WEBVTT

00:00:00.000 --> 00:00:04.080
My concern is that in those early-onset type 2 patients,

00:00:04.080 --> 00:00:05.400
we know that they progress

00:00:05.400 --> 00:00:06.360
much more quickly,

00:00:06.360 --> 00:00:09.600
they have a much faster deteriorating beta cell function,

00:00:09.920 --> 00:00:11.440
and we simply don’t know

00:00:11.440 --> 00:00:15.040
whether remission of type 2 diabetes is the same

00:00:15.040 --> 00:00:18.200
and is as effective as it is in the older population.

00:00:30.800 --> 00:00:33.160
Hello, I’m Melanie Davies and I’m a Professor of 

00:00:33.160 --> 00:00:35.600
Diabetes Medicine in Leicester in the UK

00:00:35.600 --> 00:00:37.920
and also a consultant diabetologist

00:00:37.920 --> 00:00:40.920
at University Hospitals of Leicester.

00:00:41.760 --> 00:00:43.920
So the five things that

00:00:43.920 --> 00:00:46.640
I think we don’t know yet,

00:00:46.640 --> 00:00:49.040
firstly, in terms of early-onset type 2 diabetes,

00:00:49.040 --> 00:00:53.440
so people developing diabetes under the age of 40:

00:00:53.640 --> 00:00:58.080
Virtually all of our evidence, whether it comes in terms of 

00:00:58.080 --> 00:01:01.200
outcome trials looking at cardiorenal outcomes,

00:01:01.320 --> 00:01:06.520
whether it looks at studies of diet and exercise and self-management,

00:01:06.840 --> 00:01:09.760
or whether it looks at the phase III trials of 

00:01:09.760 --> 00:01:13.760
many of the common therapies that we use routinely in the clinic

00:01:13.760 --> 00:01:16.080
are based on populations

00:01:16.440 --> 00:01:19.640
over the age of 40, whereas increasingly

00:01:19.640 --> 00:01:22.800
we are treating people under the age of 40.

00:01:25.040 --> 00:01:29.680
The second area also relates to early-onset type 2 diabetes.

00:01:29.680 --> 00:01:32.680
We hear a lot about remission and whether it’s possible

00:01:33.440 --> 00:01:37.040
to lead to remission in type 2 diabetes.

00:01:37.040 --> 00:01:40.200
And we’ve had some excellent data from the DiRECT study and from

00:01:40.800 --> 00:01:42.800
other information.

00:01:42.800 --> 00:01:47.120
But my concern is that in those early-onset type 2 patients,

00:01:47.120 --> 00:01:49.440
we know that they progress much more quickly,

00:01:49.440 --> 00:01:52.680
they have a much faster deteriorating beta cell function,

00:01:53.000 --> 00:01:54.520
and we simply don’t know

00:01:54.520 --> 00:01:58.120
whether remission of type 2 diabetes is the same

00:01:58.120 --> 00:02:00.880
and is as effective as it is in the older population.

00:02:03.160 --> 00:02:05.080
The third area is the use of

00:02:05.080 --> 00:02:07.640
some of the modern technology, for example,

00:02:07.640 --> 00:02:09.640
continuous glucose monitoring

00:02:09.640 --> 00:02:12.760
in people living with type 2 diabetes not on insulin.

00:02:12.760 --> 00:02:16.480
This has been hugely effective in type 1 diabetes.

00:02:16.760 --> 00:02:20.280
There’s reasonable evidence in people on insulin,

00:02:20.520 --> 00:02:23.600
but there’s a complete lack of evidence in people

00:02:23.600 --> 00:02:25.200
not on insulin therapy.

00:02:25.200 --> 00:02:27.120
And the reason I think this is important

00:02:27.120 --> 00:02:28.280
that we get this evidence

00:02:28.280 --> 00:02:31.600
is because we don’t know if it works in a similar way in type 1,

00:02:31.600 --> 00:02:35.480
which is very much around adjustment of insulin therapy.

00:02:35.680 --> 00:02:39.000
In type 2, there’s a whole series of other factors

00:02:39.160 --> 00:02:42.880
that could benefit type 2 diabetes but also could

00:02:42.880 --> 00:02:44.640
be an additional burden.

00:02:46.680 --> 00:02:50.720
The fourth area is how do we really tackle effectively

00:02:51.000 --> 00:02:54.680
stigma in people living with type 2 diabetes and obesity?

00:02:54.680 --> 00:02:56.320
It’s a huge problem.

00:02:56.320 --> 00:02:59.360
It really impacts on people’s lives.

00:02:59.360 --> 00:03:03.720
And I’m not sure that we have a good evidence base of interventions

00:03:03.720 --> 00:03:07.680
that could really address stigma in people

00:03:07.920 --> 00:03:10.920
living with type 2 diabetes.

00:03:12.280 --> 00:03:15.480
And the final area that I think is really important is

00:03:15.480 --> 00:03:18.520
that we’ve seen really rapid development and

00:03:18.520 --> 00:03:20.720
innovation in weight loss therapies,

00:03:20.720 --> 00:03:25.000
but we really don’t know how that impacts on physical function,

00:03:25.000 --> 00:03:27.640
on sarcopenia in people

00:03:27.640 --> 00:03:32.160
particularly with obesity, but also with type 2 diabetes and obesity.

00:03:32.160 --> 00:03:36.600
We know that in type 2 diabetes there’s accelerated ageing,

00:03:37.120 --> 00:03:40.120
poor physical function, even in people in their middle age.

00:03:40.440 --> 00:03:44.120
And yet we may be using very effective weight loss drugs

00:03:44.120 --> 00:03:45.840
that may reduce lean mass.

00:03:45.840 --> 00:03:49.640
We need to understand much more about that area.