Clinical Diabetes and Metabolism
The research carried out within the research group Clinical Diabetes and Metabolism is focused on two areas. One group aims to find new ways to prevent and treat type 2 diabetes, while another group studies diabetes nursing.
New ways to prevent and treat type 2 diabetes
Our overall aim is to identify novel pharmacological and non-pharmacological principles to prevent and treat type 2 diabetes. The treatment options have gradually improved, but this very common disease carries a high risk for cardiovascular and other organ complications. Thus, there is a great need for discovery and development of additional prevention and treatment concepts. Obesity plays a major role in the development of type 2 diabetes, and our research focuses on adipose tissue and its interaction with other organs.
One specific research topic is the link between inflammation, the immune system and metabolism. In this context we study effects of immune-modulating drugs on adipose tissue metabolism, for example glucocorticoids and agents used after transplantations. We also examine other drugs that can promote diabetes development, eg antipsychotics. These investigations are performed in adipose samples from patients and healthy volunteers. Characterization of the mechanisms behind such metabolic side effects may be utilized ‘in the opposite direction’ to prevent and treat diabetes.
Another area is obesity surgery, which typically leads to marked metabolic effects including prevention or remission of type 2 diabetes. The studies are performed in obese patients before and after their surgery, and the effects are investigated with a variety of techniques. These include PET and MR imaging, glucose challenge and adipose tissue sampling in order to characterize nutrient metabolism and hormone regulation in the whole body and in fat cells . In addition, we elucidate effects on neuronal activity and glucose metabolism in specific regions of the brain, which can be important for regulating food intake and metabolism in other organs. Taken together, the metabolic adaptation following obesity surgery could provide new insights that lead to novel pharmacological concepts in obesity and diabetes.
We also study novel drug treatments in exploratory clinical trials. In particular, we focus on modern promising drug classes used in type 2 diabetes, so-called SGLT2 inhibitors and GLP1 analogs. New therapeutic applications as well as mechanisms of action are addressed in patients with diabetes or obesity. We also participate in large-scale observational studies of long-term clinical outcomes, including effects of different diabetes medicines. In this work we utilize the unique Swedish population and health care registries.
The research group consists of approx. 20 persons including basic scientists, research nurses and physicians. We have a clinical research unit and also a laboratory for experimental work in cell and molecular biology. We have several research collaborations with academic institutions as well as industry, at the local, national as well as international level. We have access to large population cohorts that enable epidemiological studies on development of diabetes and its complications and likewise on clinical effects of different treatments.
Our research programs relate to diabetes nursing throughout the life cycle and include three main parts:
- to explore different aspects of self-management and identify factors of importance for diabetic patients’ self-care, metabolic control and health;
- to implement and evaluate diabetes care interventions aiming at improving patient prerequisites for controlling self-management.
- to construct and test psychometric properties of measures for the evaluation of patient-centered care.
In longitudinal studies we evaluate factors of importance to evaluate both patient’s perspective and perception of provided in inpatient care and primary care. It is of importance to evaluate evidence-based nursing care in order to assess whether they are effective or not. Another part of our research includes the development and testing of the measurements that give the care givers information about the patient’s health and impact of the diabetes on the daily life and health.
In longitudinal studies we investigate factors important for the diabetic patients’ self-care and quality of life. We have ongoing studies on insulin pump treatment and are especially studying why teenagers miss to take their bolus doses. The studies on insulin pump treatment also include adults with type 1 diabetes.
Today there is a debate questioning the value of self monitoring of blood glucose in people with type 2 diabetes. We have performed an intervention at 16 primary health care centres to investigate the value of self monitoring of blood glucose.
An extensive area of our research is patient education. We are conducting studies to find the best self-care and training techniques for both teens and adults. We try out various teaching methods to find the ideal model for training of people with diabetes.
Because people with diabetes often suffer from cardiovascular disease, there is therefore a natural link between the two research areas. The studies include secondary prevention, particularly targeted to patients with cardiovascular disease and their relatives.
Nursing interventions in diabetes care always aim at improving patients’ self-management, blood glucose balance and quality of life. Today we lack validated measures on health and burden of diabetes. One part of our research deals with developing such instruments in a Swedish context.
Besides a large number of original publications, our research has resulted in four doctoral theses and a textbook in diabetes care.
The education of diabetes nurses is a very important part of our activities.