DRWF Research Manager Dr Eleanor Kennedy reports from the second day of the Diabetes UK Professional Conference in Liverpool.
As the second day of the Diabetes UK Professional Conference dawns in Liverpool the rain is biblical. It is clattering down and people are queuing everywhere for buses or taxis or running with umbrellas up to shield them from the elements. But I am pleasantly surprised to see how many people have made it to the conference centre despite the weather for Professor Timo Otonkoski’s talk on stem cells. Professor Otonkoski from the University of Helsinki is at the forefront of this kind of research and he is no stranger to the DRWF having been a member of the Research Advisory Board for our sister organisation, the Diabetes Wellness Sverige, in Sweden for three years.
I am often asked when stem cells will be available for the treatment of diabetes. And it’s actually a very hard question to answer particularly when, just this week, the media has been lit up with stories of stem cell treatment apparently “curing” HIV in a patient. But that is a very different kind of case – this one relates to the treatment of Hodgkin lymphoma, a cancer of the lymphatic system, rather than the HIV that the patient also had. It is relatively well established that a person’s own harvested stem cells can be used effectively for the treatment of leukaemia or lymphoma.
Using stem cells to treat diabetes is quite a different matter because this is a complex metabolic condition and not a blood cancer. That disclaimer to one side, research continues apace to see if scientists can create stem cells that can be used in animal models to treat animal models of diabetes. Still quite far from a therapeutic use in clinic, Professor Otonkoski gave a state-or-the-art talk that outlined progress from just ten years ago when differentiation protocols were first being developed to today when we are working towards more refined, humanised animal models for type 1 and type 2 diabetes that will allow researchers to work on approaches for scalable 3-D differentiation which could more closely mimic the islet of Langerhans anatomy.
From here, I head over to a second busy lecture theatre to hear another DRWF stalwart. Professor Anna Gloyn, from the University of Oxford, is this year’s recipient of the prestigious Dorothy Hodgkin Lecture. For many years, whilst carving out an internationally recognised career in the genetics of type 2 diabetes, Anna was a member of the DRWF’s Research Advisory Board in the UK.
A passionate advocate of women in science, Professor Gloyn gives a tour de force lecture carefully guiding the audience from the complex genetics of proteins involved in insulin secretory vesicles to good examples of precision medicine that can allow physicians to rethink how they treat people with diabetes.
We already know that people with monogenic forms of diabetes, forms that are caused by a sequence change in just one gene, can have their treatment changed, for example, from daily insulin injections to oral anti-diabetic drugs. But precision medicine is now demonstrating that neither type 1 diabetes nor type 2 diabetes is a single condition. They are actually clusters of conditions and some people will respond very differently to drugs than others.
This kind of science is helping us to drill down into these clusters more effectively and allowing us to move towards an era of more tailored medicine. By identifying which gene mutations are responsible for which responses, researchers can work towards taking bench science right to the bedside and allow clinicians to make more informed decisions about how to treat individual patients based on the patient’s individual genetic profile.
But with eight simultaneous streams running through the conference each day, there is actually too much choice. How can I be in more than one place at the same time?! Should I head towards Caring for people with diabetes related foot care issues? Or opt for Macrosomia: is it inevitable, is it preventable and does it matter anyway? I choose, instead, a debate on whether continuous glucose monitoring (CGM) and continuous subcutaneous insulin infusion (CSII) is a better option in children with type 1 diabetes than CGM with multiple daily injections.
The debate goes clearly in the favour of the charismatic Professor Thomas Danne from the Diabetes Centre for Children and Adolescents at the Children's Hospital in Hannover, Germany who speaks in defence of CGM with CSII but it does catalyse a number of interesting questions from the audience about cost and availability across the UK and abroad and, importantly, how to select which patients will adopt the technology and respond better. It’s an interesting parallel with the previous session. Is this an example of precision medicine? Is this about using all of the available information to work out who the most appropriate patients are? Some patients are clearly more willing to work with the technology and more likely to succeed in controlling their diabetes given the education and the CGM and insulin pump. Maybe precision medicine is already at work.
I round the day off at the Diabetes UK celebratory evening to hear about The Robert Turner award for research impact. Research impact is a tough nut to crack. How do we define what has and what has not had impact? A grant award may have changed the trajectory of a person’s career or allowed them to leverage substantial funding from another funding agency. And those are valid examples of impact. But what about a study that changed the way we define type 2 diabetes and how doctors care for people with the condition? What about a trial that redefined treatment for type 2 diabetes around the world? What about the UK Prospective Diabetes Study? Now that’s impact.
Professor Rury Holman graciously accepts the first Robert Turner award for research impact, fitting in that he worked with the late Robert Turner and ultimately became synonymous with the trial that even today, 20 years after the first results were first announced, still resonates as one of the few trials that profoundly changed the way the world of diabetes thinks and acts.
Read the blog report from Day 1 of the conference
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Pictured: The Wheel of Liverpool on the Keel Wharf waterfront of the River Mersey