Type 2 Diabetes PSP: working to address the priorities

The Type 2 Diabetes JLA PSP published its Top 10 in 2017. Kamini Shah, Head of Research Funding at Diabetes UK, brings us up to date with work that Diabetes UK has been doing to fund and encourage life-changing research in the priority areas.

Research Workshops

Alongside the Type 2 Diabetes JLA PSP, Diabetes UK set up Diabetes Research Steering Groups (previously named Clinical Studies Groups), made up of people living with diabetes, clinicians, academics and other healthcare professionals. We asked the groups to embed the priorities from the PSP into their discussions and identify ways to take them forward. They identified a number of key priorities, many of which are from the PSP, that needed more exploration:

Remission of type 2 diabetes – priority 1 from the PSP

In 2019, Diabetes UK brought together researchers, clinicians, healthcare professionals and people with diabetes to identify key gaps in evidence, and priority research questions, to enable remission of type 2 diabetes to become a possibility for more people, and provide recommendations to researchers, research funders and commissioners of health services on how best to address them. Ten themes were identified and published in Diabetic Medicine.

Diabetes and mental wellbeing – priorities 3, 5, 9 from the PSP

We held a workshop in 2019 with world renowned researchers, from across our Diabetes Research Steering Groups and beyond, and people living with diabetes. Recommendations for the research community were made around 11 areas of mental wellbeing and diabetes. We published the priorities and research recommendations in Diabetic Medicine. In June 2019, we invited scientists to apply for funding for diabetes and eating disorders research, one of the priority areas, and were able to fund two projects, one of which is focused on type 2 diabetes.

Ageing well with diabetes - priorities 3 & 6 from the PSP

Over four and a half million people in the UK have diabetes, and over a third are over the age of 65. They are more likely to face additional challenges in self-management and have additional care needs, due to the likelihood that they are living with multiple long-term conditions. The Diabetes Research Steering Groups wanted to explore the need to improve how care for older people living with diabetes is delivered. Two of the priorities from the Type 2 diabetes JLA PSP Top 10 refer to issues central to ageing well. With clear unmet needs and concerns relating to the care of older people with diabetes established, we planned a workshop in 2021 to understand how research could address the issues identified. The workshop aimed to identify research gaps which would benefit from future research investment or influence, consult with experts in the UK within the diabetes and ageing fields, foster research collaborations and ensure the voice of older people with diabetes is at the heart of future research. The outputs of the workshop are currently being written up for publication. 

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The special series of articles in Diabetic Medicine includes all of those mentioned above, and others that reviewed some of the priority areas. You can see these and more in the articles and publications section of the JLA website. You can also read more about the Type 2 Diabetes JLA PSP and a detailed account of each of the Top 10 priorities in the final report from the PSP.

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Strategic funding

2019 – funding from Diabetes UK for diabetes and eating disorders (following on from the workshop) - improving the understanding of the epidemiology and mechanisms of eating disorders, or how to manage them effectively, in people with diabetes. Priority 3, 5, 9

2020 – partnership with National Institute for Health Research Programme Grants for Applied Research Programme (NIHR PGfAR) – focus on preventing or slowing the complications of diabetes in people at very high risk. We teamed up with NIHR PGfAR around why some people are at very high risk and to develop better ways to prevent or slow complications. This was our first partnership with NIHR for programme grants – to read more about the awarded project please click here. Priority 3, 8

2021 - partnership with NIHR PGfAR – focus on investigating the implementation, in primary care, of approaches to help people recently diagnosed with Type 2 diabetes put the condition into remission. These may be new interventions, or other approaches that complement existing programmes in order to optimise engagement or effectiveness. Currently underway – Priority 1

Researchers applying for funding from Diabetes UK

Researchers may apply to any of the Diabetes UK funding schemes and the application form asks about how potential projects address the Top 10 priorities. Below are grants that Diabetes UK has funded in the Top 10 priority areas since we started monitoring this in 2019: 

