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Estimates suggest that within fifteen years 500million people worldwide will be affected by diabetes and its devastating complications such as heart and kidney disease, stroke and blindness. This research looks at the reasons behind differences in the way that people react to treatments, in order to improve care and reduce some of the costs associated with diabetes.

Q: I see that diabetes has been referred to as the global epidemic of the 21st Century; why is this?

SG: That is quite right. If you look at information collected from around the world unfortunately diabetes is increasing at an alarming rate; estimates suggest that over the next ten to fifteen years we will have somewhere in the region of 500million people with diabetes, and that is really quite frightening. The reasons for this are that both type-1 diabetes and type-2 diabetes are increasing. Most of this is due to an increase in type-2 diabetes which traditionally has been referred to as the diabetes that occurs later on in life, but we know that it is developing at younger ages all the time. The reason for this is that unfortunately we are gaining weight; we are a heavier population and obesity is a major risk factor for type-2 diabetes. We are also living for longer, and we know that as we get older we are at an increased risk of getting diabetes.

Q: What research developments have developed over the last 5-10 years and has this lead to any new treatments in the field?

SG: There has been lots of research over the last five to ten years looking at the causes of diabetes; whether there is a hereditary component, what the environmental factors are, why some people develop some of the devastating complications including heart disease, stroke, kidney disease, blindness, and problems with lower limbs. Probably the most important and most exciting research development is the development of new treatments. When I came into diabetes 20 or 30 years ago we basically had two different types of tablets and a fairly limited range of insulin's. But in the last five to ten years we have seen many more new different types of tablets, better insulin's, treatments that are much more easier for patients to use, more convenient and it is therefore more likely for the patients to take the treatments, and I think more effective as well so that we can try and reduce some of the complications that I mentioned earlier.

Q: Will these treatments be for everyone or will there be some targeting towards certain individuals?

SG: That is a really good question and that is the area of our research. We are working on new therapies; we have a Clinical Trials Unit where we are looking at the new therapies mainly for type-2 diabetes but also for type-1 diabetes. But we are also looking at why these therapies work in some people and not so well in others. Not all treatments do work in everybody and there is very clearly, what we could call, 'responders' and 'non-responders' and increasingly we are trying to look at our treatments so we can target them towards people who respond the best. We are doing this in a number ways; one way is to look at large populations of people on different treatments and see if we can look at some of the characteristics that determine or are associated with those people who respond well and those that don't respond so well, or those who respond well to one tablet or one injection and not another. That is one way we can do it. Another way that we are doing it is we are looking at some of the medicines that General Practitioners are prescribing and following those patients up on those medicines and then bringing those patients to our Clinical Trials Unit to see if we do some fairly sophisticated blood tests and genetic tests whether we can find further characteristics and markers of people that respond and people that don't respond. And finally we are bringing people into our Clinical Trials Unit and we are giving them specific treatments and, again, doing fairly sophisticated tests to see if we can identify which people respond well to certain tablets or medicines and which people respond well to others.

Q: Why does your line of research matter, why should we put money into it?

SG: It is really important that we give patients the best treatment that we can. I think we can't just give the same treatment to everybody. We have to get to a situation where we give the right treatment to the right person at the right time in their disease. Hopefully if we can find the best treatment for the best person at the right time we can reduce the problems associated with diabetes. And also we have a finite budget. There is only so much money available for health care and it is important that we spend that money wisely. That is why I think that by investing in this there will be long term benefits, there will be savings, or at least we know that the money we have will be spent in the most appropriate way.

Q: How does your research fit into translation medicine within the department?

SG: Translational medicine is all about taking basic science, clinical research, and translating it into patient care, improved patient care and improve patient outcomes. I hope that what I have explained shows that by taking some of the basic research which we do in our diabetes centre, we look at new molecules, we look at new therapies, and we take them through into clinical trials. But by taking it one stage further in trying to identify who responds really well to certain treatments we really are translating what our basic scientists and our basic clinicians are initially identifying so that ultimately, as I have mentioned, we can improve the care of the patients and also maybe reduce some of the costs and some of the personal and social costs associated with what can be quite a devastating condition.

Stephen Gough

Personalised Treatments

Prof. Stephen Gough believes that you cannot give every patient affected by diabetes the same treatment; where people react differently to treatments provides a background to his research. Prof. Gough aims to provide the right treatment to the right person at the right time in their disease for optimum results.

This podcast presents the research done by Prof. Gough whilst working in the Nuffield Department of Medicine. Prof. Stephen Gough now works at the Radcliffe Department of Medicine.

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