To mark World Diabetes Day on Saturday 14 November, Professor Sandra MacRury and Professor Ian Megson from our School of Health, Social Care and Life Science highlight some of the projects our researchers are undertaking to further our understanding of diabetes and its treatment.
Diabetes and COVID-19
One of the most puzzling aspects of the COVID-19 pandemic is the wide range of outcomes for infected people: some experience no symptoms at all, while others are admitted to hospital, can require artifical ventilation or can die as a result of the disease. Amongst the factors that we now know to increase the liklihood of severe symptoms is pre-existing disease in infected people. Diabetes is understood to be one such disease.
At the outset of the pandemic, one of our students switched his project to investigate the link between pre-existing diabetes and severe symptoms in COVID-19. Jacob Roberts is investigating how the virus can trigger changes to cells that constitute the capillaries in our lungs to cause them to become leaky and inflamed, leading to breathing diffiulties. The team believes that these cells in patients with diabetes are particularly prone to such harmful changes, which might contribute to the severe symptoms experienced in COVID-19. Mr Roberts is funded through the Eastern Corridor Engineering Centre, supported by the European Union’s INTERREG VA Programme, managed by the Special EU Programmes Body.
Links between diabetes and cardiovascular disease
By far the biggest impact of diabetes is on the heart and blood vessels, markedly increasing the risk of heart disease, stroke, kidney disease, visual impairment and problems associated with the lower legs and feet. However, the underlying mechanism by which diabetes drives blood vessel disease is not yet fully understood.
In a recently completed PhD project funded by the European Social Fund, Maria Luisa Fiorello found that high sugar caused the cells that line all our blood vessels to stop producing substances that protect against cardiovascular disease and blood clots. The work has been published in the journal Scientific Reports. Dr Fiorello went on to show that a particular type of sugar (fructose) found in fruit and soft drinks has a very profound effect on these cells. These findings have important implications with respect to limiting our intake of refined sugar in our diet.
Remote monitoring of diabetes
The usual test for monitoring overall diabetes control requires regular blood samples. In rural areas this can involve considerable travel. Our research has shown that a method of carrying out this test using dried blood from a finger stab sample which can be carried out in the person’s home and posted to the local laboratory gives comparable results to conventional methods. This has considerable benefits not just for people living in remote or rural areas, but for the wider population of people living with diabetes in the post-COVID environment. Further trials are planned to explore integration of this method into routine practice at scale.
Another new approach to monitoring glucose levels in diabetes is the use of flash monitoring of glucose sensors applied to the arm which can provide a continuous stream of glucose levels over 24 hours. There is mounting evidence for benefits in people living with type 1 diabetes in the community. People with diabetes tend to spend longer in hospital than those without and our rural health and wellbeing research team are working with partners in Northern Ireland and the Republic of Ireland to lead a European Interreg project to explore the feasibility of using these sensors for people with diabetes in a hospital setting and to determine if they can help to reduce time spent in hospital.
This is part of a wider project around unscheduled care in diabetes and the team recently published an article on the role of ambulance staff across Scotland in transporting people with diabetes-related problems to hospital. Further analysis is taking place to examine differences in remote and rural communities.
Supporting foot health with satellites and artifical intelligence
‘Reducing amputations in diabetes’ is a technology-enabled project which has developed and evaluated a new service pathway for people living with diabetes-related foot ulceration in rural Highland areas. The trial uses satellite technology in remote primary care settings to improve connectivity and allow remote consultation for patients and community staff with the specialist diabetes foot team in Inverness. The study, supported by an Innovate UK and European Space Agency grant, involves a consortium of academic, NHS and commercial partners.
Highland has also been selected for exploring the use of artifical intelligence with large health datasets for the prediction of diabetes-related foot problems. If successful, the technology could aid earlier prevention and intervention strategies to reduce ulceration and amputations.The project is funded by the Small Business Research Institute and is being run in conjuction with NHS Highland.
Screening is also an important aspect of prevention in diabetes foot disease. One of the early manifestations of diabetes foot problems is a change in foot pressure which can been an indicator of potential ulceration. As foot pressure measurement is not routinely included in the foot screening process, we have been exploring the use of a Footscan mat to assess pressure measurements in people with diabetes with a view to conducting further trials as part of foot screening in a rural community setting.
Lifestyle and type 2 diabetes
Lifestyle is an important factor in the prevention and management of type 2 diabetes.
Being overweight or obese can contribute to the development of type 2 diabetes and, with the increasing prevalence of these problems nationally, the prevention of diabetes has become an important strategy in Scotland. The use of very low calorie diets has proven to be effective in reversing type 2 diabetes in overweight individuals. We are conducting a study in conjunction with NHS Highland of a very low calorie diet in the prevention of type 2 diabetes for people who have been diagnosed with pre-diabetes.
We are also undertaking a study with High Life Highland which involves exercise trainers supporting a programme to increase physical activity for people with type 2 diabetes in the Highland region.
To find out more about research at the University of the Highlands and Islands, visit www.uhi.ac.uk/en/research-enterprise