DRU Cymru Research Highlights in 2018
2018 proved to be an exciting year in research! Here are a few of the top highlights:
The Brecon Phenotyping feasibility study was successfully completed
DRU Cymru have supported a feasibility study investigating the optimum way of collecting a biological dataset in people diagnosed with Type 1 diabetes. The study recruited participants from the Brecon Cohort, a database of over 97% of all children diagnosed with T1D in Wales. The study commenced in Cardiff in 2017 and an additional site in Bridgend was opened earlier this year. The study recruited 86 participants.
DRU Cymru staff were involved in the design and set-up of this study from the start, producing the study protocol and public facing information before ensuring all regulatory requirements were met. The DRU Cymru Lab advised the study team on sample collection and the logistics of storage and transport of the samples as well as providing the materials required. The samples collected for this study have been stored in the DRU Cymru Lab and will be analysed at a later date.
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Using Proinsulin for the Diagnosis and Risk Stratification of Gestational Diabetes
DRU Cymru are currently running a clinical trial in pregnant women at risk of developing gestational diabetes mellitus (GDM). GDM is a glucose intolerant state, first identified or diagnosed during pregnancy and is associated with an increased risk of birth complications as well as an increased risk of future development of Type 2 diabetes for mother and baby. Because GDM is typically diagnosed relatively late into pregnancy, there is often only a short window to optimise the glucose lowering treatment. Our study aims to establish whether measurement of proinsulin early in pregnancy can help to identify or predict those who will and those who will not develop the condition. Earlier identification of GDM would offer an extended period to optimise treatment, resulting in better outcomes for mother and baby. In addition identifying those less likely to develop the condition at an early stage could result in less intensive follow-up care, reducing some of the workload from antenatal clinics.
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Ground breaking Type 1 Diabetes Clinical Trial launched in Cardiff
DRU Cymru researchers are trialling a "ground-breaking" drug that helps people with diabetes re-grow insulin-making cells. The research is being conducted in Cardiff and Swansea amongst other sites in the UK and aims to recruit eight participants who have had diabetes for more than two years to take part in wider-ranging trials. The new drug could mean that patients are no longer dependent on injecting insulin and this will potentially reduce many of the problems associated with the chronic disease.
Looking at the silver lining: The CLOUD Study
The DRU Cymru Lab was approached to provide laboratory support to a long-term, multi-centre study investigating the effect of a closed-loop insulin delivery system in children and adolescents with Type 1 diabetes. The lab involvement began at the planning stage, advising on sample collection, storage, transport and analysis. Sample collection ‘kits’ were distributed to the individual centres, prior to the study starting earlier this year. The DRU Cymru lab is responsible for ensuring that all centres continue to have sufficient stock over the 4-year duration of the study, co-ordinating regular temperature controlled shipments of samples from each of the centres and subsequent lab analysis and reporting.
We make it happen: the USTEKID Study
DRU Cymru work package leads, Professors Colin Dayan and John Gregory, were successful in securing a five-year grant from the National Institute of Health Research Efficacy and Mechanism Evaluation programme (NIHR EME). This is the first successful bid from Wales and will be used to evaluate the effectiveness of a monoclonal antibody (ustekinumab), already licensed for use in the treatment of psoriasis and Crohn's disease, as a means of preserving insulin producing cells in young people with recent onset Type 1 diabetes. This study could show that by interrupting the destruction of the insulin producing cells at the time of diagnosis, in the long term some insulin secreting capacity may be preserved and maintained.
Acyl-ghrelin mediated lipid retention and inflammation in obesity-related Type 2 diabetes
A research paper published in Molecular and Cellular Endocrinology by DRU Cymru researchers Professor Jeff Stephens, and Doctors Rachel Churm and Sarah Prior, reported a study undertaken on the protein, acyl-ghrelin, which has been shown to have several effects on the body. One role often debated is whether it can affect how the cells in our bodies store fat and whether this could be affected by high blood sugar. This study, in fat taken from people undergoing weight loss surgery, explored how acyl-ghrelin levels and the gene level of ghrelin related to fat and inflammatory markers within the fat. High blood sugar and acyl-ghrelin levels were shown to have a role in altering how we store fat within our cells, and also that both forms of ghrelin are responsible for a protective immune response which is lost in those with Type 2 diabetes.
Research Dialogue at EASD
DRU Cymru presented highlights from latest research projects at the 54th Annual Meeting of the European Association for the Study of Diabetes (EASD) held in Berlin, Germany. Professor Steve Bain presented results from the ‘PIONEER’ trial, while Professor Colin Dayan discussed his presentation on ‘Immunotherapy in type 1 diabetes’. Dr. Othmar Moser shared recommendations for ‘Basal insulin adjustments around exercise in individuals with T1D’.
Waist circumference linked to future cardiovascular risk in Welsh school children.
Research published in the European Journal of Paediatrics highlighted the associations between metabolic syndrome components and markers of inflammation in Welsh school children. This study examined the relationship between the Metabolic Syndrome and inflammation in 228 Caucasian School children aged 12-14 years in Wales. The study showed that the strongest predictor of the inflammatory aspect of cardiovascular risk and disease was central adiposity. Waist circumference in this group of children was correlated with plasma markers of inflammation, which are associated with cardiovascular risk in later life. The study uniquely demonstrate that waist circumference is the primary link between Metabolic Syndrome variables and markers of inflammation in children. Waist circumference may therefore be a useful population-level screening tool to identify future risk of cardiovascular disease.
Study of the Accuracy of the SmartSensor telemed (SSt) Oral Glucose Tolerance Test Device
The SmartSensor Telemed (SSt) home oral glucose tolerance test device is an electronic device that would have the potential to enable patients to perform an oral glucose tolerance test (OGTT) from home. It is intended to be used for screening the general population for prediabetes and type 2 diabetes, but also has the potential to be used in pregnant women to diagnose gestational diabetes.
As part of the development programme it is necessary to establish how results from this device compare with results obtained from an OGTT performed in a conventional clinic setting. In this study glucose concentrations during an OGTT were tested with fresh blood samples from a population which would be similar to that at risk of gestational diabetes in the UK and compared to reference laboratory glucose concentrations across a wide range of glucose concentrations. The study was successfully completed in June 2018 with 100 participants recruited. Analysis of the results is underway.