Diabetes Ireland Research Alliance

The Diabetes Federation of Ireland has set up ‘Diabetes Ireland Research Alliance’ as a subsidiary charity to promote Ireland as a knowledge base for global diabetes research and increase the level of diabetes research being undertaken in Ireland.

The Federation has always supported high quality diabetes research projects in a small way, but now it has taken that support to the next level by starting this subsidiary dedicated to research. “We felt that while research was one of our objectives, it was lost because education and support took up so much of our resources,” said Kieran O’Leary, CEO of the Federation.

The Federation will incur very little extra costs from the alliance as Kieran and Anna Clarke, Federation Health Promotion and Research Officer, have undertaken to manage it. “This means that the overheads are minimal and almost all of the money raised specifically for research goes straight into actual research,” said Kieran. People can raise funds specifically for research and can also donate to the research alliance at www.diabetesresearch.ie You can also donate on www.diabetes.ie or by ringing 1850 909 909

The Federation is currently negotiating a co-operative agreement with the very successful research-based organisation, Juvenile Diabetes Research Foundation (JDRF) (UK), which will help to promote diabetes research in Ireland. This agreement will:

Encourage high quality type 1 diabetes research in Ireland
Promote Ireland as a base for international led research into finding a cure for diabetes
Support a JDRF Global Research project
Raise the profile of both organisations in the Republic of Ireland
Raise funds for both the development of type 1 research in the Republic of Ireland and for JDRF global research
Enable the Federation’s research alliance to build a sustainable relationship with scientists and researchers at national and international levels.

Professor Seamas Sreenan, Consultant Endocrinologist, is Chairman of the Diabetes Ireland Research Alliance. “Diabetes is one of the commonest chronic diseases in most populations, including our own population in Ireland. Until recently, there has been no dedicated source of funds for diabetes research, but the alliance means that there will be such a source in the future,” said Professor Sreenan.

Professor Sreenan said the Diabetes Federation of Ireland could work well in collaboration with JDRF. It could capitalise on some of the strengths of the JDRF organisational skills to help promote research in Ireland. JDRF is very much focused on finding a cure for type 1 diabetes. It has funded research into islet cell transplantations and stem cell research. Six centres in the UK now accept referrals for islet-cell transplant treatment. This is good news for everyone with diabetes because as the procedure is refined and the amount of anti-rejection treatment required is reduced, it is likely that the procedure will be more accessible to all.

Islet-cell transplants
In islet-cell transplantation, islets containing beta cells (insulin-producing cells) are injected into the liver during a small operation. Once transplanted, the islets develop their own blood supply from the surrounding liver and start to produce insulin. The person receiving the beta cells, needs multiple transplantations to provide them with enough beta cells to produce sufficient insulin. So far, most people who get the transplantations still need some insulin injections.

Researchers are also looking for other ways to source islet cells. Embryonic stem cells are probably the most often quoted because they can grow indefinitely and turn into any type of body tissue.

The use of embryonic stem cells remains controversial, since the only way to obtain them is from the embryo, which is ultimately destroyed. Recently, interest has turned to other sources of stem cells.

In a combined USA-Japanese study, researchers successfully modified skin cells so that they behaved like stem cells (Science, December 2007). Even this method attracts controversy because in order to grow the cells, they must be injected by modified viral genes.

Without research funding these type of developments cannot happen. “Pretty much every change in diabetes care in the last 10-15 years has been evidence based,” said Professor Sreenan. “now researchers are looking for a source of insulin producing cells that you can give to someone with diabetes and essentially cure the condition,” continued Professor Sreenan.

“In type 1, research is focused on finding a way that you don’t have to inject insulin every day. That is a major inconvenience for a lot of people. Most of these things will be aimed at either preventing diabetes developing, for example a vaccine, or once the diabetes has developed finding a way to replace the insulin without having to give injections.

“Insulin pumps and continuous glucose monitors have been significant developments in the last 15 years. It is the best way we have at the moment of mimicking what the pancreas does. “normally, the pancreas trickles out insulin 24 hours a day. That helps control your sugar levels between meals and then after a meal you will get a boost of insulin in response to the sugar you have taken during the meal. That is essentially what we are doing with the pump. We give a slow trickle of insulin 24 hours a day. Then you also programme the pump to give a bolus dose of insulin around mealtimes. At the moment, it is the most similar to the normal insulin-secreting pattern that we have.

“The continuous glucose monitor is a more recent development. It is still at a very early stage, but it is developing very quickly and we will see a lot of development in these monitors over the next 10 years,” said Professor Sreenan.

Professor Sreenan said the Diabetes Federation had already contributed to several research projects in Ireland in conjunction with the Health Research Board and the Medical Research Charities Group.

Type 2 and obesity
One of these projects was the study by Dr Donal O’Shea in Loughlinstown Hospital that looked into people with type 2 diabetes undergoing Bariatric surgery (surgery on the stomach to help someone lose weight) over a three-year period. It may lead to identifying how and what fat cells need to do to protect from us the harmful effects of obesity. This might lead to new treatments that help prevent the development of type 2 diabetes.

Foot care
The Federation had also given funds to a ‘Diabetic Foot Study’ in Galway. This three year research study, which started in July 2008, is studying foot problems in a group of patients with diabetes from the West of Ireland. The research will help inform policy decision makers on the merits of a national diabetic foot programme for all people with diabetes in Ireland. The cost of this study will be €220,000.

“We would like to see more research that will bring tangible benefits to people who have diabetes. If possible we would like those benefits to be reaped sooner rather than later,” said Professor Sreenan.

Health beliefs
The Federation has also supported a study into health beliefs and how they affect people with type 2 diabetes. This study examined the adoption of diabetes self-management, dietary, physical exercise and medication adherence behaviours of people newly diagnosed with type 2 diabetes and what perceptions might influence them.

This study showed that the average age of diagnosis with type 2 diabetes was 55 years of age. Men at diagnosis were younger, attended group diabetes education quicker, had a more positive diabetes attitude and perceived themselves to have more social support than women should they need it. People newly diagnosed with type 2 diabetes required and undertook diabetes self-management behaviours differently which are influenced by demographic factors.

The results indicate that women know what dietary recommendations they need to undertake and have already acted on those prior to attending for care. However, women fail to increase their level of physical activity and may require more support to do so.

Peer support
The Health Research Board funded research by the Federation into peer support education for people with type 2 diabetes. The funding was used to set up a five-year randomised control trial (RCT) to evaluate whether a peer support programme delivered at community levels for people with type 2 diabetes would improve biophysical and psychosocial outcomes. It is also examining whether or not this is an acceptable, cost effective intervention in the primary care setting.

Cystic fibrosis
Another Federation supported research study established the prevalence of diabetes and pre-diabetes in children with Cystic Fibrosis (CF) attending the three national paediatric centres in Dublin. The study highlighted that introduction of insulin therapy earlier in the management of impaired glucose improved quality of life and reduced morbidly.

“The Federation has always had a tradition of supporting research, but we were just using whatever donations were given on a small scale. The linkup with the Health Research Board has been an opportunity to enhance this funding. We would hope that we can develop this further through our collaboration with the JDRF,” said Professor Sreenan.
“I would like to emphasise that the aim is to support and fund research into all forms of diabetes. not just type 1. We would hope that the research funded would lead to improvements for the management of diabetes for people living with the condition,” said Professor Sreenan.