Current Research Strengths

Diabetes & Obesity Research Priority Area Current Research Strengths

34% of our Commonwealth's population is obese and we are ranked 5th highest in the nation for adults and 1st for youth ages 10-171. As obesity is a risk factor for diabetes, it’s not surprising that 15% of our population is diabetic; we rank 7th highest for diabetes2, representing ~ 530,000 Kentuckians3. Also alarming is the fact that ~one-third of our population is considered prediabetic and that many of these individuals are unaware they have the condition. Prediabetes not only increases risk for diabetes but also for serious comorbid conditions such as heart disease and hypertension, both of which contribute to overall mortality. Finally, it is important to mention that obesity and diabetes are also recognized risk factors for cancer and that Kentucky has the highest rate of cancer in the country. Recent reports of a significant increase in obesity-related cancer in young adults are especially worrisome5 for Kentucky because of the very high rate of obesity in our youth.

Fortunately, UK has significant current research strengths that allow it to address the Commonwealth's health disparity in obesity and diabetes. Further, we are working to integrate and facilitate obesity/diabetes research across the campus from basic through population research. (As examples, there are opportunities to align with the Markey Cancer Center and the Cancer Metabolism COBRE to address the role of obesity/diabetes in cancer risk, as well as with UK Pediatrics/OB-GYN to raise awareness and prevention efforts among the youngest in our population).

Current Research Strengths in 5 Key Focus Areas

The significant role of comorbid conditions in obesity and diabetes

These include hypertension, cardiovascular and fatty liver diseases. While comorbid diseases are defined as those being associated with another condition, to what extent these comorbidities contribute to the onset, persistence and severity of obesity and diabetes is a key question.  As an example, recent studies show that periodic fasting can reverse fatty liver disease, result in weight loss and improved glycemic control4. Thus, a comorbid condition (e.g., fatty liver disease) may not simply represent an association but instead represent a cause-and-effect relationship. Research in comorbid conditions is particularly strong at UK and its researchers are well poised to leverage their expertise to help mitigate the obesity/diabetes disparity.        

Identification of mechanisms underlying obesity/diabetes

Among these is inflammation, typically a beneficial response in response to injury or exposure to pathogens/toxins.  However, ongoing and chronic inflammation can be maladaptive and is associated with many of the comorbidities mentioned above as well as with obesity and diabetes. What causes persistent inflammation is still largely unknown but researchers at UK are working to identify key molecular and cellular pathways. Some of these potential pathways involve dysregulated adipose tissue biology, abnormal pancreatic hormone (amylin) secretion leading to vascular complications and circadian disruption. Perhaps remarkably, all of these pathways are associated with an inflammatory phenotype. Ultimately, the goal is to mitigate these factors and the associated inflammatory response to offset the disease-related burden and consequences of obesity and diabetes.

The role of environmental factors across the lifespan

UK researchers have shown that persistent exposure to environmental pollutants/toxins can increase susceptibility to obesity/diabetes. Some of these pollutants include the polychlorinated biphenyls (PCBs) which contaminate regions of the Commonwealth and, thus, pose significant health risks to its population. Other relevant environmental risk factors for our state include exposures to cigarette/e-cigarette smoke and to psychosocial stress. Researchers at UK have shown that exposures to these factors during the prenatal period result in obesity in the offspring. Collaborative efforts among basic science and clinical departments (UK Pediatrics/OB-GYN) have been established to facilitate further research on these topics. Other work is assessing the impact of chronic, life-long stress. Importantly, UK is studying not only the underlying mechanisms imparted by these environmental factors but also possible interventions to reduce susceptibility to obesity/diabetes.     

Interventions in Obesity/Diabetes

Collaborative efforts among UK researchers in the College of Health Sciences and the College of Medicine have led to studies examining whether a drug used to treat diabetes (metformin) can augment the effects of resistance training in older adults. Advancing age is a major risk factor for obesity/diabetes and resistance training can help prevent the onset and mitigate the effects of diabetes and obesity. A major goal of studies such as these is to promote a “longer healthspan” among our population. Along these lines, skeletal health also impacts healthspan, however, a major complication of diabetes is bone disease; ongoing studies at UK are working to identify the underlying mechanisms as well as potential therapies to reduce diabetes-related osteoporosis and fracture risk. Other studies are examining thermogenesis as a defense against obesity/diabetes and identifying factors in human adipose tissue stores that may promote “fat-burning” and weight loss. Some of the efforts in these areas hold promise for a personalized therapeutic approach.

Established community intervention programs 

This is a research major strength represented by efforts across multiple UK colleges, including the Colleges of Medicine, Public Health, Nursing, Education and Agriculture, Food and Environment, to name a few. UK researchers and UK’s Cooperative Extension have established strong partnerships with local diabetes coalitions, health departments and community organizations. UK researchers are also partnering with churches in programs to help promote weight loss and to offset risks from diabetes. They have also established programs in underserved areas of Appalachia to promote healthy diet interventions and to teach diabetes self-management to augment clinical care. UKHC efforts via Kentucky TeleCare are especially critical as they provide a means for rural healthcare sites to connect with UK medical specialists (The National Institute for Minority Health and Health Disparities-NIMHD cites lack of access to health care as a major barrier to overcoming health disparities). As an example, UK physicians are using state-of-the-art cameras and telemed in underserved Appalachian communities to monitor diabetes related eye disease and to stave off blindness, a major complication of uncontrolled diabetes. There can be no doubt that UK’s presence in these communities is critical to stemming the health disparity problem in the Commonwealth and that UK’s Diabetes and Obesity Research Priority Area is playing a major role. 

Citations

1. From <https://stateofobesity.org/states/ky/>
2. https://stateofobesity.org/diabetes/
3. http://main.diabetes.org/dorg/PDFs/Advocacy/burden-of-diabetes/kentucky.pdf
4. Taylor R (2019) Calorie restriction for long-term remission of type 2 diabetes.  R. Clin Med 19:37
5. Sung, H., R.L. Siegel, P.S. Rosenberg, and A. Jemal, Emerging cancer trends among young adults in the USA: analysis of a population-based cancer registry. Lancet Public Health, 2019.