Warwick Postgraduate Poster Competition 2009
James Larkin, Daniel Zehnder, Naila Rabbani and Paul J. Thornalley (2009)
Post graduate poster fair, Warwick University - Medicine faculty winner and regional finalist.
The emerging role of thiamine in diabetic complications
Diabetes is a disease of glucose (sugar) metabolism characterised by high blood glucose levels that is rapidly approaching epidemic proportions. It currently accounts for 10% of all hospital spending in the UK, mainly to treat complications associated with the disease. It is these complications, including diabetic retina disease, nerve disease and kidney disease, which are the leading cause of death amongst diabetic patients. Our research investigated the link between these debilitating complications and a potential treatment, a simple vitamin: thiamine, or vitamin B1.
Diabetic patients are markedly thiamine deficient having blood levels around 75% lower than normal. This is important because thiamine is critically involved in aspects of glucose metabolism. Normally, glucose provides the body with energy with only a small percentage causing damage. In a diabetic patient, with higher glucose levels than normal, some "spills over" into damaging pathways. It is this spill-over that is behind chronic diabetic complications. Thiamine potentially represents a novel therapy because it promotes an alternative spill-over pathway, one that will divert glucose to safe products and away from damage.
To test this theory, we conducted a trial of thiamine therapy in diabetic patients in Lahore, Pakistan. We gave diabetic patients either thiamine therapy or placebo for three months and monitored them for symptoms of diabetic kidney disease. The thiamine not only halted diabetic kidney disease advance, but actually reversed early symptoms. This important finding highlights a potential cheap therapy to help alleviate diabetic kidney disease in a world with a rapidly escalating diabetic population.