If you are at risk of developing diabetes, it will come as no surprise if your doctor suggests you keep an eye on your weight and step up your physical activity. A number of lifestyle aspects are known to play a role. Other insights are only just emerging: new EU-funded research highlights the importance of living in sync with your body clock.
The EuRhythDia project is studying the role of disrupted sleep-wake patterns in the onset of type 2 diabetes in a bid to improve prevention. It focuses on people who have to be out and about when everyone else is asleep: the night shift workers who are keeping our world ticking over while the rest of us are exploring the land of Nod.
Half way into the project, the partners already have a number of achievements to report. They have set up extensive trials assessing the potential of light therapy, melatonin and exercise, and identified biomarkers that will help to spot persons at risk much earlier than before. They are also generating leads for the development of new drugs to treat diabetes.
A sign of the times…
There are two main types of diabetes, a condition that causes a sugar levels in a person’s blood to become too high. Type 1 occurs when the body stops producing insulin to move sugar (glucose) from blood to cells so the body can use it. Type 2, which is far more common, occurs when the body still produces insulin but is unable to use it, or it doesn't produce enough insulin to function properly. Type 2 diabetes usually occurs in adulthood, although more and more younger people are being affected.
“The increasing incidence of type 2 diabetes in Europe is caused by the lifestyle that is prevalent here,” says Professor Rainer Böger of the University Medical Center Hamburg-Eppendorf, the project co-ordinator.
“Very little exercise, lots of calories, high blood pressure and plenty of stress, increased glucose levels over time… At some point, the body can’t counteract this any more,” he adds. Recent studies show that the risk is five times higher among night shift workers than for the rest of the population, suggesting that atypical schedules also play a role.
But the condition does not develop overnight. Some people are in a so-called pre-diabetic state for 20 years before the actual disease sets in. Lifestyle changes during this period can turn the situation around.
EuRhythDia set out to improve prevention for people who are at greater risk because they work unsocial hours. Doing so involves finding ways to diagnose such individuals earlier and developing therapies that can help them to adjust their body clock.
…and a matter of timing
“All the metabolic activities of the body are activated in the morning,” Böger explains. “In the evening, the body releases melatonin as a signal for the body to reduce its metabolic activities – a way of saying that there is no food to be expected, no exercise to be done, and that this is rest and relaxation time.”
This means that night shift workers are active and also have to eat while their metabolism is basically asleep. EuRhythDia has developed three therapeutic approaches that can help people who always work nights to establish suitable sleep-wake patterns and enable persons on rolling shifts to minimise the disruption.
One of these approaches involves desktop light therapy devices, used during the first half of a night shift to override the body’s response to the fact that it’s actually dark outside. Another relies on melatonin, which people could take to get to sleep when their regular downtime begins.
The third method harnesses the power of physical activity – a cornerstone of the prevention and management of diabetes, but the objective here is different. The novelty lies in the fact that EuRhythDia encourages night shift workers to exercise at specific times. Thirty minutes of endurance training just before they head off to work can help to keep their metabolism ready for action.
But for prevention to work, says Böger, people need to be aware of the need – and the link between the body clock and type 2 diabetes is only beginning to emerge. EuRhythDia has set up a dissemination programme aimed at patients, practitioners and scientists.
Project details
- Project acronym: EURHYTHDIA
- Participants: Germany (Coordinator), Switzerland, Finland, Belgium, UK, Netherlands, France, Italy, Austria
- Project reference: 278397
- Total cost: € 7 695 927,2
- EU contribution: € 5 997 889,45
- Duration: October 2011 - September 2016