And there are further startling new insights to come from Imperial’s network of diabetes researchers. While it may seem unsurprising that a patient’s diabetes will influence their health in other ways, striking evidence is emerging of how one type – gestational diabetes, experienced during pregnancy – affects not only the mother’s own health but also that of their child, even after birth.
“Diabetes in pregnancy is associated with a number of risks to the mother and baby, including a greater risk of pre-term labour, stillbirth and congenital malformations,” explains Dr Karen Logan (PhD Clinical Medicine Research 2016), Honorary Research Associate at Imperial’s Department of Medicine. “More recently, associations have been demonstrated between diabetes in pregnancy and longer-term health risks in offspring. Our research showed that diabetes in pregnancy is associated with greater fat deposits in early infancy.”
The mothers in Logan’s study all had their condition well controlled during their pregnancy, but the study’s findings showed that diabetes in the mother can trigger changes in the baby at a very early stage. And that’s worrying, because it throws the problem forward to the next generation. “Long-term health can be influenced in the womb and in early infancy, and diabetes in pregnancy may contribute to the worldwide epidemic of obesity and diabetes,” Logan says.
This deepened understanding of the complex causes and consequences of diabetes only heightens the urgency around effective intervention and prevention. Indeed, the two go hand in hand. And this is where Imperial’s network of expertise is leading the way in delivering a whole new range of diabetes interventions, arising from interdisciplinary collaborations.
For example, Gary Frost, Professor of Nutrition and Dietetics, is working on clinical trials of a cheap food ingredient that works in the same way that appetite-supressing legumes do, and has the potential to prevent weight gain in adults who wouldn’t naturally eat peas and beans by becoming part of their everyday diet. He is also working with clinician and Professor of Practice, Anne Dornhorst, on innovative approaches to gestational diabetes. “Using novel food supplements, we hope to offer women new ways to improve their pregnancy outcomes and long-term health,” says Dornhorst. The sort of interdisciplinary working enabled by Imperial’s collective expertise is, she says, “quite simply essential”.
Professor Bloom enthuses about the range of work being conducted across the university’s departments. “We have a division that looks at metabolic engineering which developed small artificial pancreases; a bariatric arm that can predict who will respond to surgery; a wing studying complications of diabetes; nutritionists looking at the kind of food that will protect us from diabetes; and geneticists working out who’s susceptible. We cover everything from the most basic biology to translational use, doing patients good here and now.”
‘Patients’, however, isn’t a word you’ll hear Professor Chris Toumazou using often. Toumazou is Regius Professor of Engineering, and among his innovations are an artificial pancreas for type 1 diabetics and an intelligent neural stimulator that provides a drug alternative for obesity. His latest venture, though, is taking diabetes intervention out of the realm of hospitals, research labs and policy makers’ offices. Instead, Toumazou and colleague Dr Maria Karvela are the co-founders of a spin-out company, DNA Nudge, that is taking diabetes prevention and intervention into supermarkets and high streets – and directly to ‘consumers’ via their smartphones.
“We now have the ability to sequence DNA on a microchip,” Toumazou explains. “And we know that a DNA-based diet will improve health.” The device offering the help is a blue plastic disc the size of a compact mirror, from which juts a microchip. “This replaces an entire lab,” Toumazou says. “It removes the stigma of it being anything medical.” Karvela adds: “The test helps glucose management, and hypertension goes down. So, the idea is to help people use their genetics to nudge their eating decisions for them.”
The consumer provides a saliva sample from which the chip sequences their DNA and creates a profile of their body’s particular susceptibilities – how well it processes fat, sugar and salt, what foodstuffs are craved, and how the body manages weight and appetite. It then empowers them to go and do something about it. The chip’s results are uploaded into a smartphone app and a wearable smartband that lets shoppers scan any grocery barcode and get an instant thumbs up or down as to whether it’s a suitable purchase for them.
It assists consumers in the course of their everyday life, ‘nudging’ them to make healthier choices that can prevent obesity and diabetes before they ever arise. “It’s not about telling people to eat grapes instead of biscuits,” says Toumazou. “It’s about what biscuits are better
Imperial expertise is opening up a new front in diabetes prevention, using cutting-edge technology to solve the oldest conundrum of public health: how to reach ‘consumers’ before they become ‘patients’. The future of the fight against diabetes just got personal.
To find out more, visit www.imperial.ac.uk/giving/transforming-health