Diabetics saved by the cold Hugo Thomassen

Diabetics saved by the cold

In Body
Written by  Hans van Vinkeveen Thursday, 15 October 2015 14:37

Exposure to a chilly environment causes muscles to absorb more glucose from the blood. This surprising discovery by Patrick Schrauwen, professor of diabetes at Maastricht University (UM), inspired a new area of research and promises to improve the lives of people with diabetes. It also earned Schrauwen a publication in the leading journal Nature Medicine.

 

It’s not every day that researchers do a double take at the result of an experiment. But it happened to the team headed by Schrauwen and his colleague Wouter van Marken Lichtenbelt, UM professor of Ecological Energetics and Health. “We’d expected an effect, but not this big”, Schrauwen explains. “Everyone was saying: wow, there’s really something going on here. I wouldn’t go so far as to call it a Eureka moment, but the result was certainly surprising. Overwhelming, even.”

The experiment clearly showed that exposing diabetes patients to a cold environment leads to significantly increased muscle sensitivity to insulin, allowing on average a staggering 43% more glucose to be absorbed from the blood. This is a promising finding for people with type 2 diabetes, whose muscles have a greatly reduced response to the hormone insulin, leading to dangerously high blood sugar levels.

Silent killer
Type 2 diabetes, once known as adult-onset diabetes, can nowadays even be seen in children. Its chief cause is obesity. An estimated 900,000 people suffer from this type of diabetes – and that’s on the low side, says Schrauwen. “The problem is, you don’t really notice the symptoms of high blood sugar at first. The negative effects come later. You can compare it to sugar on your teeth. If you don’t brush you’ll end up with cavities. Similarly, if your blood sugar is too high for years, your body will suffer. With serious consequences: cardiovascular disease, deteriorating eyesight, kidney damage. Type 2 diabetes is a silent killer.”

The link between cold and increased insulin sensitivity is not entirely new. In 2013, UM’s Anouk van der Lans discovered that cold stimulates brown fat. The experiment by Schrauwen, Van Marken Lichtenbelt and their team, however, shows that brown fat could not have explained the substantial increase in insulin sensitivity that was measured. The true root cause has not yet been determined, but it is clear that the effect is primarily in the muscle.

Cold stress
Schrauwen emphasises that this is a ‘proof of concept’ that raises many new questions. For example, the scantily clad participants spent six hours a day for ten days in a temperature of 14 degrees Celsius. Is a slightly more comfortable temperature also beneficial? And how long does the increase in insulin sensitivity stick around after the test? In other words: is the effect immediate and transient, or are there structural changes in the body? Is the signal that leads to increased insulin sensitivity triggered by some sort of cold stress? Schrauwen suspects that this might be the case. “Exercise has a similar effect. It’s basically just pushing your body out of your comfort zone.”

The remarkable findings were published in the highly reputed scholarly journal Nature Medicine. Is this the cherry on top of his career? “It’s a top journal, so I’m very proud. It’s also quite unique for research on human subjects to make it into this journal; most of the publications stem from animal research.” But ultimately, his aim is not merely to collect plaudits. “It’s about helping to solve a major social problem. A publication like this can pave the way for funding for follow-up studies. And it’s always good when science reaches the general public through the media.”

Long-term vision
This is also how Schrauwen views the prestigious Vici grant he was awarded some years back. It’s an important tool to build a successful career in science. “Science doesn’t have a money tree; you’re always fighting for funding. Grants like this give you the freedom to do good. They show that you’ve proven yourself and facilitate research by making the next grant more attainable. You can’t really do without them in solving a problem as big as diabetes.”

Schrauwen has already published over 200 articles and received various awards for his diabetes research. How does he explain his success? He laughs. “What’s the formula for success? I don’t know. Luck, maybe, that’s part of it as well. I’m good at committing to a long-term vision, though. Being focused on a goal means you don’t let yourself get distracted by other promising research. A renowned scientist once said to me: If you believe in something, you’ve got to latch onto it. That’s how you make it.” Collaborating with other researchers is also important. “The problem of diabetes is too big to solve on your own. Our research is a true team effort; it’s helped a number of team members to grow and succeed.”

Treatment
Thanks to the experiment, cold tests have gained momentum in diabetes research. Until now, Schrauwen explains, there were two ways to influence insulin sensitivity: insulin administration and physical exertion. “The cold test is a third way that will hopefully bring us one step closer to a new therapy for diabetes patients.”

In a more extensive follow-up study, the team will look for insights into a more effective treatment for type 2 diabetes. “One option is helping people to create a colder environment in their own home, which is something my colleague and friend Van Marken Lichtenbelt is working on. Another is unravelling the molecular mechanism behind all this. Can the signal triggered by cold be elicited in some other way? If so, you can start developing medication that has the same effect.”

Patrick Schrauwen (1971) is professor of Metabolic Aspects of Type 2 Diabetes Mellitus at the Department of Human Biology and Movement Science of the NUTRIM research school. In 2008, he received the prestigious Vici grant from the Netherlands Organisation for Scientific Research (NWO). Schrauwen’s research focuses on the origins of insulin resistance, the early stage of type 2 diabetes.

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