Earlier focus on diabetes may yields results

Friday 18 September 2020

Around 1.7 million Australians have diabetes. And between 30 per cent and 40 per cent of people with diabetes will develop kidney disease. This can significantly shorten their life.

Professor Josephine Forbes, Program Leader for the Chronic Disease Biology and Care Research Team and a National Health and Medical Research Council (NHMRC) Senior Research Fellow, is looking to change this.

Her work is meeting unmet clinical needs for those who live daily with Type 1 diabetes and she is focused on the ultimate goal of prevention of diabetes.

“The Mater Young Adults Centre sees those with chronic complications which develop in early life. For them it’s a long and winding road managing their risk for complications such as kidney disease. Watching these youth made me wonder whether focusing on them was a better place to start to deliver better outcomes in the future,’ Professor Forbes said.

She began her career in paediatric nephrology before partnering with organisations such as the Juvenile Diabetes Research Foundation (JDRF), to focus on finding new medicines to treat diabetes complications. However, this work in advanced glycation, mitochondria and diabetes has led to a potential treatment that might prevent type 1 diabetes.

“Often we focus on fixing the symptoms and lose track of the underlying problem—which is fair when you are helping someone with a life threatening disease. However, as a researcher we see things through a different lens which can assist our teams to make such breakthroughs as what we saw earlier this year, with our work testing mediciens which target RAGE that may prevent Type 1 diabetes such as the biologic seen in Expansion of Functional Regulatory T Cells Using Soluble RAGE Prevents Type 1 Diabetes.   

“Along with this, we have been looking at complications that arise in young people 15 to 25 years old with risk for kidney disease to see if it is evident soon after the development of diabetes. This age group historically has poor blood sugar control due to growth needs, hormones and other changes which occur during puberty, but we are asking whether certain pathways are already altered and might be reprogrammed to stop kidney disease from developing. We’re thinking about how early we can say they ‘have’ kidney disease and can we intervene to prevent it from becoming more advanced.

“My team and I also are looking at therapies which target mitochondria. My hunch is that one of the underlying risks for complications could be mitochondrial dysfunction and we are working with companies to walk some of these mitochondrial medicines through the strict processes which line their pathway to patient care.”

Mitochondria are the power stations in our bodies that take in fuels such as sugars and proteins from the food we eat to produce transportable battery like energy called ATP that our bodies use to function properly. Mitochondrial syndromes (or dysfunction) are disorders that occur when these power stations malfunction. Professor Forbes and her team think that this also happens in diabetes when fuel demands and supply change—as diabetic youths are typically more active and eat more often than their older counterparts. 

Professor Forbes’ work, in collaboration with Mater Young Adult Health Centre, examines kidney function in youth who have had diabetes for about ten years and are at higher risk of kidney and cardiovascular disease.

“We sometimes get distracted by the over 50 plus age bracket which certainly has a high diabetes incidence. However, diabetes is increasingly diagnosed in children and adolescents who will have it for a long time.  These young people are the ones whose live are being cut short and so we should be looking at earlier, rather than later, to help end this disease.”