New Targets for Managing Diabetes

A new report for the World Health Organisation has identified five core national targets for UN member states aimed at reducing diabetes risk and ensuring that people with diabetes have equitable access to comprehensive and affordable care and prevention.

Edward Gregg, Head of RCSI’s School of Population Health

with undiagnosed diabetes and many go without timely care for extended periods.

In high-income countries, the current proportions of people who meet recommended targets for risk factors, such as glycated haemoglobin or blood pressure, ranges from 50% to 70%.

The lead author on the report for WHO Global Diabetes Compact was Professor Edward Gregg, Head of RCSI’s School of Population Health. Its recommended targets, published in The Lancet, are:

1. Of all people with diabetes, at least 80% have been clinically diagnosed;

2. For people with diagnosed diabetes, 80% have glycated haemoglobin (HbA1c) concentrations below 8·0% (63·9 mmol/mol), an important biomarker for diabetes;

3. 80% of those with diabetes have blood pressure lower than 140/90 mm Hg;

4. At least 60% of those with diabetes who are 40 years or older are receiving therapy with statins;

5. Each person with type 1 diabetes has continuous access to insulin, blood glucose meters, and test strips.

Recent global estimates indicate that 537 million adults have diabetes, of whom 80% live in low-income and middle-income countries (LMICs). The global impact and cost of diabetes are expected to grow considerably, disproportionately affecting the most disadvantaged populations.

Population-based studies show that, at present, the delivery of evidence-based care for people with diabetes is suboptimal even in well-resourced health systems. Many countries have high proportions of their populations

The situation is worse in LMICs with just half of the people with a diagnosis of diabetes having good glycaemic control, and about one in four having good blood pressure control.

Professor Edward Gregg, Head of the School of Population Health, RCSI and lead-author on the report said: “Diabetes is one of the world’s most challenging public health issues due to its high and growing prevalence, and the impact it has on individuals, health systems and national economies. Yet we know that the worst outcomes from diabetes can be prevented and that many interventions are cost-effective and feasible to implement. However, there are enormous global gaps in their delivery that the efforts of the Compact can alter.

“Type 2 diabetes can be delayed or prevented through intensive lifestyle interventions and medication for individuals at high risk, and population-wide changes to dietary quality, physical activity levels and prevalence of obesity. For people with diagnosed diabetes, delivery of essential medications and management of glycaemia and cardiometabolic risk factors, alongside early screening for complications via well organised care can reduce acute and chronic complications and extend life.”

According to Professor Gregg, “While these goals are ambitious, their achievement can reduce the number of people living with diabetes and greatly improve the outcomes and quality of life of people who are diagnosed with the condition. We hope the WHO Global Diabetes Compact serves as a helpful framework for countries to take action and reduce the burden of diabetes globally.”

The Global Disease Compact was assembled by the WHO to identify potential metrics across four domains (structural, systems or policy level, processes of care, biomarkers and behaviours, and long-term health events and outcomes) and three risk tiers (diagnosed diabetes, high risk for diabetes, and whole population), and prioritised metrics according to their health importance, modifiability, data availability and the degree to which they represent areas of global inequality.

Shedding New Light on the Ageing Process

Scientists from the Trinity Biomedical Sciences Institute (TBSI) have shed new light on ageing processes in the brain. By linking the increased presence of specialised immune cells to conditions such as Alzheimer’s disease and traumatic brain injury for the first time, they have unearthed a possible new target for therapies aimed at treating age-related neurological diseases.

The research, which benefited from a collaboration with experts at the University of Maryland School of Medicine and focused on microglia in the brain and spinal cord, is published today in leading international journal, Science Advances.

Microglia are a unique type of immune cell whose job it is to support nerve cells, defend against invading microbes, clear debris and remove dying nerve cells by engulfing and eating them. Emerging research indicates that microglia can have different functional responses depending on molecular and biochemical changes occurring within these specialised cells.

In fact, various subtypes of microglia can be distinguished based on a property called autofluorescence. This is the tendency of cells to emit light of one colour after they have absorbed light of another, and it occurs because specific substances inside the cells absorb light. The substances stored in specialised cellular compartments include fat molecules, cholesterol crystals, metals and other misfolded proteins.

David Loane, Assistant Professor of Neuroscience in Trinity’s School of Biochemistry and Immunology in TBSI is the lead author of the research. He said,

“As the brain ages, these materials build up inside autofluorescent microglia, which increase their autofluorescence as a result. Unfortunately, this accumulation of cellular debris also makes it harder for the microglia to perform their essential garbage collection tasks in the brain and to prevent neurological injury and neurodegenerative disease.

“In this study we found – in aged animals – that these microglia adopt a unique, dysfunctional state, which has a number of problematic impacts. For example, there is an increase in cellular stress and damage, an accumulation of fats and iron, alterations to metabolic processes and an increase in production of molecules that over-egg the immune response.”

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