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Type 2 diabetes — sowing the seeds for a solution

New cases of type 2 diabetes are on the rise, but the way we use drugs to manage the disease can be costly — and can even increase the risk of heart attack or stroke. CBU researchers are testing flaxseed as the possible key to safer, more effective treatment.

Cape Breton has among the highest rates of type 2 diabetes in Canada. In 2001 about 8% of Cape Bretoners had been diagnosed with it, and by 2007 that figure had shot up to approximately 12%, with every indication that rates will increase further still. Type 2 diabetes, which features declining insulin concentrations in the blood and/or an inability to effectively use insulin, is a serious and growing health issue around the world — with Canada being no exception.

Furthermore, the combination of a sedentary population with excessive caloric intake and a shifting demographic toward older persons with concomitant age-driven diseases is severely burdening healthcare budgets. By 2010, it is thought that diabetes will cost the Canadian healthcare system $15.6 billion a year — and that number will increase to $19.2 billion by 2020 (Canadian Diabetes Association). Children are now increasingly being diagnosed with type 2 diabetes as well.

A person facing a lifetime of diabetes is not as likely to be as productive in the workplace due to numerous severe complications of the disease, not the least of which are depression, shock, sadness, fear, anger, vision diminishment or loss, problems with digestion, skin- and foot-care issues, heart attack, stroke, end-stage kidney disease, hypertension and even limb loss. Decreased workplace productivity reduces the tax base used to fund already overstretched healthcare budgets. On 28 October 2008 the Conference Board of Canada released a report indicating that Canada placed 10th out of 16 countries in health and quality of health services, down from a fifth-place finish in the 1990s. The report indicated that Canada may well fall further down the list if Canadians do not address chronic diseases such as diabetes. As a result it is clear that the ever-more-rapidly developing downward spiral will have profound consequences, including perhaps a diminution of the impact of attempts to improve the local economy.

Unfortunately, there is no evidence of a plateau or decrease in cases anywhere in sight. Prevention through diet and exercise has been a resounding failure. Consequently, in the prevention and management of type 2 diabetes the focus has now shifted to drugs and nutraceuticals — concentrates of one or more molecules from plants or animals. Ed. Barre’s lab at CBU is concerned with the reduction or elimination of the difficulties with polypharmacy. Polypharmacy is the concurrent use of numerous drugs to control the many features of pre- and post-onset type 2 diabetes. It is exceptionally costly; heightens the chance of drug interactions and side-effects; and increases the number of different doses and the frequency with which the patient must deal with them. Polypharmacy frequently results in poor patient compliance and subsequent poor management of the disease, which in turn results in even more aggressive impairment of vascular function with a much greater risk of heart attack or stroke — the cause of death in 80 % of all type 2 diabetes cases.

Barre’s laboratory has three main objectives:

1) find the minimal number of agents that will at least in some persons prevent or significantly manage type 2 diabetes in terms of all of the traits above, thus reducing polypharmacy

2) examine candidate genes for genetic sequence (genotyping) and by extension gene expression, as a means of identifying individuals who do respond best to objective 1, and why

3) assess potential molecular triggers for type 2 diabetes. Such triggers could then, as appropriate, be eliminated from or reduced in concentration in the plasma by dietary or drug interventions.

Nutraceuticals are being investigated in Barre’s laboratory. A trial with flaxseed oil in type 2 diabetics conducted by Barre’s lab yielded only a decrease in the pro-thrombotic (tendency of blood to clot) state in males and females and a drop in blood-serum cholesterol levels in females only. Blood pressure, obesity measures, inflammation and blood glucose levels were not significantly affected. However, the data is being further parsed using genotyping.

Currently a flaxseed lignan complex is being investigated in type 2 diabetics, with a view to reducing polypharmacy. Lignans are a group of estrogen-like compounds that are particularly abundant in flaxseed. The complex in question contains three molecules that, collectively, will hypothetically address elevated blood glucose, elevated blood-plasma fat levels (dyslipidaemia), hypertension, obesity, inflammation and the pro-thrombotic state — at least in some individuals. Identification by genotyping and gene-expression levels of those persons who best respond to the amelioration of such traits is critical to the reduction of polypharmacy. Ultimately this lignan complex will be tried in the prevention of type 2 diabetes.

Currently investigation of potential type 2 diabetes triggers is underway in the laboratory.

Of course, the simplest and cheapest approach to preventing type 2 diabetes, in most cases, is to get people to be much more physically active and rigorously follow Canada’s latest (2007) food guide. This approach would prevent 90% of new cases. Going for walks; buying and consuming a wide variety of inexpensive and locally produced high-quality foods; and demonstrating these behaviours to children and others would be good for the healthcare system and the economy – so long as people adhered to the plan.

For more information contact:

Dr. Ed. Barre
Department of Health Studies
Cape Breton University
Sydney, Nova Scotia
B1P 6L2
Phone: (902) 563-1921
Email: .(JavaScript must be enabled to view this email address)