Researchers measured insulin and C-peptide levels of 87 diabetics(67 men and 20 women). Actually, beta cells in the pancreas that make insulin also release the C-peptide-a polypeptide composing of 31 amino acids. Although C-peptide does not actually affect the blood sugar of a person, the doctors can measure its level to figure out how much insulin the person’s body is making.

What made researchers measure the C-peptide levels along with insulin levels in the diabetics under study? This is because C-peptide gets secreted at a more constant rate across time durations as compared to the insulin secretion. Also, C-peptide levels are more stable compared to the insulin levels (its half-life is nearly six times that of insulin)which facilitates testing of beta cells’ response, the study has pointed out. The results revealed that the persons included in the study had largely the features of adiposity characterised by high body fat, abdominal fat and fatty liver condition, which may not be visible from outside.

The study has concluded that nonobese (BMI below 25) and even lean (BMI below 19) Indians have high body fat, excess fat in the liver and skeletal muscles and lesser skeletal muscle mass. In particular, they have ectopic fat in the liver (non-alcoholic fatty liver disease) and pancreas (nonalcoholic pancreas disease), which may contribute to insulin resistance leading to diabetes even in young age.

Along with high body fat and visceral fat, researchers also found elevated levels of insulin and C-peptide in the 87 diabetic patients studied by them. Such patients would benefit better from pharmacotherapy using insulin sensitizers or weight loss therapy, the study noted.

Summarising the outcome of the study, Dr. Anoop Misra, chairman Fortis C-DOC who led the study, told India Science Wire: “Indians have normal weight-high body fat and low muscle mass. They are not overtly obese but have not only high body fat but fat which is located in the crucial organs of metabolism, i.e., liver and pancreas. Once this occurs, the action of the insulin hormone becomes jeopardized, and blood sugar startsincreasing.”

“Indian physicians should urge patients to lose weight even when they are in normal body mass index (BMI) category to maintain body habitus at leaner side. This could prevent diabetes in those who do not have it yet, and blood sugar levels are better managed in patients with diabetes.” he added.

Credits: India Science Wire

Smart insulin- The major drawback of Type I is the dependence on regular external doses of insulin. While technology has made it more and more manageable with insulin pens, it results in the patient’s life to be largely centered around their medication. In 2015, researchers at the University of North Carolina devised a glucose-monitoring, insulin-delivery system using nanotechnology and biomedical engineering. The smart insulin patch consists of an array of tiny needles which can be used anywhere on the body to detect glucose levels and release insulin accordingly. The technology is currently undergoing revision and pre-clinical testing.

Islet transplant- Recovering healthy pancreas from cadavers and transplanting islet cells into the liver of the patient is an experimental procedure in practice since 2008 to assist with Type I. However, the success rate of this intervention is low due to rejection by the patient’s immune system and dependence on immune-suppressants which increase the risk of infection. It also does not completely reverse the patient’s insulin-dependence and requires regular low doses of insulin. A variation of this therapy at the University of Miami in 2017 was a successful transplant of pancreatic islet cells into the stomach lining of the patient which resulted in her complete remission from Type I and independence from constant insulin injections.

Stem cell therapy- With the evolution of cell biology techniques, we now have the ability to program immature cells to develop into a specific lineage of cells. Viacyte, a California based biomedical engineered a direct delivery device in April 2017, which when placed under the skin delivers stem cells into the bloodstream. These stem cells are programmed to home into the pancreas and develop into mature insulin-producing cells to replace those eliminated by the immune system. While this device is still in its nascent stages of the trial, it would be a life-saver for patients with highly variable glucose levels and severe risk of hypoglycemia.

Immature beta cells- Another variation of the stem cell therapy may be derived from our ability to now image the pancreatic tissue at unprecedented resolution. Scientists from the University of California, Davis identified an immature population of beta cells which can produce insulin but, unlike mature beta cells, are unaffected by the presence of glucose in the blood since they do not have glucose receptors. This discovery could lead to a deeper understanding of how beta cells function, and these immature cells can be manipulated to produce more insulin to keep the glucose levels in check. In February 2018, researchers at the University of Miami identified the exact anatomical location of pancreatic stem cells which can be stimulated to be glucose-responsive insulin-producing cells. Subsequently, University of California, San Francisco reported that beta cells can be ‘trained’ to adapt to a deficiency in oxygen and nutrients due to exposure before and during the transplantation, ideally ensuring an endless supply of insulin-producing beta cells.

IgM immunotherapy- The antibody IgM has been used as a diagnostic marker for Type I since the early 2000s. A team of researchers at the University of Virginia have found a new role for IgM as a vaccine against Type I autoimmunity. Injecting human IgM into diabetic mice resulted in a reduction of autoimmune reactivity, restoration of the balance of cells in the pancreas and reversal of Type I.

Methyldopa- This is a classic case of serendipity in science. Methyldopa is a clinically approved drug to treat hypertension. Scientists at the University of Colorado and the University of Florida screened all FDA-approved small molecules to check if any of them could prevent the autoimmune pathway of Type I from getting activated and Methyldopa was a successful candidate. After successful experiments on mice and a pilot clinical study, the drug can be developed as a vaccine to prevent Type I in those at risk.

Vaccines- Enteroviral infections are known to cause Type I in newborns by triggering an autoimmune response against islet beta cells. At the University of Finland, scientists have developed a vaccine that can potentially eliminate enteroviruses and thus prevent Type I. Another common vaccine B.C.G. used routinely against tuberculosis has been used by doctors at the Massachusetts General Hospital as a vaccine against Type I. They have been successful in a pilot clinical trial by reducing the insulin dosage to one-third of the patient’s initial requirement even after 5-10 years of the vaccination.

