Experts examine the diabetes surge: its causes, research breakthroughs, and what lies ahead
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To mark World Diabetes Day and as part of the IA4T2D project, the GCAT|Genomes for Life team at Germans Trias i Pujol Research Institute (IGTP) has conducted interviews with leading scientists in the field of diabetes. Each expert shared valuable insights into the causes, challenges, and potential solutions for managing and preventing this widespread disease.
Diabetes is a chronic disease that occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces. Its prevalence rose from 108 million in 1980 to 422 million in 2014, and it is estimated to rise beyond half a billion by 2030. The situation is even more concerning in low- and middle-income countries, where the mortality rate from this medical condition has increased.
Diabetes is not a single disease. Most of the affected, though, have a certain form, type 2 diabetes (T2D), previously known as non-insulin dependent or adult-onset diabetes. Until recently, this type of diabetes was mostly seen in adults, but it is now becoming increasingly common in children. A healthy diet, regular physical activity, maintaining a normal body weight, and avoiding tobacco use are all effective ways to prevent or delay its onset. To reduce its impact, we need to gain a better understanding of how environmental factors interact to strengthen prevention efforts.
GCAT|Genomes for Life, a strategic project of IGTP, is involved in a project that harnesses artificial intelligence to predict and prevent type 2 diabetes. The IA4T2D project aims to develop predictive methods using artificial intelligence approaches that integrate genetics, clinical data, lifestyle factors, and environmental data from T2D patients. By combining these diverse data sources, its promoters intend to create comprehensive models for accurate risk assessment. Additionally, the project will incorporate epigenetic changes related to environmental exposures into these predictive models. This holistic approach, titled "IA4T2D: Development and Implementation of Integrated Artificial Intelligence Models for the Prediction of Type 2 Diabetes Risk" seeks to enhance our understanding of how various factors interact to influence diabetes risk, ultimately leading to more effective prevention and management strategies for patients.
The initiative is a collaboration between teams from the Barcelona Supercomputing Center-Centro Nacional de Supercomputación (BSC-CNS), led by Dr David Torrents, the University of the Basque Country/Euskal Herriko Unibertsitatea (UPV/EHU) and IGTP, and is part of the Complementary Plan for Biotechnology Applied to Health, coordinated by the Institute for Bioengineering of Catalonia (IBEC).
The GCAT team spoke with leading experts in the field to gain insights into the causes and potential solutions for the diabetes epidemic. Dr Dídac Mauricio, head of the Endocrinology, Diabetes and Nutrition Research Group at the Sant Pau Research Institute, director of the Endocrinology and Nutrition Department at Sant Pau Hospital and scientific director of CIBERDEM; Dr Sílvia Bonàs-Guarch, staff scientist of the Computational Biology and Health Genomics group at the Centre for Genomic Regulation (CRG); and Dr Josep Maria Mercader, assistant investigator at the Massachusetts General Hospital, instructor at Harvard Medical School, i affiliate faculty at the Broad Institute. Also, with the participation of Dr Rafael de Cid, leader of GCAT.
From left to right: Dídac Mauricio, Josep Maria Mercader and Rafael de Cid.
What is behind the rise in diabetes cases?
When asked about the reasons for the rise in diabetes cases worldwide, all three experts pointed to lifestyle changes as a primary driver. Dr Mauricio emphasised the "radical change in the lifestyle of human beings in the past few decades", particularly in dietary habits and decreased physical activity, which has led to increased rates of overweight and obesity, conditions closely linked to T2D. Dr Mercader echoed this sentiment, adding the ageing population and social disparities to the mix. "Healthy food, opportunities to exercise and easy access to healthcare may not be a problem in Spain but it is in other countries where these are highly dependent on socioeconomic status".
Dr Bonàs-Guarch, while emphasising the crucial role of lifestyle factors, also highlighted the significant influence of an individual's genetic predisposition. Although it is not responsible for the increase in cases, genetics must be considered when evaluating disease progression and treatment response. "Understanding the genetic differences allows for the development of more targeted treatments, improving efficacy and reducing side effects for patients".
Breakthroughs in diabetes research and treatment
Recent advances in diabetes research have brought some improvements in both treatments and personalised care. Dr Mercader highlighted the new class of medications based on GLP-1 agonists as a major breakthrough, as they "reduce the risk of diabetes, reduce body weight and also diabetes complications such as coronary artery disease or stroke". However, he explains that "not everyone has equally favourable response to each glucose lowering medications, so although, in average, GLP1 agonist class seem to improve treatment, precision medicine approaches may be used to establish the best medication for each patient".
Similarly, Dr Mauricio emphasised the importance of newer drug classes, such as incretin-based therapies and sodium-glucose co-transporter-2 inhibitors, which are "useful not only as glucose-lowering drugs but also for prevention of chronic complications". He also underscored the advent of new insulin analogues and innovations in insulin delivery systems. Looking to the future, he believes that "the field of diabetes precision medicine is now a new horizon in the application of personalised diabetes care".
Both experts stressed the importance of large biobanks and research cohorts, such as the UK Biobank and the GCAT cohort in Catalonia, which provide valuable data for studying diabetes. Dr Mercader pointed to ongoing efforts like the All of Us program in the US, which aims to include underrepresented populations, ensuring that future treatments benefit everyone. He also made an interesting remark: "The bottleneck will soon no longer be the availability of the data, but the ability and the sufficient workforce to analyse such huge amounts of data".
Notable projects in diabetes research and management
Ongoing projects in diabetes research are paving the way for more precise and effective patient care. Dr Sílvia Bonàs-Guarch is involved in the project "Impact T2d: Una Estrategia Genómica para Implementar Medicina de Precisión en la Diabetes Tipo 2", which focuses on integrating genomic and clinical data to better address the complexities of T2D. " By integrating different types of polygenic risk scores (PRS) and key rare genetic variants, the project will group patients according to their genetic and clinical information. This will allow healthcare providers to match patients with treatments that are better suited to their genetic profile" she explained. Dr Bonàs-Guarch also added that "the project may discover new genetic variants linked to type 2 diabetes, which may offer new avenues for the development of novel diabetes-modifying strategies".
When asked about the project that prompted these interviews, IA4T2D, Dr Rafael de Cid explained: "Exploring how long-term environmental factors – like temperature, air pollution, or access to green spaces – affect type 2 diabetes through epigenetic changes, will help to understand how the environmental influences contribute to the progression of diabetes, which could help healthcare providers better identify individuals or vulnerable communities who may benefit from targeted interventions, developing effective public health strategies". He emphasised the potential broader implications of the study: "While this is a small pilot study, validating our findings in larger cohorts will be crucial to help us build a robust evidence base to support effective interventions and policies in diabetes management".