DRWF Research: Developing health models for prevention and treatment of diabetes
Read Day Six of DRWF Research Manager Dr Eleanor Kennedy’s blog reports – now into the second week of Diabetes UK’s new-look Professional Conference.
The Diabetes UK Professional Conference is advertised as an event of more than 60 sessions offering named lectures and Professional Interest Group meetings alongside a range of multidisciplinary content to update and educate healthcare professionals, researchers and scientists, although I must admit that there is not as much for basic scientists as there usually is. However, I will keep looking!
What can I offer you today?
Well, I start the day at a session entitled IMI-RHAPSODY: Biomarkers of glycaemic deterioration, innovation and next steps, which is quite a mouthful. Professor Ewan Pearson is the chairperson for this session and he is another well-known face at DRWF as a former member of the Research Advisory Board.
Professor Pearson introduces the session as conveying “…a process of basic science discovery through to population-level data analysis through to how do we actually take biomarker discovery into clinical trials…”.
Perhaps my quest for basic science is about to be answered!
The IMI-RHAPSODY is funded to the tune of 18.5 million Euros by the Innovative Medicines Initiative and comprises a number of pharmaceutical companies, academic organisations and university hospitals among others. The stated goal of RHAPSODY is to define a molecular taxonomy of type 2 diabetes that will support patient segmentation, inform clinical trial design and the establishment of regulatory paths for the adoption of novel strategies for diabetes prevention and treatment. The specific goals within this overarching mission statement are to define disease trajectories, collect bio-samples and generate multi-omic data, to identify diagnostic and prognostic biomarkers and to define how biomarkers predict dysfunctions in beta cells and/or in insulin target tissues. Through all of this, the team involved hopes to develop health economy models for the use of biomarkers in prevention and treatment.
It’s a lofty set of aims and ambitions - what does it all actually mean for the person living with diabetes?
Well, the first important part of this is the basic science bit. By using preclinical, animal models, the team aims to identify candidate biomarkers for the progression of type 2 diabetes, identify novel regulators of beta cell adaptation to metabolic stress and identify plasma biomarkers predictive of beta cell function and identify the tissues and metabolic pathways involved in the production of these biomarkers.
Much of this work as it progresses into clinical models is underpinned by some very complex analysis of big data to analyse multiple cohorts in parallel without disclosing any sensitive, patient-based data. Coupling all of this together has allowed the researchers to provide a new granularity on the likely molecular processes involved in diabetes pathology in each of the five diabetes sub-groups originally described by a Scandinavian team led by Professor Leif Groop, in a DRWF-funded study.
It's an interesting session packed with results and enough basic science to satisfy my appetite so, from here, I jump into something completely different…
Integration of emotional and psychological support into routine care
The first talk, Making mental health the golden thread in diabetes care, focusses on the experience in north west London and starts with a thought-provoking statistic. Seven in 10 of people interviewed for Diabetes UK’s Too often missing report, said that living with diabetes they often felt overwhelmed by the demands of the condition. Of these, three-quarters said that it affects how they manage their diabetes.
The scale of the challenge facing mental health teams is huge given that diabetes (both type 1 diabetes and type 2 diabetes) increases the incidence of depression by nearly 40% and around 20% for anxiety and eating disorders compared to those without diabetes. Moreover, people with pre-existing mental health issues at the time of diagnosis can have about a two-fold risk of suboptimal glycaemia management which, in turn, can lead to a vicious cycle of diabetes complications further affecting mental health.
Pandemic impact on psychological wellbeing
Of course, never being far away from Covid-19 throughout the conference to date, there has been a recognised impact of the pandemic on mental health with trauma, bereavement, financial instability, disrupted education, inactivity and isolation all playing key roles.
This means that there are two key areas of diabetes psychology concern – the support and increasing competencies of the diabetes multidisciplinary team (MDT) in not just recognising but acting appropriately on distress for the person with diabetes and the impact of this increased chronic demand on the health and wellbeing of healthcare professionals and the diabetes MDT.
One speaker stressed the fact that “mental health” is an unhelpful catch-all phrase. Psychological wellbeing is more appropriate as it describes a continuum with normal stress reactions are one end of the scale and diagnosable mental ill-health at the other. This continuum of psychological wellbeing for people with diabetes ranges in severity and content and information from a good assessment can be mapped to help to identify these.
Disruption and innovation
The session ended with a look at the context of Covid-19 from a healthcare professional viewpoint. The pandemic has been a disruptor and an innovator for diabetes services, but burnout, anxiety and post-traumatic stress disorder are real issues so the mental health - or psychological wellbeing – and emotional needs of our healthcare teams need to be centre stage as well. However, this speaker highlighted the issue of culture in the healthcare setting “…where sometimes it’s a badge of honour to be resilient and coming to work when you’re feeling slightly unwell or to address hard work and stay late”.
Is that healthy? She suggested not and that all healthcare professionals need to be better equipped to provide emotional and psychological support for people living with diabetes though improved training and support for their own mental health.
So, from molecules to mental health and from biomarkers to better resources, Day Six covered it all!
Further reports to follow – visit DRWF news page
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