The causes of type 2 diabetes are not entirely mapped out, and epigenetics is contributing with important insights. Charlotte Ling, professor of diabetes and epigenetics at Lund University, is one of the authors behind a review article on this topic, published in Nature Reviews Endocrinology. She has carried out research within the field for almost 20 years and has contributed to several studies mentioned in the review article.
“When I started my research career in epigenetics and type 2 diabetes, there were not many studies in this field. Since then, our knowledge has developed greatly. Now we know that we can affect our genome and risk of developing type 2 diabetes through our lifestyle choices. Our way of life can make us ill, but we can also reduce our risk by eating healthy foods and exercising on a regular basis,” says Charlotte Ling, research group leader at Lund University Diabetes Centre.
Important lifestyle factors
We inherit our genes, and they rarely change. However, lifestyle factors such as obesity, unhealthy eating, and physical inactivity, as well as ageing, can cause major epigenetic modifications in healthy individuals. There is mounting evidence that these factors also contribute to the development of type 2 diabetes.
DNA methylation, one of the mechanisms that causes epigenetic changes, is a chemical process through which methyl groups attach to the DNA molecule, affecting the function of genes. Several studies have identified altered DNA methylation in pancreatic islets, adipose tissue, skeletal muscle, and the liver in individuals with type 2 diabetes. In the future, epigenetic biomarkers could be an important tool for clinicians when they to individualise the treatment of type 2 diabetes patients.
“Hopefully, this kind of research will lead to the development of an epigenetic biomarker that can foresee who will develop type 2 diabetes. However, more research is needed before such a biomarker can be used in the clinic,” says Charlotte Ling.
Clinical biomarkers
The drug metformin has been used to treat type 2 diabetes for decades. Metformin lowers blood sugar levels in patients and reduces the risk of developing complications. However, not all patients respond to the treatment and those individuals are at risk of elevated blood sugar levels. Some patients also experience side-effects from metformin.
Charlotte Ling’s research group has discovered epigenetic biomarkers that predict which individuals with type 2 diabetes will benefit from the drug, and which are likely to suffer from side-effects.
“There is growing awareness withinn the health care community that patients with diabetes need tailored treatment. We hope to develop biomarkers that can be used by healthcare professionals to foresee who will benefit from metformin and other treatments of type 2 diabetes,” says Charlotte Ling.
Complications of type 2 diabetes
Epigenetics can also be used to develop markers that predict common complications of type 2 diabetes, which would allow for individualised treatment of patients. Charlotte Ling’s research group is currently developing biomarkers that can predict complications in type 2 diabetes, such as stroke, heart attack, and kidney disease. Charlotte Ling emphasizes how important it is that epigenetics and genetics collaborate in this endeavor.
“We need to collaborate with geneticists to identify clinically useful biomarkers. It is crucial that we are humble and search for the best combination of biomarkers,” says Charlotte Ling.
