Can our vision hold the key to better diabetes outcomes?

Professor Chris Nolan, Director of Endocrinology and Diabetes for ACT Health and Professor of Endocrinology at the ANU Medical School serves patients at The Canberra Hospital and conducts research about all forms of diabetes.

Professor Ted Maddess from The John Curtin School of Medical Research studies a range of eye diseases. He and his group have invented a machine that accurately maps the visual field of the retina, and also tests the nerve connections between the eye and brain.

Could this invention help diabetes patients? The two researchers got together to find out.

They are exploring whether Professor Maddess’s invention can do these jobs: early detection of diabetes for people at risk, and effective management of the disease by closely tracking its effects.

The technology can find two complications of diabetes related to eyesight: retinal neuropathy, or damage to the retina (which is a neural tissue, an outgrowth of the brain); and retinopathy, where abnormal blood vessels of the retina cause a loss of vision.

Retinal neuropathy seems to precede retinopathy, and finding it could inform treatment decisions and patient behaviours – to prevent more serious damage.*

This test may not only help diabetes patients by preserving eyesight through early detection and treatment, but also by serving as an indicator to whether a patient’s individual treatment is preventing damage to the rest of their body. Other diabetes complications include cardiovascular disease – which kills over 60 per cent of people with type 1 diabetes, kidney failure, foot ulcers and lower limb amputations.

The collaboration between this vision researcher and diabetes clinician became even more exciting when the project was folded into the winning Grand Challenges SchemeYour Health in Your Hands: Future Personalised Medical Technologies for a Sustainable and Effective Healthcare.

This project seeks to deliver better care for chronic diseases, regardless of a person’s location or access to a major hospital.

The first aspect is early detection of chronic diseases, followed by better management of a disease through precision therapies. With further innovation in miniaturised or wearable sensors, patients in any location would be able to record timely information about their health as they undergo daily activities. Both the cost and outcomes of disease management could improve by less episodic intervention, and by targeting treatments to an individual’s specific condition.

Your Health in Your Hands will focus first on two chronic diseases: diabetes and multiple sclerosis (MS).

Diabetes alone affects seven per cent of Australia’s adult population (rising to 14 per cent among indigenous adults). Its death rate is twice as high in rural areas where detection and management services are less available. The disease is underdiagnosed; a quarter of sufferers are diagnosed only after the disease presents serious health consequences.

The project brings together innovations from several corners of the University. These include:

  • Genomics, to figure out which patients are at risk and help devise effective, personalized therapies
  • Engineering, to create tools that measure key aspects of an individual’s health
  • Public health experts, to improve the patient experience and ensure delivery across the population; and
  • Big data, to process the avalanche of data to discover how genetics, symptoms and diseases are related, and to find which therapies work best for which patient.

The team involves 52 researchers at ANU, across six Colleges. The University’s depth and breadth provide a unique environment for the success of this wide-reaching effort.

Eye health for diabetes sufferers is just one piece of the puzzle.

“You need to ask a bunch of independent questions. Medical knowledge is multidimensional. Maybe we measure 10 things about each patient – if they all tell you the same thing, you might as well have asked the same question 10 times” explains Professor Ted Maddess. “You want to have multiple tests that each give you different information.”

This way you can find out what makes one diabetes patient (or MS patient) different from another, and which treatments will be most effective for that individual person.

When experts from different fields get together, possibilities expand.

Professor Maddess described a meeting of the Grand Challenges team where Professor Nolan posed a question.

“Chris was saying ‘This is what diabetes is. It would be great if we could measure this.’ And then the chemist and the engineer in the room said, ‘I measure that!’”

*Almost all patients with type 1 diabetes, and 60% of those with type 2 diabetes, currently develop vision-threatening eye damage within 20 years of diagnosis.