Type 2 diabetes and obesity: What do we really know?

By studying how our genes express themselves in response to environmental factors and changes in lifestyle, we will better understand how health recommendations and treatments can be tailored to each individual.

"Environmental factors that disturb cellular and physiological processes and have an effect on the individual's predisposition to diseases, such as type 2 diabetes, are likely to do so through active, and reactive, modulation of genome function. There is a compelling rationale behind this concept, but the details about how these processes work remain poorly defined," says Paul Franks.

"However, there is emerging evidence that epigenomic changes such as DNA methylation and histone modifications, which affect the ways in which genes are transcribed and translated into proteins, are important features of these processes," he continues.

Previous research has largely focused on dietary components and which diet would be best to lower the risk of obesity and type 2 diabetes, but so far there is no clear evidence from epidemiological or clinical trial data that a specific diet is optimal for long-term weight-loss or lowering the risk of diabetes. Some types of dietary fat may be harmful while others may in fact be protective. The researchers also concluded that the widely established view that vitamin D supplementation lowers blood sugar levels and the risk of type 2 diabetes is unlikely to be accurate.

In recent years, there has been an explosion of interest in the role of the gut microbiome in the development of type 2 diabetes and obesity.

"Several studies have detected differences in the composition of the gut microbiome between healthy people and those with obesity and type 2 diabetes, but the cause and effect remain unclear," says Mark McCarthy, and continues:

"In addition, both high and low birth weight have been linked to type 2 diabetes later in life. It seems as if these associations reflect the complex interplay of genetic variation in both the foetus and the mother, along with the impact of the intrauterine environment."

The major challenge is getting closer to a mechanistic understanding of why type 2 diabetes and obesity occur and why they have become so much more common in the last 40-50 years.

"We have only a superficial understanding of that. It often gets blamed on our western lifestyle but the specific components of modern life that are most damaging remain unclear. We also know that this occurs on the background of hundreds of genetic differences that influence predisposition. The genetic findings are increasingly allowing us to understand the mechanisms involved, and to start to connect the genetic and environmental contributions," says Mark McCarthy.