TYPE 1 DIABETES
• The body does not receive insulin, since the islet cells producing insulin in the pancreas have been destroyed.
• Insulin regulates blood glucose and is vital for the functioning of the body.
• A person with Type 1 diabetes will need insulin for the rest of their life; otherwise they will risk coma and death.
• More than 50 genes predisposing people to diabetes are known, but they do not cause the disease in isolation.
• The ultimate cause of the disease is not known and there is no prevention or cure.
TYPE 2 DIABETES
• The ability of the body to produce insulin is compromised and the blood glucose level becomes too high.
• Caused by one’s genetic predisposition and lifestyle.
• Develops slowly and may be asymptomatic for a long time.
• The illness may also be associated with insulin resistance.
• There is no actual cure, but weight loss, exercise and a healthy diet may help the individual to become symptom-free.
• Changes in one’s lifestyle are also essential for prevention.
Permanent lifestyle changes
AGE, GENDER, height, weight, waistline. A test mapping one’s risk of getting diabetes collects basic information that it then uses to provide a risk score. The higher the score, the greater the probability of getting Type 2 diabetes within the next ten years.
Health care services have been using the risk test for a long time, and now the StopDia project at the University of Eastern Finland is promoting its use elsewhere in society. By December, the online test had been taken by 21,000 people in the study areas, in other words, the South Karelia, Northern Savonia and Päijänne Tavastia regions.
Among them, 12,000 people were in the risk group and were directed to contact their health care services team.
THE STOPDIA PROJECT has an ambitious goal: to find the best methods of preventing Type 2 diabetes and disseminating them all across Finland. The disease is rapidly becoming more common, and according to the Finnish National Institute for Health and Welfare, currently approximately 500,000 people have Type 2 diabetes.
It is absolutely possible to stop the spread of Type 2 diabetes, but it will require considerable efforts. The environment and lifestyles should be changed to ensure that people don’t become ill, says Professor Jussi Pihlajamäki, who is heading the project.
There are functioning tools for prevention, but the actual practices vary from one municipality to another. That is why proving the effectiveness of these tools is difficult and they are not widely used. The intention of the StopDia project is to test the methods in large groups of people.
Pihlajamäki compares the study with the North Karelia Project, which helped reduce cardiovascular disease mortality by more than 70 per cent.
Our project is a modern-day North Karelia Project; only the tools are different from those used a few decades ago. We apply digital solutions and involve psychologists and behaviorists to ensure the lifestyle changes are meaningful and easy to incorporate in daily life.
THE PROJECT’S AIM is early identification of individuals with a high risk of diabetes and then to guide them to make healthier lifestyle choices in order to prevent the onset of the disease in the first place. However, in borderline cases it is enough that the individual becomes aware of their risk and hopefully changes their lifestyle accordingly.
We would like to see the risk test used commonly in the whole of Finland, so that people could create a habit of testing their diabetes risk every now and then. Our intention is not to scare people but to empower them. That is why our motto is “Take control of the risk”, says research manager Jaana Lindström.
The tools of prevention are simple: weight loss, exercise and a healthy diet. The StopDia project studies how to make these changes permanent.
Our goal is to help individuals identify the good things they already have in their daily life and then to increase them, says research director Pilvikki Absetz.
Group guidance and an application developed for supporting lifestyle changes are used to accomplish this. The participants themselves get to choose what kind of small changes fit their daily lives best.
We want participants to succeed in their efforts, which is why the measures proposed are small and easy to incorporate into daily life. Over time, these changes will become habits which will have a big impact, Absetz says.
Diabetes is rapidly becoming more and more common all over the world, and researchers are urgently looking for ways to wipe out this disease. Researchers at the University of Tampere are developing a vaccine against Type 1 diabetes, and a project at the University of Eastern Finland is investigating the best methods to prevent Type 2 diabetes.
Significant progress was made in diabetes research last fall. For the first time, scientists managed to prevent the onset of diabetes caused by enterovirus.
Laboratory mice were inoculated with a vaccine containing inactivated enterovirus. None of the vaccinated mice got diabetes, whereas 50% of the mice in the control group did. The study was conducted by researchers from the University of Tampere and the Karolinska Institute in Stockholm.
We achieved three significant results: we were able to demonstrate that the vaccine produces proteins, or antibodies, that can identify viruses, prevents the onset of diabetes, and does not cause side effects, says Vesa Hytönen, Associate Professor at the University of Tampere.
The fundamental goal of the vaccine study is to find a way to prevent Type 1 diabetes in people. Since the vaccine works with animals, we are now one step closer to studying the vaccine with humans.
For the time being, the factors that cause the onset of Type 1 diabetes, or juvenile diabetes, are not fully known and no preventive treatments exist for the disease.
