-depth interviews and personal diaries exploring issues of self-care, the challenges of the condition and the way individuals deal with these challenges with the aim to develop a deeper understanding of the role of resilience in dealing with a complex and demanding illness. A key element will be the comparison of individuals with good glycaemic control with those with poor control; in line with the resilience approach a key aim will be to provide an initial resilience profile of the young adult with type 1 diabetes with good blood glucose control. This initial study will provide the basis for further applications carrying out a longitudinal study, possibly incorporating neurobiological assessments, and contributing to the development of targeted interventions.