Diabetes

Flinders Leads International Trial for New Obesity and Diabetes Treatment

Diabetes Risk For Steroid Therapy

Friendly Gut Bugs

Researchers Tackle Diabetes Riddle

Nerve Damage in Diabetes

Flinders Leads International Trial for New Obesity and Diabetes Treatment
First Published: Enews - June 2010
Updated:

A new bariatric surgery technique, developed by an international collaboration featuring Flinders University surgeons, is showing promise in the treatment of not only obesity but also Type II diabetes and hypertension.

Unlike traditional bariatric procedures which involve restricting or rerouting food or removing part of the stomach, in this new procedure two electrodes are implanted through keyhole surgery and attached to the vagus nerves at the entrance to the stomach.

A device similar to a pacemaker is then implanted just under the skin which sends electrical pulses to block the vagus nerves, which results in the patient feeling fuller and less hungry.

A Flinders team led by Professor Jim Toouli, Professor of Surgery at Flinders University, was second in the world to perform this procedure in 2006 (beaten only by a Mexican team who started earlier because of the time difference).

After successful trials in three centres around the world, the device was found to successfully aid weight loss and specialists also noted it appeared to control type II diabetes and high blood pressure quicker than other forms of bariatric surgery.

Type II diabetes is characterised by high blood glucose levels and is linked to obesity through the accumulation of fat in the liver which can cause insulin resistance.

A second international trial focussed on the implications of the procedure for 30 type II diabetes patients has recently concluded. Flinders was the largest of four trial centres, performing the procedure on 10 patients.

Professor Toouli said the trial has "shown great results" and the procedure could be a significant alternative in the treatment of type II diabetes and high blood pressure if diet and exercise fail to manage the condition.

"Because the procedure is minimally invasive, it could also be used to treat type II diabetes sufferers who are not as obese who would not normally be considering having a major operation."

However, the researchers are yet to determine why the device is more effective in controlling the conditions than traditional weight loss surgeries.

"We believe blocking the nerves could cause hormonal and neurotransmitter changes which may cause this result," Professor Toouli said. "It is now the subject of further laboratory research here at Flinders to better understand how that works."

Diabetes Risk For Steroid Therapy
First Published: Investigator - July 2009
Updated:

Elderly people on long-term steroid therapy could be living with undiagnosed diabetes, researchers have shown.

Staff Specialist and Endocrinologist from Southern Adelaide Diabetes and Endocrine Services Dr Morton Burt said steroids can cause diabetes because they make the body resistant to insulin (the hormone that lowers blood glucose). They also stimulate appetite and cause weight gain.

Dr Burt’s research, which is funded by Foundation Daw Park, through their sponsor Defence Industry company Pacific Marine Batteries, has investigated the reliability of diabetes screening tests for people receiving long-term glucocorticoid (steroid) therapy.

‘Steroids are a common treatment for inflammatory diseases, including chronic lung disease and joint diseases such as rheumatoid arthritis, and are most commonly required in elderly people,’ he said.

Dr Burt compared the amount of blood glucose before eating in the morning (fasting glucose) with a blood glucose measurement before and two hours after a 75gram glucose drink (oral glucose tolerance test). The glucose tolerance test is the current ‘gold standard’ test for diabetes. It is used less frequently than fasting glucose because it is more expensive and takes longer.

Dr Burt found that patients on steroid therapy generally have normal fasting glucose levels. It was only by measuring blood glucose after the glucose drink that diabetes could reliably be diagnosed.

The research team will now investigate the metabolic effects of low dose steroids in elderly patients and why steroids only affect glucose levels after food.

Friendly Gut Bugs
First Published: Investigator - December 2008
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A Flinders Medical Centre endocrinologist says eating foods that encourage ‘friendly gut bugs’ may be a key to preventing Type 1 diabetes.

‘Feeding young children foods rich in inulin and probiotics may actually help protect them against Type 1 diabetes, which is primarily a condition that affects children,’ Professor Nikolai Petrovsky, Director of Endocrinology said.

Inulin-rich foods include onion, garlic, chicory and artichoke. Probiotics can be found in yoghurts and probiotic drinks.

Professor Petrovsky’s comments follow research conducted at the University of Chicago and published in Nature journal which supports the ‘hygiene hypothesis’ that lack of exposure to specific organisms may actually predispose to allergies, asthma, and immune system disorders. In particular, the researchers were able to show that higher levels of ‘good bacteria’ in the gut could lower the incidence of type 1 diabetes.