IT IS NO COINCIDENCE that Finland is the very place where a vaccine against Type 1 diabetes is being developed. The number of Finns who have the disease is 50,000, which is more than anywhere else in the world, proportionate to the population.
Diabetes is becoming increasingly common all around the world. In Finland, Type 1 diabetes cases have multiplied since the 1940s and 1950s, and today, more than one in two hundred people suffer with the disease.
Plenty of effort has been put into investigating the reasons for this, but no definite cause has been found. However, what is known is that environmental factors play an important role, and blame has sometimes been put on milk and sometimes on Vitamin D insufficiency. The connection between enteroviruses and diabetes has become stronger year after year, but whether enterovirus does cause diabetes in people is yet to be ascertained.
For example, in the DIPP study being conducted at the University of Tampere, enteroviruses have been detected in children with diabetes more often than in their healthy control group. In addition, infections caused by enteroviruses are most common in Finland in the fall and winter, and the incidence of diabetes is also cyclical.
We know that enteroviruses, and more specifically viruses in the Coxsackie B group, tend to gather in the pancreas, which produces insulin, says Olli Laitinen, Docent of Medical Biochemistry.
Thus, it is possible that enteroviruses that have found their way to the pancreas destroy the islet cells that produce insulin. This would explain at least some Type 1 diabetes cases.
According to another theory, enteroviruses cause a long-lasting infection in the pancreas, resulting in the body attacking itself. If the insulin-producing cells remain infected for a long time, the body may start to see them as a threat and will launch an immune response against them.
We talk about autoimmune diseases, which also include diabetes, Laitinen says.
Yet another attempt to explain the generation of autoimmune diseases is the hygiene theory. According to this theory, people living in urban environments are susceptible to many illnesses because their environment is too clean. In a way, their immune systems do not have enough to do and become lazy.
Today, we come into contact with viruses less frequently than before and have fewer virus infections. That is why our immune system is thrown out of balance more easily and viruses that were previously harmless may become dangerous, Vesa Hytönen says.
WORK TO DEVELOP a diabetes vaccine has been underway in Tampere for several years, since it is the only way to find out if enteroviruses are a cause of diabetes. Enteroviruses are very common and often cause flu in small children. A vaccine that succeeds in blocking the functioning of the virus will help us understand if vaccinated individuals become immune to Type 1 diabetes.
The functioning of the virus contained in the vaccine has been chemically blocked. This will induce the body to produce enterovirus antibodies even though there is no actual infection.
When the vaccinated individual comes into contact with a live enterovirus, the antibodies will attack the virus right away and stop any infection from developing.
With diabetes, it is essential to destroy the viruses before they reach the pancreas, Laitinen says.
The polio vaccine, which is safe, efficient and has been successfully used for decades, was used as a model for the diabetes vaccine. Polio, too, is caused by an enterovirus, and thanks to the vaccine, this disease has been all but eradicated worldwide.
THE NEXT STEP is to study the vaccine with people. In fact, a leap might be a better word to describe the course of events, since the transition from animal experiments to studies on humans is long and arduous. The criteria for manufacturing a vaccine are strict and the study must be designed to ensure safety. The results must also be approved by the pharmaceutical authorities.
Manufacture of the vaccine will be transferred from the university to a pharmaceutical plant, where the level of hygiene is much higher and maximum safety has been ensured, says Professor Heikki Hyöty.
He has been studying diabetes for years and, along with colleague Mikael Knip, established Vactech Oy, where the prototype of the diabetes vaccine was developed. The vaccine used in the mouse experiment last fall is also based on Vactech’s vaccine.
Last summer, Vactech signed an agreement with the US-based Provention Bio, which will provide funding to study the vaccine on humans.
The study will be conducted in Finland and we believe it can start within two years, Hyöty says.
Two functioning vaccines against enteroviruses have already been developed: the polio vaccine and a vaccine against an enterovirus strain common in China. These vaccines have also provided good background for the one that we are developing in Tampere, Olli Lahtinen and Vesa Hytönen say.
The first phase of the study involves ensuring the safety of the vaccine among a small group of adults. Confirming the connection between diabetes and enteroviruses will be tackled in the third phase. The third phase will involve vaccinating children under 12 months of age, who have not yet been exposed to enteroviruses associated with diabetes.
Thus, it will take several more years before we know if the vaccine is effective in preventing Type 1 diabetes.
It should be kept in mind that enteroviruses cause other illnesses, too, such as meningitis, myocarditis and hand-foot-and-mouth disease. We believe that the vaccine may provide considerable benefits in preventing these diseases too, Hyöty says.
First time published in Mylab Nyt -magazine 2018 1.