Diabetes is a disease that has reached pandemic proportions in the GCC region, and Qatar is no exception. Almost one in five of Qatar’s population suffers from diabetes, with this figure expected to more than double over the next two decades. “The rate of diabetes is unbelievably high in Qatar, and it’s a very big problem. Each year we see more and more cases of a disease that, in many circumstances, can be prevented,” says Dr. Nasser Rizk, associate professor of human physiology, pathophysiology and endocrinology at the College of Arts and Sciences in Qatar University.
Dr. Rizk, in collaboration with a team of QNRF-funded researchers from Qatar University, Dr. Mahmoud Zirie, consultant and head of the endocrinology and diabetes division at Hamad Medical Corporation, and Dr. Amrita Cheema, an associate professor at Georgetown University, are studying ways to predict the course of type 2 diabetes. The most common form of the disease, type 2 diabetes accounts for more than 85 percent of cases worldwide. Their goal is to develop improved intervention mechanisms to avoid complications that routinely arise among diabetes sufferers.
The onset of type 2 diabetes occurs when the human body is unable to use the insulin that it creates. Insulin, a hormone produced by the pancreas, enables cells to convert glucose (sugar) from the blood into energy. If glucose levels become excessive and it continues to circulate through the body in high amounts, it disrupts cell pathways and functions, and can change the structure and biochemical profile of cells. Diabetes leads to raised blood sugar levels which, over time and if not properly treated, can cause serious damage.
The QNRF-funded project utilises molecular profiling tools to understand how biological processes are altered by the disease.
“At the earlier stages of the study we were just examining metabolites, which are the products of metabolism such as vitamins and amino acids, but now we are working with what we call the three-tier approach, which includes looking at the gene, protein and metabolite levels to try to understand the pathways which ultimately lead to metabolic dysfunction,” says Dr. Rizk.
According to Dr. Rizk, all three levels are interconnected. Genes dictate protein expression, proteins account for the make-up of all cells as well as their processes, and metabolites give us an idea of how cells are functioning.
If diabetes is not treated, the damage can be irreversible and severe, and may include heart failure, kidney failure, blindness and loss of limbs. The team has designed its project to pinpoint the key factors involved in causing these complications, and is researching preventative methods that may help mitigate such damage.
“Our goal is to identify how key genes behave in the protein and metabolite levels. Once the pathway is known we can add inhibitors to hinder the function of the elements which are causing retinal or kidney problems,” says research assistant Dr. Isha Sharma. “With this knowledge we can provide preventative measures. So, for example, if we know from well before that a particular patient could suffer from blindness, we can ask the patient to receive anti-VEGF therapy to slow vision loss and provide the proper medication to prevent this from happening before it is too late.”
Diabetes has been classified by the World Health Organisation (WHO) as a pandemic, the only non-infectious disease to be given this classification. In 2013 there were 382 million people worldwide living with diabetes. This number is predicted to rise to 592 million people - mostly in Africa, the Middle East and South East Asia - by 2035. Early intervention is essential if this alarming increase is to be limited.
“Prevention is the key and it is better than treatment,” says Dr. Rizk. “You can of course save lives, and save money.”
One of the biggest contributory factors to type 2 diabetes is obesity, and a major reason for the Gulf region’s high rate is due to the population’s increasingly sedentary lifestyle. The focus of the study’s next phase will be on obese patients, especially among the younger generations. The average age for the onset of type 2 diabetes is over 30 years of age but, as Dr. Rizk explains, the number of young children suffering from obesity is increasing. The team is working to encourage those at risk of developing diabetes to change their lifestyles in order to avoid contracting the life-threatening disease.
“It’s a challenge to change people’s mentalities, behaviours and lifestyles, but we believe that, when the patients see their clinical profile and understand the risks he or she could be putting their bodies through, they will be determined to take better care of themselves,” says Dr. Rizk. “We want to make people aware that you have higher chances of preventing this type of diabetes by changing what you eat, getting more exercise and stopping smoking.”
Despite the challenges, Dr. Rizk is optimistic about the chances of reducing incidences of diabetes in the future, and points out that awareness of the disease has grown exponentially in Qatar, which is now a regional leader for high-quality research.
“Research is helping Qatar gain recognition all over the world not only as a Gulf state but as an area which can reproduce good data and research. We are heading in the right direction and gaining more and more interest from young students,” says Dr. Rizk. “As long as we have young students who are interested in research we have to value them because they are the real resources. We are getting older and it is crucial to develop the new generation that will continue to carry out research in this country.”
The research team’s work has been published in a wide variety of globally respected journals including The Journal of Endocrinology and Metabolism and the Journal of Molecular Biosystems. This June, Dr. Rizk and his team gave a presentation at the 16th International Congress of Endocrinology and the Endocrine Society’s 96th Annual Meeting and Expo in Chicago, USA.
Systems approach towards diabetes research using molecular profiling tools
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