SURVEYS

While brainstorming about our project topic, we carried out two surveys.

The first one is about metabolic disorders in general. We focused on metabolic diseases causing a restriction in diet. For instance, people with celiac disease cannot consume gluten-containing foods, or people with diabetes mellitus have to be careful about glucose consumption. We placed kidney diseases, diabetes mellitus, high cholesterol, podagra and celiac disease in our questions. Our aim was to see the public perception of these diseases.

When we shared this survey with the public, 195 people answered it and we have collected the data. When we asked about the most prevalent disease among those five diseases mentioned above, we saw that by far the most common answer is diabetes mellitus. The results made us want to focus more on diabetes mellitus. This survey also contains questions that helped us see the awareness rates of public regarding the metabolic diseases.

Our second survey, which is prepared by Saint-Joseph Private French High School's iGEM Team Saint_Joseph, is focused on diabetes to understand if people know the general information about the disease, the physical and emotional difficulties patients go through; and to see if they are careful enough to avoid getting diabetes themselves in the future. The data we collected with this survey shows that although most people are aware of the causes and difficulties of the disease, most of them do not take enough care about how much glucose they consume.

These surveys made us realize once again that we should work more to raise awareness about diabetes mellitus. YOU CAN FIND THE RESULTS OF THE SURVEYS FROM HERE& HERE.

EXPERT OPINION (Prof. Dr. Bülent Yıldız)

In this interview, we asked several questions to Professor Yıldız regarding the current diagnosis and treatment of diabetes and the effects of this disease on the patients’ lifestyle.

Professor Yıldız initially informed us about the mechanism of diabetes mellitus and the differences between its types, type 1 and type 2. He emphasized that “There are approximately 7 million diabetic patients in Turkey. We can say that approximately 92-93%, even 95% of them are with type 2 diabetes, remaining ones are with type 1 diabetes.”.

When we questioned why the prevalence of diabetes is so high and asked the relation between nutrition, insulin resistance and glucose tolerance, Professor Yıldız answered with the Thrifty Hypothesis. He said that the genetic characteristics of our hunter-gatherer ancestors were programmed to store the energy once they found it since nutrition was scarce in nature. This energy is stored in the form of fat in adipose tissue. He stated that “If we were to look from an evolutionary perspective insulin tolerance is an advantage, for survival. But, in today's conditions where access to food is so easy and where people are so sedentary, insulin tolerance becomes a disadvantage, the progression of diabetes becomes easier.”

Professor Yıldız also informed us about the diagnosis procedure of diabetes. He explained the specific complaints that bring people to the hospital. Drinking too much water, urinating often, generally good appetite and especially in type 1 diabetics weight loss are the symptoms. But, in type 2 diabetics drinking water and urinating often are generally seen, which are called hyperglycemia symptoms. Upon these symptoms, the tests that are done are oral glucose tolerance test and hemoglobin A1C test.

While talking about the treatment process, Professor Yıldız strongly emphasized that “... an indispensable part of diabetes is training. It (diabetes) is not like a viral infection. It ( diabetes) is a disease with which you will live together throughout your life when you were diagnosed. Thus, the patient should initially learn this disease.” We learned that some essential changes should be done in the lifestyle of every patient. These are the regulation of dietary habits and planned exercises by physical activity. If blood glucose level continues to be high despite these changes, oral medications, tablets, started to be used. “If the diagnosis of our patient is type 1 diabetes, the patient should use insulin treatment from the beginning. If the patient was diagnosed with type 2 diabetes, oral medications, non-insulin injectable medications, and insulin are used in different combinations in addition to changes in lifestyle.”

We also asked the social and psychological effects of having diabetes to Professor Yıldız. As he explained, accepting the diagnosis and adapting to a new lifestyle may become very hard both for the patients and their family. The psychological situation of the children are much more affected. As we learned, firstly, insulin pens are used for children. After a certain age, insulin pumps are used. Both accepting their diagnosis and dealing with the treatment that they should strictly follow may cause anxiety and depression for children. Professor Bülent underlined that patients definitely have to follow the necessary treatment even though it is so hard since they might have to face with organ damage without the treatment.

