Through Professor Mark Cooper and his department’s work, great strides are being made in the management of diabetes-related kidney and heart disease.

“It’s an exciting time for research into diabetic kidney disease,” says Professor Mark Cooper AO, head of the Diabetes Department in the Central Clinical School at Monash University. Professor Cooper has spent more than 20 years researching the complications that arise from type 2 diabetes.

“The complications of diabetes are all related to elevations in blood sugar,” he says. “You can end up with complications like kidney and eye disease as well as nerve damage and vascular disease. This affects the heart – so heart attacks, heart failure, strokes. Then you can also have effects on peripheral blood vessels. If that’s very serious you can end up with peripheral vascular disease, which can lead to amputation.”

Professor Cooper’s work focuses mainly on kidney disease and, to a lesser extent, vascular disease. In diabetes, the pancreas often struggles to produce enough insulin to maintain normal blood glucose levels and Professor Cooper’s work looks at how glucose damages the kidneys in people with both forms of diabetes. “Glucose promotes the production of a range of proteins and signalling molecules, which then damage the kidney,” he says. “By studying that pathway, we can block some of those steps and reduce the complications.”

New treatments for kidney and heart disease

Professor Cooper says his research team have found that some new drugs that lower glucose levels also benefit the kidneys and the heart. They are currently looking at how one of these groups of drugs, GLP-1 agonists, actually does this. This study, funded by Diabetes Australia, may lead to new treatments to treat and reverse diabetes-related complications.

He says his department is also working on several other interesting studies that have received Diabetes Australia funding. One recent study, led by Dr Matthew Snelson, has found that a diet high in processed foods increases the risk of kidney disease and that foods high in resistant starch help to improve kidney health. With Diabetes Australia’s funding, a clinical trial is planned for later this year.

Other studies are looking into what Professor Cooper calls “glucose or metabolic memory”. “If a person has a period where their diabetes isn’t so well controlled, despite a subsequent improvement, they pay a price for up to five to 10 years afterwards because of this metabolic memory. The body remembers this period of prior bad glucose control.”

He says through Diabetes Australia funding some members of his department are looking at a modification of one of the proteins inside the cells that cause this “metabolic memory”. He says they have discovered this protein can be blocked with a drug that has previously been used to treat cancer.

Professor Cooper says his research aims to treat and reduce diabetes-related complications such as kidney and heart disease. “Diabetes is the most common cause of kidney disease in the world,” he says. “Half the people in the world on dialysis have diabetes.”

If you’re on dialysis, you need treatment three times a week “and the outlook is not particularly good”. He says some people can have kidney transplants but this is a major operation with a long recovery time and many people are too old for this surgery.

Professor Cooper says type 2 diabetes is also one of the most common causes of heart attacks. “Now that cholesterol levels have decreased, blood pressure control is better and people are stopping smoking, the main reason why heart disease hasn’t disappeared is diabetes.”

The cost of diabetes-related complications

The total annual cost for Australians with type 2 diabetes is up to $6 billion and Professor Cooper says 80% of this cost relates to complications. “All our treatments are about reducing the burden of complications so that you end up with a longer life and a better quality of life.”

He says while we are a long way from a cure for both type 1 and type 2 diabetes, great strides are being made in their management.

“When I started there were three drugs to treat diabetes. Now, there are probably at least 12 different classes of drugs. In the last 10-15 years there have been major advances in diabetes management. In diabetic kidney disease, we’ve probably slowed the disease’s progression by more than 50%. There’s no doubt the future will be better.”