The DiRECT study from the Newcastle University, the UK with 300 diabetics aged 20-65 demonstrated that a severely calorie-restricted diet can result in remission of Type II in around 86% of the patients. This is a very promising result since there is a rapid increase in obesity and Type II. A strict weight loss intervention may be a means of both prevention and cure of Type II diabetes. Interestingly, Lorcaserin, a weight loss drug was reported by Harvard University to reduce the incidence of diabetes and the risk of hypoglycemia in patients being treated for obesity. This is supported by multiple recent findings from the neurobiology community that obesity results in activation of the microglia cells in the brain and results in impaired modulation of hormones and increased glucose levels or resistance to insulin and hence treating obesity would also reduce the likelihood of an array of metabolic disorders.

Wearable technology has translated to better diagnostic and monitoring devices for diabetes. We have had home kits for monitoring blood glucose levels since 1981, but almost all variants require blood by pricking the finger with a lancet. A proof-of-concept study in South Korea of a wearable glucose monitor in the form of contact lenses has been successfully tested in rabbits. The silicon lens has an outward facing LED which is switched off in response to high levels of glucose in the tears as detected by a sensitive nano-sized glucose monitor. While this technology needs more work before it can be available for humans, it is a step in the direction of real-time, non-invasive glucose monitoring. Another variant of the wearable monitor is a color-changing tattoo ink with liquid biosensors developed by MIT and Harvard Medical School which can detect changes in the glucose levels, pH or salt in the interstitial fluid between the cells. This study is currently in research mode with no plans for clinical trials. However, the possibility of using the human skin as an interactive display for physiological monitoring is extremely attractive for developing non-invasive diabetes management products as is the case with an armband that can monitor the glucose in sweat via an ionic sensor. The simple bioengineered product from the University of California, Berkeley is primed for continuous monitoring of not just glucose, but also sodium, potassium, body temperature and other physiological parameters with a fully integrated electronic system that can log and update the data into a mobile device, making non-invasive continuous monitoring a possibility.

The Mexican cavefish has been established as a new model organism for studying diabetes. It’s a blind fish that lives deep in the sea with no access to light and food for long periods of time. It has evolved to survive these harsh conditions by having an insatiable appetite and insulin receptors which do not respond in the presence of high blood sugar. As a result, the cavefish is severely diabetic but can function normally. While this physiological make-up is fatal to humans, understanding the function of the glucose regulation in cavefish may be vital to developing novel therapies for diabetes management and cure.

With medical technology advancing fast, we may be looking at a future with the potential to decrease healthcare costs worldwide to deal with diabetes in its diagnosis, management, and prevention.

Sahana Shankar is a Ph.D. candidate in Structural and Molecular Biology at Academia Sinica, Taiwan. When she is not extracting protein, she loves to travel, read and writes scicomm articles. Her passion is to translate the science in fascinating research papers in health and medicine into common parlance. She believes understanding the science behind the world around us is indispensable to our engagement with it. She has contributed to Brainwave, a children’s science magazine from the Amar Chitra Katha family and Newslaundry, an independent news portal.

While World Health Organization (WHO) recommends 800 grams or 5-9 servings of fruit or vegetables per day, the new study has shown that it takes just half – that is, 375 grams to get the desired health benefits. This is important for people living in countries who cannot afford a lot of fruits and vegetables.

Potatoes and other tubers were not included and fruit juices were not considered as fruits while calculating the intake. Legumes included beans, black beans, lentils, peas, chickpeas, and black-eyed peas.

The researchers attribute beneficial effects of consuming fruits and vegetables to presence of antioxidants like vitamin C, vitamin E and carotenoids, and fiber in them, which reduces bad cholesterol, improves insulin response, lowers the blood pressure, prevents fat deposition in blood vessels, and improves cellular function in the body.

“Although there is a popular belief that fruits, and vegetables are healthy, there was no long-term study data to support this and hence our findings are new and significant,” said Dr.V Mohan of the Dr. Mohan’s Diabetes Specialties Centre in Chennai, who contributed to the study.

The decade-long research was done in 18 countries with 135,335 participants aged 35 to 70 years. Healthy individuals with no reported diseases and complications were enrolled for the study. They were given questionnaires to record daily diet, lifestyle habits like smoking, physical activity and alcohol intake, and their socioeconomic status like education, income, and employment.

At the end of the study, researchers recorded the number of deaths, cases of cardiovascular diseases, heart attack, and stroke. Then the data was analyzed to see if consuming higher amounts of fruits, vegetables, and dal is related to the number of deaths and adverse outcomes on health. “We found that regular consumption of vegetables, fruits and legumes protectedpeople from cardiovascular disease and death”, states Dr. Mohan.

“This study does not distinguish between cooked vegetables and raw ones, although it is common knowledge that cooking destroys some of the vitamins and minerals, hence as far as possible we should use raw vegetables like tomato, cucumber, carrot and green leafy vegetables which can be consumed raw”, pointed out Dr. Mohan.

According to Estefania Toledo, professor at the Department of Nutrition of the Harvard School of Public Health, Boston, USA, who is not connected to the study,“Increased consumption of fruits and vegetables should beat the expense of reducing other foods and drinks, such as sugar sweetened beverages, red and processed meat, saturated and trans fat, refined cereals, and sugar rich desserts”. She added that consuming more plant-based foods helps replace detrimental foods, which benefits the overall dietary pattern.

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