Name: Dr Piyara Begum, Manchester University

Fellowship: Three Year Research Fellowship jointly funded by Diabetes UK

Grant: £177,327


More than two million people in the UK have diabetes and a further million are thought to have the disease but do not yet know it. Diabetes has many unpleasant symptoms. One that is little talked about, seldom successfully treated and into which little, if any, research has been undertaken is diabetic diarrhoea. This often happens because one effect of the disease is to cause damage to various parts of the nervous system, in this case in parts of the gut that control bowel function. Diabetic diarrhoea is extremely unpleasant for the sufferer and often causes so much embarrassment that the patient won’t even discuss it with his or her doctor.
Diabetic gastroenteropathy (DGE) is a cause of significant symptoms in patients with diabetes (eg diarrhoea, gastroparesis), and is believed to result from damage to the nerves that control the automatic functions of the gut. Currently, and somewhat surprisingly, no investigative tool exists to study how the nerves that control the workings of internal organs function, but recent technical developments in neuro-gastroenterology at Hope Hospital now permit this crucial tool-kit to be developed for clinical research and practice.

In addition, it is not possible to obtain direct anatomical information about nerve fibres in the digestive system without full thickness biopsy, which is not possible in routine practice. However, recent developments in diabetes research in Manchester have used a highly novel approach, corneal confocal microscopy (a non-invasive method of measuring nerves in the front of the eye), to assess corneal nerve structures in normal subjects and in patients with diabetes. This has shown that certain changes in the structure of the cornea, relate to the severity of nerve damage in diabetic patients.

This research project hopes to extend these exciting techniques into understanding the physiological basis for the gastrointestinal symptoms endured by people with diabetes leading to earlier diagnosis and hopefully, the development of new treatments.

The plan is to develop a method of assessing how well the special nerves (known technically as “autonomic nerves”) which control the gut are working. Initially the method will be tested in healthy subjects and later extended to patients with diarrhoea associated with diabetes. These tests will show:

1. Whether abnormalities of gut-nerve condition corresponds with other abnormalities of gut function, as measured by pressure-patterns, speed of transit and abnormal bacterial growth.
2. Whether particular patterns of symptoms relate to identifiable abnormalities of gut-nerve function.
3. Whether corneal confocal microscopy can show nerve abnormalities which correspond to alterations of nerve function in the gut.

This research work is of clear importance to people with diabetes since chronic diarrhoea and other symptoms caused by gut-nerve damage such as vomiting and impaired nutrition, can seriously damage their quality of life. These conditions are poorly understood and remain under-researched. Patients may undergo extensive, unpleasant but unnecessary invasive investigations which serve little purpose other than reassuring the doctor that a different disorder has not been missed.

Developing a 21st century tool-kit to investigate and understand the true physiological processes at play will enable the establishment of evidence based practice to (a) permit accurate and earlier diagnosis, (b) develop a clearer understanding of prognosis by following up a group of patients and (c) underpin the development and assessment of future therapeutic interventions to help these patients live with improved quality of life. Understanding the biological nature and physiological basis of symptoms is of itself beneficial to individuals dealing with chronic disease.

The potential difference made to the lives of people with diabetes could be predicted over the short term in reducing unnecessary investigation whilst affording positive diagnosis, and in the medium term in forming a new understanding of the changes that take place in the gut’s nerve system, leading to innovative therapeutic approaches.