‘The findings reflect a study I did on identical twins in Denmark during my PhD. We found that in about 40 percent of identical twins, one twin developed Type 1 diabetes while the other did not – which indicates there must be an environmental in addition to a genetic basis for autoimmune diabetes.’

‘It now appears that having good bacteria in the gut, which is an environmental factor because these bacteria are influenced by what you eat, can protect you against Type 1 diabetes even if you are genetically susceptible to it.’

Professor Petrovsky said ‘encouraging the good guys and shutting out the bad guys’ was the best strategy to good intestinal health.

‘That means not overloading children on carbohydrates and sugar which encourages the growth of bad bacteria, and feeding them inulin-rich foods and probiotics to encourage the good guys.’ Professor Petrovsky said the US research could go some way to explaining why the rate of immune diseases such as asthma and diabetes were on the increase in the western world.

‘As a society we’re becoming obsessed with cleanliness, but the research shows that some bacteria should be encouraged – as they can actually help pave the way to good health.’

He said keeping a child on breast milk for the first 6-9 months of their life was best, as breast milk would encourage the growth of the right type of protective bacteria in their gut. ‘And then when they’re weaned, their diet should contain a proportion of fibre and inulin-rich foods suppled by regular ‘top-up’ doses of probiotics from eating naturally-fermented foods such as yoghurt and cheese. So to the adage that ‘we are what we eat’ we need to add the adage ‘our health relies on the bacteria within us’.

Researchers Tackle Diabetes Riddle
First Published: Investigator - July 2008
Updated:

Why do some people with diabetes develop diabetic-related eye disease over others?

It may all be in the genes, according to new research at Flinders Medical Centre.

Researchers have long been confounded as to why some people with well-controlled diabetes go on to develop sight-threatening diabetic retinopathy, while others with out-of-control diabetes do not.

Clinical PhD student Dr Sue Abhary, based in the Department of Ophthalmology at Flinders Medical Centre, is trying to find out why.

‘Diabetic retinopathy is one of the complications of diabetes and while most people with diabetes will go on to develop some sign of the eye disease, in many the changes aren’t sight threatening. Some may not even notice any changes in their eye sight.’

But for some people who reach the extreme end of the scale, she said diabetic retinopathy could result in blindness.

Sue said three factors affect the development and progression of diabetic retinopathy:

• How long the person has had diabetes
• Poor sugar control
• Untreated blood pressure.

However interestingly, some people who have all these risk factors don’t develop any signs of diabetic retinopathy and vice versa.

Flinders researchers believe the answers could be found in the genes, and have begun a research project testing the DNA of patients with diabetes.

‘We think that there is a genetic component, and what we’re trying to ascertain is what gene can make one person go blind over another, and vice versa,’ Sue said.

‘She said preliminary results on 570 patients were indicating that genetics could indeed play a role.

‘While it’s still very early days, we’ve found that there is a variant of a gene in some patients that may protect them from developing diabetic retinopathy – regardless of whether their diabetes is well controlled or not.’

She said the gene called vascular endothelial growth factor (VEGF) is involved in new blood vessel formation and leakiness.

Nerve damage in Diabetes
First Published: Investigator - July 2006
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Understanding diabetic associated nerve damage in the anorectal region is a key focus for Dr Penny Lynn, Senior Research Officer within the Department of Human Physiology at Flinders.

Diabetes forms when blood sugar levels are not controlled either through a decreased production of insulin within the body or the body’s inability to respond to the insulin that is produced. Keeping the blood sugar levels within a normal limit is the best way to reduce or prevent the complications associated with diabetes such as cardiovascular diseases, chronic renal failure, retinal and nervous system damage.

For many with diabetes, the nerve damage can lead to embarrassing complications such as faecal incontinence. This is due to the nerves in the anorectal area being no longer able to properly control the defecation process.

Up to 20% of diabetics experience some sort of defecation related complication such as faecal incontinence over the course of their disease. Understanding which nerves are damaged and in what order they are damaged will lead to a better awareness of the mechanisms causing this symptom and could lead to a better way of controlling or preventing this distressing problem.

“This symptom, while not the most serious, is indicative of an awful lot of nerve damage,” says Dr Lynn. “Many people don’t report this problem as they are too embarrassed, however it is quite common and with more awareness in the processes that lead to this issue we may be able to create a solution.”

Currently little is known about the groups of nerves within this area. A large portion of Dr Lynn’s project will be to identify which types of nerves sense activity in the anorectal area. Once these have been identified it will be easier to trace how diabetes causes this damage.

If the groups of nerves which are predisposed to this type of damage are successfully identified the Flinders team will be one step closer to creating a drug which can protect them.