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Geeti Arora does research in Ludhiana but is a PhD student at LUDC

Ever since she was a child, Geeti Arora wanted to do research, preferably on diabetes. Now she does, at Lund University Diabetes Center, though most of her work is performed in Ludhiana in India where she also works as a doctor.
The design of Geeti Arora’s thesis is unique and has great potential for important new insights on both gestational diabetes and type 2 diabetes.

I was lucky to get this contact and that there was an interest here in Sweden and Denmark, says Geeti Arora on one of her regular working visits from Ludhiana, in the Indian State of Punjab in northern India, to the Lund University Diabetes Centre (LUDC) in Malmö.

Works as diabetes doctor

It started with a course in diabetology in India. Geeti Arora, who works as a diabetes doctor, was one of the participants and she made contact with the lecturer, Allan Vaag, consultant and professor of diabetes at the Steno Diabetes Center in Denmark, and Adjunct Professor at Lund University.
- I told him who I was and what I wanted to do and Allan was interested, Geeti Arora continues. He put me in contact with Leif Groop on LUDC and now they are both my supervisors.

The samples are collected in India

During her dissertation work she will investigate 5 000 pregnant women in northern India, among other things, by using a test that measures the body's capacity to take care of a specified quantity of sugar.

The women will also provide blood samples to be analyzed for insulin levels and genetic variants. The samples will be collected in India and analyzed at LUDC.

Common and rapidly increasing

- We want to know how common gestational diabetes is in northern India and what characterizes the women who fall ill, Geeti Arora explains.

India has one of the highest incidences of type 2 diabetes in the world. In addition, it has been predicted that the increase in prevalence of the disease will be one of the fastest in the world, resulting in 80 to 100 million diabetics in just a couple of decades.

High risk for type 2 diabetes later

It is known that the link between diabetes during pregnancy and the onset of type 2 diabetes later in life is strong. It is also known that the risk varies widely in different populations.
In Scandinavia, approximately two percent of women get gestational diabetes. About half of them later develop type 2 diabetes.

Several times more common

For Arabic and Asian women, the corresponding figure for gestational diabetes is between five and ten percent, and in southern India, one study indicates that between 20 and 30 percent are affected.
It is not known how many of them will later develop type 2 diabetes.

A blank spot on the map

Northern India, where Geeti Arora works, is an almost entirely blank spot on the map in terms of gestational diabetes.
- There has not been much research done, even though we know that both gestational diabetes and type 2 diabetes are very common, says Geeti Arora.
- And that is why her research is so important, says Allan Vaag and adds:
- We know that the diabetes panorama of gestational diabetes and type 2 diabetes looks different in India but we do not know what these differences are due to and it is very interesting to find out.

More susceptible to diabetes

- Compared to Europeans, Indians are more susceptible to type 2 diabetes, Allan Vaag exemplifies. Those that fall ill are often less obese than patients in the West. For Indians, a modest overweight can be sufficient to develop disease.
The rapid increase in India can be explained by a growing transition to Western lifestyles and the increased risk of obesity.

Western lifestyle

- The increased susceptibility is due to greater genetic vulnerability in India compared to for example Europe. The western lifestyle therefore has more serious health consequences, says Allan Vaag, adding that poverty and malnutrition, causing children born with low birth weight, are also reasons why type 2 diabetes is so common.
- Yes, because we know that low birth weight is a risk factor for type 2 diabetes.

Unknown genetic risk variants

One of the major gaps in knowledge is the nature of the genetic vulnerability to diabetes in the population in northern India.
- Very little is known about what risk variants exist in the population and, in principle, nothing about the role of genetics in gestational diabetes. Which is why we will analyze the blood samples Geeti Arora will collect.

Pregnancy is demanding

Because pregnancy places great demands on the body's ability to secrete sufficient amounts of insulin, important clues to both genetic and non-genetic factors that increase the risk of type 2 diabetes may be gained by studying women with gestational diabetes.

The risk of birth defects

In addition, Geeti Arora’s studies will provide answers to whether also slightly increased blood glucose levels, below the limit for gestational diabetes, increase the risk that the child is born with deformities. She will also investigate if gestational diabetes is more common in the cities or in rural areas.

Free insulin

Another important consequence of Geeti Arora’s thesis is that women who are diagnosed with gestational diabetes will get good care and insulin treatment.
- Primarily I prescribe lifestyle changes, but it is rarely enough and then you have to give insulin. For the benefit of both mother and baby, says Geeti Arora.

A lot of work and travel

She will conduct her research in parallel with her normal work as a doctor in the Deep and Ved hospitals in Punjab.
- There will be a lot of work and a lot of travelling to Sweden and Denmark, but my research is important and very inspiring, says Geeti Arora who will spend several weeks each year in Scandinavia.

Knowledge and enthusiasm

- We combine an interesting and almost completely unexplored area with Geeti Arora’s knowledge and enthusiasm. Together with the expertise available here at LUDC and Steno Diabetes Center, the project will contribute many important new insights, says Allan Vaag.

Text: Tord Ajanki/Emma Ahlqvist

 

Geeti Arora
Geeti Arora.

Geeti Arora
Geeti Arora is working as a diabetes physician in India.

Allan Vaag and Geeti Arora
Allan Vaag and Geeti Arora.

Lund University Diabetes Centre, CRC, SUS Malmö, Entrance 72, House 91:12. SE-205 02 Malmö. Telephone: +46 40 39 10 00