Seeing that the current treatment causes many difficulties in patients’ lives, we asked questions like “What can be possible new treatments and approaches in diabetes mellitus, which can ease patients’ lives?”. Upon this, Professor Yıldız mentioned injectable and oral treatments being developed. He also pointed out that “But in 10 years, the long-awaited oral insulins, that were previously in injectable form, for type 1 diabetes are expected. There has been a lot of research in that area.” Then, Professor Yıldız said that “We are also working on microbiome/microbiota.” and emphasized that probiotic applications might be promising in diabetes mellitus. He explained us probiotic systems and the procedure of developing a probiotic drug. He stated that “This area of research is paving the way for the area of Microbial Endocrinology, maybe in 5-10 years we will refer to it this way. Yet, we don’t have such an area, officially. But I believe in 8 to 10 years, this area will be cutting edge.

After Professor Yıldız mentioned the probiotic trend, we mentioned to him that we want to use synthetic biology to develop a therapeutic for diabetes mellitus. Then, we asked about the possibility of the incorporation of synthetic circuits expressing insulin to the probiotic systems that he mentioned. He answered by “Currently, six groups within microbiome are mentioned. We see that they have mechanisms to reduce insulin resistance as one of the jobs they do in the body, especially on short-chain fatty acids. If a system that can secrete insulin could be constructed on these probiotics, we would hit two birds with one stone.”.

Evaluating what we learned in this interview, we decided to design a system to be used in probiotic bacteria, which can be orally administered to the patients.

DIABETES PATIENT TRAINING

Our team members attended one of the regular briefings given about diabetes by a nurse at one of Hacettepe University Hospitals. This briefing is given to patients who have been newly diagnosed and/or patients who are lacking information about the treatment of diabetes. In this briefing we first learned what diabetes is and how it prevails. Then we talked about the lifestyles they have to adopt. Hearing what strict rules they have to live by actually shocked us, some of the rules they have to follow are;

They have to always be aware of their blood glucose levels.
They have specific sleep schedules tailored to fit their insulin injection schedules.
They can rarely eat anything with granulated sugar, when they do they have to closely monitor their blood sugar levels and stabilize them.
Patients were urged to keep their insulin cold at all times. The nurse suggested that when travelling, they should carry the insulin with a block of ice to keep it cold. Although the manufacturer states that the insulin will still function up until 28 days at room temperature the nurse insisted that the should be kept cold.
The nurse strongly urged the patients to exercise daily.

Then we talked about what could happen if one didn’t follow these guidelines. Firstly she mentioned the risk of a stroke or a heart attack if you don’t take your prescribed medication regularly. Secondly she talked about eyes, apparently high blood sugar can affect the capillary vessels behind the eye and cause retinopathy, glaucoma, cataracts and other eye problems. Finally she mentioned footcare, high blood sugar levels can damage nerves which can cause diabetic neuropathy. This damage to the nerves can lead to loss of feeling and even the smallest of cuts or sores can turn into ulcers. Ulcers in extreme cases can spread to the bone or lead to gangrene, in which case amputation would be needed. Unfortunately, for a patient at the briefing this was the case, she had to get her left foot amputated. This really peaked our interest, that mishandling diabetes could cause such big problems, so we did some research of our own. It turns out that the cause of approximately 50% of all foot amputations in the US is diabetes [1].

Overall we think that this was an enlightening experience for us. We were stunned at the strict rules and at the serious repercussions if one were to fail to follow these rules. We are glad to have been able to have this experience alongside diabetic patients.After the briefing we had the chance to talk to the patients about diabetes and to talk about our project and get their ideas and opinions on it.

What Did We Integrate

The nurse talked about how sometimes people, especially elderly people, either get bored or are daunted by the regular insulin injections.

STORY BOOK

As a collaboration with other iGEM teams, we started up a collaboration for the translation of our storybook “The Adventures of Umay in Synthetic Biology” into other languages. We sent an English version of our story to the teams that contacted us. The teams that translated our story into their languages are listed at this page.

Thanks to their efforts, our storybook is available in 17 different languages and this allows us to reach thousands of young scientists worldwide and introduce them synthetic biology in a fun way. Diabetes is a big problem in every country.

SYNTHETIC BIOLOGY FOR EVERYONE

You can find more information about this concept we followed this year from HERE

Team:Bilkent-UNAMBG/Human Practices