14 November 2016

Preventing diabetes

On this day exactly 125 years ago, physician Sir Fredrick Grant Banting was born. Together with Charles Best and John Macleod, Banting discovered that insulin could be used to treat diabetes. Every year, organisations around the world use Banting's birthday – November 14th – to create awareness for the rapid rise in the number of diabetes patients. UM professor Patrick Schrauwen specialises in the metabolic aspects of type 2 diabetes. “The main solution is prevention,” he argues, “We should ensure that people do not get diabetes.”

“It is good to build awareness for diabetes, because diabetes is often underestimated,” says Schrauwen, “It doesn't kill you – or at least – not directly. You are slowly destroying your body. But the process is so slow that people often do not notice it until it is too late.” Prevention plays an important role in reducing the number of diabetes patients, says Schrauwen, especially now that type 2 diabetes has become more common and now that patients are becoming younger.

Energy use

In his research, Schrauwen focuses on the effects of different lifestyle factors on insulin sensitivity. Diabetes patients are less sensitive to this protein. Preventing overweight and obesity plays an important role in lowering the number of diabetes patients, he explains. It can be reduced through two different methods – by reducing the energy intake and by increasing energy use. In his research, Schrauwen focuses on the latter. “Over the last years, much attention has been paid to the role of nutrition in preventing and reducing overweight and obesity. Which makes sense, because if you eat less, you'll loose weight.” Reducing your energy intake is also easier than increasing your energy use, he adds. “You cannot double your energy use, unless you're a top-level athlete.”

As a result, relatively little attention has been paid to increasing energy usage. “And that's a pity, because we believe this is a key factor in the prevention of diabetes, even if it doesn't directly result in weight loss. We can see that exercise has significant health benefits, especially for people who are overweight or obese and are at-risk for diabetes. So we should pay more attention to keeping the body moving. Not just literally, but also figuratively. You can do this through excise, but you can also do this with colder temperatures. If you are in a cold environment, your body will have to produce more energy to stay warm.”

Cold temperatures

In 2015, Schrauwen and fellow UM researcher Wouter van Marken Lichtenbelt conducted a study into the effects of cold temperatures on the insulin sensitivity of diabetes patients. They discovered that the insulin sensitivity of the muscles increases when patients are exposed to a cold environment 6 hours per day for 10 days. “The effects are even bigger than the effects of training and exercise.”

The researchers had expected that this would be caused by the extra production of brown adipose tissue, but the effect was so large that it could not be explained by the brown adipose tissue alone. “We were quite shocked by that,” says Schrauwen. This discovery has led to a shift in focus of their study. “We are repeating the study, so we can take a more detailed look at the muscle, because the mechanism seems to be situated within the muscle. Once we know how cold temperatures positively affect the muscles, we can maybe develop new therapies for the prevention and treatment of diabetes.”

The team also hope to start a project where they will look into practical applications of their discovery. “You can tell someone 'You have to sit in a cold room for six hours a day', but that is obviously unattainable. So we would like to investigate how much is enough. How often would you have to be in a cold environment? How long does the effect last? Can we shorten the time period to, say, half an hour per day, for example?”

Other lifestyle factors

In addition to studies into the effects of a cold environment, Schrauwen's team also investigate the effects of other lifestyle factors. “We are also conducting studies into day-night rhythms. We're currently working on a project where we replicate the effects of a jet lag.” Test subjects stay in a closed room for 3.5 days while the scientists adjust their day-night rhythm to the point where they are sleeping during the day and are awake at night.

“It allows us to unravel the effects of night work. If you sleep during the day and are awake during the night, you will have to take breakfast at night. How does your body handle this? If your body does not handle your breakfast properly, more may be stored in the adipose tissue and the muscles. These are all factors that could cause diabetes. We've almost completed that project, and I'm very curious about the results.”

Patrick Schrauwen (1971) is professor of Metabolic Aspects of Type 2 Diabetes at the department of Human Biology and Movement Sciences, part of the research school NUTRIM. Earlier this year, he became the second Dutchman ever to receive the prestigious Minkowski prize which is regarded as the most important award in diabetes research. In his research Schrauwen focuses on the causes of insulin resistance, the early stage of type 2 diabetes.

By: Britta Wielaard