Diabetes

There are two types of diabetes whose causes and management are different:

• Type 1 diabetes occurs in young subjects, often during childhood, and is due to an autoimmune destruction of the pancreatic islets which no longer secrete insulin.
• Type 2 diabetes (90% of diabetes cases) occurs later, in adulthood, in relation to insulin resistance (hepatic, muscle and fat cells are less sensitive to the action of insulin; the result is increase in blood glucose levels and insulin secretion by the pancreas – hyper insulinemia, up to the exhaustion of pancreatic cells).

The main risk factors for type 2 diabetes are linked to lifestyle – too fatty and too sweet food, physical inactivity, obesity. Other factors that can intervene are certain medications (eg neuroleptics) or the unbalanced intestinal flora (microbiota).

The chronic complications of diabetes generally occur in the long term after 10 to 15 years of evolution and are essentially linked to multi-organ atherosclerosis:

• CVA : cerebral vascular accident
• Myocardial infarction : each year there are 1000 deaths among 10,000 diabetics hospitalized for a myocardial infarction
• Lower limb amputations – arteriopathy : each year 9,000 diabetics are amputated
• Dialysis – nephropathy : every year 3,000 diabetics are on dialysis or undergo a kidney transplant

Other diabetes-related complications are:

• ocular – diabetic retinopathy
• peripheral nerves – neuropathy
• hepatic – diabetes is an independent risk factor for the accumulation of fat in the liver (“fatty liver disease” or NAFLD) and for liver cancer. Learn more.

Lifestyle measures play a major role in the management of diabetes and aim to:

• A balanced diet
• an increase in physical activity
• weight loss

The main drugs used are:

• metformin, sulfonylureas to stimulate insulin secretion,
• DDP4 inhibitors that block the degradation of GLP1
• SGTL2, or iSGTL2 which inhibit glucose reabsorption in the kidney

Glucagon-like peptide-1 (GLP1) receptor agonists are now widely used and act by several mechanisms. They slow down gastric emptying, limit appetite and stimulate insulin secretion, but only in the event of a rise in blood sugar (thus avoiding the risk of hypoglycaemia).

At the IHU, research on diabetes goes from the most fundamental aspects to helping patients on a daily basis. Thus, the teams are interested in the links between diabetes and other metabolic diseases such as non-alcoholic fatty liver disease (NAFLD) with original research avenues: role of lipids in cell membranes (sphingolipids) or certain liver cells in particular involved in inflammation.

They are also studying the relationship between the aging of adipose tissue and insulin resistance, a true pre-diabetic state.

The impact on insulin resistance of bariatric surgery, which aims to reduce fat mass, is also actively studied.

A new line of research to which the IHU is contributing has just opened up, it concerns the impact of diabetes on heart disease, in particular heart failure, and aims in particular to understand the beneficial effects on the heart of new antidiabetic drugs.

One of the feared complications of diabetes is the diabetic foot which can lead to amputation; the teams have implemented innovative treatment for this disease and, in collaboration with engineering students on campus, have developed a connected insole to prevent it.