Video transcript
If I think about my research, I have been working on many vascular growth factors about modulation of vascular growth factors and preventing diabetic kidney disease. I'm referring to the balance of angiopoietins and angiopoietin receptor, which is a vascular growth factor that works in conjunction with VEGF. And, yes, many things to understand still, but I think the story is coming up to something quite nice. And, let's see, the next few years we might approach some important step in translating that to the patient. My name is Luigi Gnudi. I'm a professor of diabetes and metabolic medicine at King's College London, and I work at Guy's and St Thomas’ NHS Foundation Trust. Many questions to answer in diabetes and diabetes medicine. I think the important one for the work I do with patients are the new recent drug discoveries, SGLT2 and GPL-1 analogues. I know, they are respectively, very effective for cardiorenal protection. and the GLP-1 for weight loss and also cardioprotection, possibly renal protection. Important questions are the mechanisms of action. It would put myself in a more comfortable situation. We have many theories, many hypotheses, but some have been demonstrated partially, in part it is work in progress, but really this is, I think, important. For GLP-1 analogues or the coming up GIP/GLP-1 analogues and many more molecules which are currently used for the treatment of diabetes and obesity recently licensed in the UK and around the world, again mechanisms of action, but also what is the long-term effect of these drugs on the patient? Trials are short and we need to learn a lot about this medication. And the effect satiety. I would define this as a treatment, not as a cure. The patient stops the medication they will start eating, because this is the satiety signal disappears. Food is very important in terms of well-being, satisfaction. And is a drug good enough? Is there any problem that patients might develop in the future? Maybe mental health, there are some big question marks there. So I think it is an important drug for obesity. We need to be a bit careful, using it in the right patient, and we need to learn a lot more. But certainly a great discovery for satiety and obesity in the future. Another important question I have relates to the work I do. I see patients with chronic vascular complications, in particular, involving diabetic kidney disease that usually is characterised by protein in the urine, albuminuria, and progressive renal function decline. We now see patients with renal function decline and no albuminuria at all, sort of a new phenotype. We have some ideas from biopsies, of what the cause is, more an atherosclerotic disease, I think, we need to learn more about these patients and how to better help them in terms of slowing down the progression of kidney disease. If I think about my research, I have been working on many vascular growth factors about modulation of vascular growth factors and preventing diabetic kidney disease. And I think, the story started probably 15 years ago. I think we're moving on. I'm referring to the balance of angiopoietins and angiopoietin receptor, which is a vascular growth factor that works in conjunction with VEGF. And, yes, many things to understand still, but I think the story is coming up to something quite nice. And, let's see, the next few years we might approach some important step in translating that to the patient. Another important problem in diabetes care is the diabetic foot. We see these patients with peripheral vascular disease, neuropathy, they develop ulcer. Sometimes they don't even realise they have an ulcer, because they don't feel anything. And us clinicians, well, we should look better at their feet. But once we have an ulcer and we start treating it, it takes ages, a long, long time for the ulcer to heal because of issues in microcirculation, because of periperhal vascular disease, because of glycaemic control etc. And really, this takes a lot of good quality of life away from the patient, a lot of resources from the healthcare system, healthcare professionals. We have fantastic teams, where I work, and really they do miracles. But really, if we could have some new tools, something that will help us helping the patients and have the healing of this ulcer a bit more rapid and effective, it'd be great, really. I know there are a lot of tools, a lot of devices, a lot of new techniques that are coming out continuously. Hopefully the future will give us something better for the patient.