Diabetes: A multi-faceted approach to a multi-faceted disease

LIH research initiatives battle diabetes from all angles

• Deep Digital Phenotyping Research Unit
• Precision Health Research at DoPH

On the occasion of World Diabetes Day, LIH Deep Digital Phenotyping Research Unit Dr Guy Fagherazzi takes us through the research projects that are actively improving the screening, and care of this complex disease, addressing it from various angles.

Diabetes is a chronic medical condition with two primary types: type 1 (T1D), characterized by the body’s inability to produce insulin, and type 2 (T2D), in which the body struggles to effectively utilize insulin, a hormone crucial for sugar metabolism. Currently, diabetes affects 1 in 10 of the world’s population, but many remain undiagnosed due to screening challenges. This situation is alarming, given the sharp increase in diagnosed cases, with estimates suggesting that by 2045, 1 in 8 adults will grapple with diabetes.

While a cure remains elusive, diabetes management involves lifestyle changes and potentially daily insulin injections. However, this necessitates constant monitoring of blood sugar levels, through medication, exercise and diet, which can exert a significant emotional and psychological toll on those living with the condition.  

On the occasion of World Diabetes Day, we interviewed Dr Guy Fagherazzi about the initiatives that his team at the Luxembourg Institute of Health’s Deep Digital Phenotyping Research Unit is undertaking to combat diabetes.

Dr Fagherazzi, could you tell us about the primary goals of your team’s diabetes research initiatives, and how you are showcasing these projects on World Diabetes Day?

G.F.: “Our team has two main objectives. Firstly, we are focused on shedding light on the prevention of diabetes-related complications. Secondly, we are working to emphasize the significance of identifying the risk of type 2 diabetes early on, with the goal of delaying or even preventing its onset.  We have various projects we’ve undertaken to achieve these goals.”

Let’s start with the projects tackling the psychological burden of diabetes. Can you tell us more?

G.F.: “Addressing the psychological distress associated with diabetes is a significant focus of our work, and we have more than one project addressing this. In a study led by PhD student Dulce Canha, under the guidance of Dr Aguayo and myself, for instance, we found that hybrid closed-loop insulin delivery systems, which are expected to improve control of blood glucose levels and reduce the daily burden of diabetes, had a positive impact on reducing diabetes distress in adults. However, it’s important to note that these improvements were not observed in children living with diabetes. We have shown that even the most advanced technologies failed to completely remove diabetes distress, highlighting the significant need to identify innovative solutions that could prevent high levels of diabetes distress and improve the general well-being of people living with diabetes.

In another project called PsyVoice, led by PhD student India Parker and guided by Dr Gloria Aguayo and myself, we are testing voice-based digital interventions to enhance diabetes management. The project’s goal is to create a remote monitoring device that can assess a patient’s psychological well-being. This approach can pave the way for digital health interventions customized to each patient’s abilities and interests. We are also exploring the needs and preferences of individuals with type 1 diabetes and those caring for children with type 1 diabetes regarding voice-based resources, with the aim of developing a co-designed tool to help manage diabetes distress.

You mentioned digital health interventions: is this something that features in more of your projects?

G.F.: “Digital health solutions play an indispensable role in our research endeavours due to their capacity to elevate patient care, optimize healthcare delivery, and effectively process extensive patient data for research purposes. One illustrative project within our research portfolio features PhD student Abir Elbéji, who is pioneering a voice-based methodology within the Colive Voice project, a worldwide digital health study led by the Luxembourg Institute of Health. In this innovative initiative, voice recordings from individuals living with type 2 diabetes are harnessed to forecast symptoms and disease severity, discerning and categorizing vocal biomarkers. Ultimately, our goal with this project is to develop artificial intelligence methods that can screen for diabetes simply using a rapid voice recording. Preliminary findings suggest promise for an accurate and scalable screening tool for type 2 diabetes in the adult U.S. population, which could potentially reduce undiagnosed cases.

We also have an ongoing project led by PhD student Charline Bour in the Department of Precision Health, which investigates regional differences in the burden of diabetes on a global scale. This research involves analysing more than 40 million diabetes-related social media posts from all over the world, revealing that individuals with diabetes face varying challenges in disease control and symptoms based on their geographical location. This information will be invaluable in designing diabetes programs that enhance personalized medicine and self-management, addressing the specific concerns of the local population.

In another project, led by PhD student Charline Bour, we are focused on investigating regional differences in the burden of diabetes on a global scale. This research involved the analysis of a substantial dataset comprising 34 million social media posts. The results of our study have shown that individuals with diabetes experience diverse challenges in terms of disease control and symptoms, depending on their geographical location. This information will aid in designing diabetes programs that enhance personalized medicine and self-management, catering to the most relevant concerns for the local population.”

But your research is not only addressing the psychological burden of diabetes: can you tell us how you are improving diagnosis and treatment?

G.F. “Of course. One of our collaborative efforts with French diabetologists and the large SFDT1 study has led to multiple projects. These projects primarily focus on type 1 Diabetes (T1D). Together with Dr Aguayo and our French partners, the collaboration explores critical disease factors, such as deciphering the heterogeneity of glycaemic phenotypes among people with T1D using advanced artificial intelligence (AI) approaches on data from continuous glucose monitoring devices. This highlights the importance of considering factors beyond isolated glycaemic metrics and moving away from one-size fits all approaches for glycaemic control and leaning towards precision health strategies in diabetology. We are also conducting a study, led by PhD student Dulce Canha, to better understand the determinants of diabetes distress, with the goal of developing preventive strategies to reduce the emotional burden of diabetes and improve glycaemic control. Furthermore, we are investigating the factors that lead to less frequently-studied diabetes complications such as musculoskeletal disorders that affect almost 1 in 3 T1D patients.”

Thank you, Dr Fagherazzi. Do you have any concluding remarks?

G.F.: “Our collective efforts are dedicated to making a meaningful impact in diabetes care. We are committed to innovative research, using AI, digital biomarkers and digital epidemiology that can ultimately enhance the lives of those dealing with this chronic condition. These projects, and the many ones to come, represent our commitment to making a positive difference in the realm of diabetes.“