Curry, current and collective wisdom: New horizons for diabetes
By Dr. Arya M. Sharma
These are interesting times for research into diabetes treatment.
Recently, I chaired and spoke at the opening session of the 1st Canadian National Summit on Metabolic Surgery in Montreal, Quebec. There, I reminded the audience that diabetes currently affects more than three million Canadians, a number that is expected to reach 3.7 million by 2020 as we continue to see the impact of the obesity epidemic.
According to the Canadian Diabetes Association, diabetes is a contributing factor to the deaths of approximately 41,500 Canadians each year, and despite all ongoing efforts, only about 50% of known patients with diabetes are at the recommended target for glucose control.
As conference chair, Dr. Nikolas Christou, highlighted in his introductory remarks, the remarkable remission rates of diabetes and other metabolic problems with bariatric surgery has spawned an increasing interest in surgical options for treating type 2 diabetes, even in patients who may not meet the current criteria for bariatric surgery. Suffice it to say, there is little doubt that the vast majority of diabetic patients undergoing bariatric surgery will experience a marked improvement — if not complete remission — of their diabetes.
Obviously, more work has to be done to determine the risk/benefit ratio of this seemingly drastic approach to treating diabetes.
There are other rather interesting approaches to treating diabetes out there that have made headlines recently.
Researchers have looked into the potential benefits of spices like fenugreek, a common ingredient in South Asian cuisine that has long been attributed medicinal properties for the treatment of diabetes, and turmeric, the yellow spice that gives curry its colour. A paper published online inMolecular Nutrition and Food Research suggested that the beneficial effects of fenugreek may derive from its capacity to stimulate formation of new fat cells and reduce inflammation in fat tissue. Another study suggested turmeric prevented the formation of fat cells while promoting adipocyte cell death — in some ways the exact opposite of what fenugreek appears to do. It remains to be explained why, despite the avid ingestion of these “anti-diabetic” spices on the Indian subcontinent, it is now home to the greatest number of people with type 2 diabetes anywhere in the world.
Other efforts toward new diabetes treatments have produced the VBLOC device, which uses intermittent electrical signals to reduce food intake by blocking vagal signals from the stomach and gut to the brain. The system is implanted laparoscopically. Participants at 20 months in the randomized, double-blind, controlled, pivotal EMPOWER study experienced an almost 20% excess weight loss, while averaging nine hours of device use per day.
In another ongoing study (VBLOC-DM2 ENABLE), obese patients with type 2 diabetes showed an improvement in HbA1c levels of 0.8%, as well as a 25% excess weight loss over 12 months, while averaging about 14 hours per day of therapy with the implantable Maestro RC System.
It remains to be seen how effective any of these (or other) approaches will be in terms of addressing the urgent needs of millions of people with diabetes worldwide, but they do illustrate how widely we have cast the net for new solutions. They reflect the sense of urgency and the spirit of innovation with which the research community has embraced the diabetes conundrum.
Hopefully, combined with what we already know about the prevention and treatment of diabetes, any and all new tools will be quickly made available to those who require them.