In Australia, 280 people develop diabetes every day—that is one person every five minutes. Diabetes Australia calls it the epidemic of the 21st century and the biggest challenge confronting Australia’s health system.
This World Diabetes Day, 14 November, we talk with Emily Burch—lead researcher and PhD candidate at the Menzies Health Institute Queensland—about type 2 diabetes, sometimes called ‘the silent undiagnosed diabetes’.
Q & A:
What sparked your interest in diabetes?
In my undergraduate degree in Nutrition and Dietetics, I found learning about diabetes very interesting as it is a progressive condition where the body gradually becomes resistant to insulin or it cannot produce enough. Then Associate Professor Lauren Ball, NHMRC Research Fellow at Griffith University, talked to me about her plan for the 3D study into type 2 diabetes and together with my other supervisor, Professor Lauren Williams, we fleshed it out. The 3D study became the basis for my PhD research.
My interest in type 2 diabetes is due to the human component. Compared to type 1 diabetes, which is an autoimmune condition, type 2 diabetes is a progressive condition and there are many factors that can inhibit someone’s ability to make lifestyle changes—mental health, family situation, money concerns etc. This is what interests me.
Why was your examination of diet and type 2 diabetes ground-breaking?
At the beginning of my PhD, I conducted a systematic review to investigate what people with type 2 diabetes were eating. Whilst the literature about dietary patterns that reduce the risk of developing type 2 diabetes is extensive, what I discovered is no one had studied what people newly diagnosed were eating in their natural habitat and how it changed over time.
The literature that existed before our 3D study looked at the diet of those with type 2 diabetes solely from a single point in time and only once. But with other chronic diseases there are lots of longitudinal studies that investigate how diet changes over time; this approach needed to be applied to type 2 diabetes.
The objective of our research was to investigate how diet quality changes over time and to identify factors associated with improvements after type 2 diabetes diagnosis among participants in the 3D study.
What factors are associated with improvement in type 2 diabetes?
In [the] majority of cases, people newly diagnosed with type 2 diabetes are encouraged to make healthy lifestyle changes including improving their diet quality and exercise habits before medication is introduced. However, previous research has shown participants feel restricted in food choices, are uncertain of ideal dietary behaviours and feel unheard and rushed when speaking about their diet with health professionals.
We worked with Diabetes Australia to recruit participants and interviewed 225 adults newly diagnosed with type 2 diabetes to collect demographic, diet, physical and health data across 12 months. We wanted to find out whether people changed their diet quality after diagnosis with type 2 diabetes and what other factors, if any, were associated with improvements.
The 12-month data is currently in the process of being published, so I will speak about the findings from the first 3 months of the study which have been published. We found that lifestyle behaviours including having a lower body mass index (BMI), being a non-smoker and being more physically active were associated with diet quality changes in the first 3 months after diagnosis.
Why is support just as important as knowledge for people with type 2 diabetes?
There is a big role for support, particularly from government. People can have all the knowledge in the world about what they should be eating, but so many factors can inhibit them from using that knowledge to make healthy changes, particularly to diet. As I said earlier, in the first 3 months after diagnosis we found those that improved were more active, were non-smokers and had a lower BMI. For the future, we need to understand why these people find it harder to change their diet. For example, are those who are not as active living in lower-socio economic areas where their access to safe parks and exercise facilities is limited? Are they struggling with other family issues or psychological issues that reduce their time to exercise or affect their mobility?
We noted in the 12-month paper (due to be published soon) that the mental health of people diagnosed with diabetes significantly declines over time which implies that people when newly diagnosed need more mental health support. A recent study I read stated that people with type 2 diabetes, who have mental health issues, are up to three times more likely to experience negative health outcomes such as an increased risk of cardiovascular disease. This is a huge concern.
What advice would you give other PhD researchers?
I would give the same advice someone gave me—the most important thing even before you choose your topic is to wisely choose your supervisor. And I totally agree. My discussions with my supervisors have inspired me and shaped my research. I’ve also learnt that getting your research out there into the public eye to influence things like policy is really important. It’s not just about publishing the papers and then never talking about them again.
I also would remind PhD researchers that your PhD isn’t going to be a perfect, smooth three or four years. It is not going to be a streamlined ride, there are going to be issues, but these are all part of the learning. In the end, examiners don’t need to see a perfect research process, they need to see that you have learnt along the way.
Finally, technology. Undertaking PhD research involves learning lots of new programs, particularly statistics and data analysis programs. It is a lot of learning and there will be some technology failures, but it is very interesting and worth the effort.
With the Healthy Primary Care team at Griffith University, Emily has published several research papers for her PhD:
Dietary intake by food group of individuals with type 2 diabetes mellitus: A systematic review
How does diet change with a diagnosis of diabetes? Protocol of the 3D longitudinal study
Short-term improvements in diet quality in people newly diagnosed with type 2 diabetes are associated with smoking status, physical activity and body mass index: The 3D case series study
For more open access research on diabetes visit Griffith Research Online.