Research Project	Addressing Priority Number
Endothelial protein C receptor (EPCR) mediated enhancement of retinal vessel repair as a novel strategy to prevent early-stage diabetic retinopathy	8
Characterization of the eNOS-PYK2 Protein-Protein Interaction using Surface Plasmon Resonance and Isothermal Titration Calorimetry	6
Impact of chronic inflammation on cardiac metabolic remodelling in diabetic cardiomyopathy (dbCM)	6
Metabolomics of faecal samples to identify markers of type 2 diabetes incidence	2
To understand mechanisms regulating smooth muscle cell stiffness in people with diabetes	6
Identifying serum BACE1 as a novel biomarker for cardiovascular complications in Type 2 diabetes	2
Developing a mouse model of type 2 diabetes remission	1
VEGFC gene manipulation to protect from diabetic kidney disease: a translational approach	6
Does the exercise-regulated myokine β-aminoisobutyric acid protect against skeletal muscle dysfunction in diabetes?	5, 6
Evaluating Microbiome Causality in the Gut-Liver Axis and Impact on Insulin Resistance	2
Understanding the role of inflammatory-derived senescent T cells during type 2 diabetes	1, 6
Diabetes Remission Clinical Trial (DiRECT) 5-years follow-up: Final 2-year support	1
Towards targeted dietary support for shift-workers with Type 2 diabetes: a mixed-method study	3, 5
Do aromatase inhibitors increase the risk of type 2 diabetes in postmenopausal women with breast cancer?	2
Using machine learning to predict painful diabetic neuropathy	8
A tailored intervention to reduce sitting behaviour in people with Type 2 Diabetes: A randomised-controlled feasibility study	3, 5
Exploring the contribution of lymphatics towards diabetic kidney disease and their potential as a therapeutic target	6
Online guided self-help for the management of binge eating disorder in adults with Type 2 diabetes: intervention adaptation and feasibility testing	3, 5, 9
Deep learning for the automated prediction of diabetic retinopathy progression	6
Regulation of G-protein-coupled receptors in the development of type 2 diabetes	6
What factors in human blood cause insulin resistance and promote development of Type 2-Diabetes?	2
Re-Purposing Anti-Ageing Drugs to Heal Diabetic Foot Ulcers	6
Evaluation of Footwear Fit Guidelines Under Pressure in At-Risk Feet	3
Defining the role of edited microRNAs in diabetes mediated brain microvasculature alterations	8
Role of the GSK3-NRF2 axis in beta cell decline in type 2 diabetes	2, 6
Understanding how BMP9 protects from diabetes-induced blood retinal barrier breakdown	6
Impaired maternal β-cell adaptation to pregnancy: effects on glucose homeostasis in mother and offspring	2
Developing and Evaluating A Multifactorial Intervention to Improve Cardiovascular Outcomes in Adults with Type 2 Diabetes and Current or Previous Diabetic Foot Ulcers (MiFoot)	3, 8

 

The Type 2 Diabetes PSP research priorities published in 2017 were:

1. Can Type 2 diabetes be cured or reversed, what is the best way to achieve this and is there a point beyond which the condition can't be reversed?
2. How do we identify people at high risk of Type 2 diabetes and help to prevent the condition from developing?
3. What is the best way to encourage people with Type 2 diabetes, whoever they are and wherever they live, to self-manage their condition, and how should it be delivered?
4. How do stress and anxiety influence the management of Type 2 diabetes and does a positive mental wellbeing have an effect?
5. How can people with Type 2 diabetes be supported to make lifestyle changes to help them manage their condition, how effective are they and what stops them from working?
6. Why does Type 2 diabetes get progressively worse over time, what is the most effective way to slow or prevent progression and how can this be best measured?
7. Should diet and exercise be used as an alternative to medications for managing Type 2 diabetes, or alongside them?
8. What causes nerve damage in people with Type 2 diabetes, who does it affect most, how can we increase awareness of it and how can it be best prevented and treated?
9. How can psychological or social support be best used to help people with, or at risk of, Type 2 diabetes and how should this be delivered to account for individual needs?
10. What role do fats, carbohydrates and proteins play in managing Type 2 diabetes, and are there risks and benefits to using particular approaches?

The full list of 24 questions discussed at the priority setting workshop can be seen on the JLA website.