Your priorities for Type 2 diabetes research: The top 10 They’re here. The difference priorities make In 2011, the top 10 research priorities for people with Type 1 diabetes were found. Ever since researchers around the world have been making progress in tackling them. Turn to page 22 The top 10 research priorities for to find out how. Now people with Type 2 diabetes and those who care for them have their people with Type 2 diabetes. top 10 priorities too. Thousands of people helped us along the way Some of them will not surprise you, some we’re already doing a lot of work into, others A huge 4,000 people helped us in our search for the Type 2 diabetes research priorities. Here's have had little investigation. All of them show what matters most to people living with and why they wanted to help. treating Type 2 diabetes. We found them with the James Lind Alliance and the help of more than 4,000 people with “I thought it was important to come together with a diverse range of people, Type 2 diabetes, carers and healthcare professionals across the UK. with different insights, to create a shared vision for the future of research.” Rachel Armstrong, Community Matron and carer of her mother who has Type 2 diabetes Why we need research priorities Type 2 diabetes is one of the fastest growing health crises of our time. We need to “I felt it was crucial that the voices of people with Type 2 from ethnic minority improve the lives of those who have Type 2 diabetes, and prevent more people from backgrounds are heard, especially considering ethnicity is a key risk factor developing the condition. for the condition.” Tony Kelly, living with Type 2 diabetes and Diabetes UK Community Champion There are almost 3.6 million people in Everything we know about treating the UK diagnosed with diabetes. diabetes, technologies and management is a result of research. 90 percent of these have Type 2. “I wanted to give healthcare professionals a say. I thought that research judged But there’s still a long way to go a priority by those on the front line of Type 2 diabetes could have great value.” Around 1 million are estimated to in our fight against diabetes. have diabetes but have not been Katie Gray, podiatrist who works with people with Type 2 diabetes diagnosed and 11.9 million are at For every £1 the UK spends on increased risk of getting Type 2. caring for diabetes, it invests just Read on to see what made it into the top 10. half a penny on research1. To maximise the impact of research, we’re giving people with diabetes a louder voice. Scientists and research funders usually make decisions around what to research. But with only a limited amount of funding available, we're committed to changing this. Dr Elizabeth Robertson, Director of Research at Diabetes UK, explains “We need to make sure research that we fund has the greatest possible benefit for people with diabetes. Knowing the most important priorities of people living with or treating Type 2 diabetes will help us direct funding to where it’s needed most.” 1 Research spend figures are derived from the UK Health Research Analysis 2014 www.hrcsonline.net/pages/uk-health-research-analysis-2014. People with Type 2 diabetes and Figures include research infrastructure spending by funders of specific medical conditions, but do not include an attribution of infrastructure spending by research funders focused on multiple health conditions. NHS spend for diabetes was sourced from Hex et. al., Estimating healthcare professionals deciding on the the current and future costs of Type 1 and Type 2 Diabetes in the UK, Diabet. Med. 29, 855–862 (2012) : dx.doi.org/10.1111/j.1464- top 10. 5491.2012.03698.x. 3 Priority 10 Priority 9 What role do fats, carbohydrates and proteins play in managing How can psychological or social support be best used to help Type 2 diabetes, and are there risks and benefits to using people with, or at risk of Type 2 diabetes, and how should this be particular approaches? delivered to account for individual needs? Thinking about food suddenly becomes a vital part of anyone’s life when they have Type 2 diabetes. Type 2 diabetes is about more than just the pancreas. For many, it brings new challenges, confusion, But too many people aren’t sure what they should be eating. And it’s getting more confusing. For a frustration, guilt and anxiety. And it can be lonely. Despite this, psychological and social support for long time the advice has been the same, eat a healthy, balanced diet. But, increasingly, different diets people with Type 2 diabetes is all too rare. are becoming popular. “The serious consequences of living with Type 2 diabetes are underestimated. “More research should be done on how the