Internal Medicine resident Calvin Ke
When Calvin Ke — a UBC Internal Medicine resident — approached his supervisors about his interest in conducting research on diabetes, he never expected the opportunity to lead to the discovery of dramatic findings with the potential to shape clinical practice guidelines in British Columbia.
“I was always interested in endocrinology and diabetes, and I wanted to involved myself in some research that would be meaningful during my residency,” says Dr. