Kenny Kalin

Glycemic control – a challenging task in type 2 diabetes.

Type 2 diabetes (T2D) is a challenge to health care systems around the world. Glycemic control is of the essence to prevent future complications in persons with T2D. My work focuses on identifying factors that impede glycemic control in T2D.

T2D is a multifactorial disease where treatment varies depending on the patient’s preconditions. The pharmacological treatment aims to achieve well managed blood glucose, blood pressure and blood lipid levels. Glycemic control decreases the risk for development of microvascular complications, but to some extent also macrovascular complications.

Metformin is recommended as the first-line option in most guidelines for pharmacological treatment aimed to achieve glycemic control. Metformin is regarded as a safe and cost-effective drug with long clinical history. It is however assoicated with a non-negligible risk of gastro-intestinal side effects.

Our hypothesis is that patients suffering from gastro-intestinal side effects have a different microbiota compared with patients that are not afflicted by GI adverse events or that they develop an unfavorable microbiota composition during metformin treatment, which has been shown in small experimental studies.

Data shows that gut microbiota have an influence on the effect of metformin treatment, through a so far unknown mechanism.

Gut microbiota composition is affected by external factors such as drugs and food. Saccharin, a NAS (non-caloric artificial sweetener), has been associated with the development of insulin resistance. Is is therefore of importance to establish whether NAS can negatively affect the development of isulin resistance. Exploring this mechanism is of great value since NAS are probably consumed extensively by persons with T2D because NAS is regarded as a way to achieve weight reduction.

Type 2 diabetes (T2D) is a challenge to health care systems around the world. Glycemic control is of the essence to prevent future complications in persons with T2D. My work focuses on identifying factors that impede glycemic control in T2D.

T2D is a multifactorial disease where treatment varies depending on the patient’s preconditions. The pharmacological treatment aims to achieve well managed blood glucose, blood pressure and blood lipid levels. Glycemic control decreases the risk for development of microvascular complications, but to some extent also macrovascular complications.

Metformin is recommended as the first-line option in most guidelines for pharmacological treatment aimed to achieve glycemic control. Metformin is regarded as a safe and cost-effective drug with long clinical history. It is however assoicated with a non-negligible risk of gastro-intestinal side effects.

Our hypothesis is that patients suffering from gastro-intestinal side effects have a different microbiota compared with patients that are not afflicted by GI adverse events or that they develop an unfavorable microbiota composition during metformin treatment, which has been shown in small experimental studies.

Data shows that gut microbiota have an influence on the effect of metformin treatment, through a so far unknown mechanism.

Gut microbiota composition is affected by external factors such as drugs and food. Saccharin, a NAS (non-caloric artificial sweetener), has been associated with the development of insulin resistance. Is is therefore of importance to establish whether NAS can negatively affect the development of isulin resistance. Exploring this mechanism is of great value since NAS are probably consumed extensively by persons with T2D because NAS is regarded as a way to achieve weight reduction.


Umeå University

Supervisor: Olov Rolandsson, Professor