major food groups affect the People may feel isolated and struggle to adapt to changes that may be required. management of Type 2 diabetes. There are options which contradict the current Having psychological and social support is paramount to help people manage advice of a ‘balanced’ diet, such as a low carb high fat plan. And we need to their condition, but we need to understand how best to deliver this.” understand more about how effective these can be.” Ingrid Small, works with people with Type 2 diabetes in a Manchester Mental David Roberts, living with Type 2 diabetes Health NHS Trust What we already know What we already know Carbohydrates are the only food group that directly affect blood glucose levels. There’s a lot of debate around Support works. People who get social support from friends and family, healthcare professionals and the amount of carbohydrates people with Type 2 diabetes should eat to best manage their condition. support organisations, are better able to manage their condition, more likely to make lifestyle changes and feel less distressed 1. One trial compared the effects of two diets in people with Type 2 diabetes. One was very low in carbohydrates, low in ‘bad’ fats and high in ‘good’ fats. The other was high in carbohydrates and low People with Type 2 diabetes who get psychological support have also been shown to have better blood in fats. The diet lower in carbohydrates was linked to better blood glucose control, a lower risk of heart glucose control and less distress, than people who didn’t receive any help 2. disease and taking fewer diabetes medications1. But we don’t know the long-term effects on health. It’s also thought that Mediterranean-type diets are effective at improving blood glucose control and Why we need more research lowering heart disease risk in people with Type 2 diabetes 2. Safer blood glucose control and less distress could mean fewer complications and fewer people experiencing the emotional problems diabetes can bring. Why we need more research More research will allow us to find the most effective forms of support and show how valuable support We know that driving down blood glucose levels means fewer complications and that what people eat can be as part of routine Type 2 diabetes treatment. By finding out more we’ll be able to offer the right has a crucial part to play in this. support to the right people, and improve their wellbeing. By understanding the risks and benefits of different diets, that focus on eating more or less of particular food groups, people with Type 2 diabetes can feel more confident about the approach they choose. What we’re working on right now And along with dealing with confusion and anxieties around what to eat, healthcare professionals will be able to support people to pick a diet which works best for them. We’re funding work to understand how we can best support specific groups of people with Type 2 diabetes. At the University of York, Dr Najma Siddiqi is hoping to find better ways to support people with a mental health condition manage their diabetes. At King’s College London, Professor Lance McCracken is hoping to help people with diabetic neuropathy manage their pain by adapting a type of psychological support, called Acceptance and Commitment Therapy. 1 Tay, J., Luscombe-Marsh, N. D., Thompson, C. H., Noakes, M., Buckley, J. D., Wittert, G. A., ... & Brinkworth, G. D. (2015). Comparison of low-and 1 Strom, J. L., & Egede, L. E. (2012). The impact of social support on outcomes in adult patients with type 2 diabetes: a systematic review. Current high-carbohydrate diets for type 2 diabetes management: a randomized trial. The American journal of clinical nutrition, 102(4), 780-790. diabetes reports, 12(6), 769–781. 2 Esposito, K., Maiorino, M. I., Bellastella, G., Chiodini, P., Panagiotakos, D., & Giugliano, D. (2015). A journey into a Mediterranean diet and type 2 2 Ismail, K., Winkley, K., & Rabe-Hesketh, S. (2004). Systematic review and meta-analysis of randomised controlled trials of psychological interventions diabetes: a systematic review with meta-analyses. BMJ open, 5(8), e008222. to improve glycaemic control in patients with type 2 diabetes. The Lancet, 363(9421), 1589–1597. 4 5 Priority 8 Priority 7 What causes nerve damage in people with Type 2 diabetes, who Should diet and exercise be used as an alternative to medications does it affect most, how can we increase awareness of it and for managing Type 2 diabetes, or alongside them? how can it be best prevented and treated? Once someone is diagnosed with Type 2 diabetes they need to constantly manage their blood glucose High blood glucose levels can damage small blood vessels which supply the nerves.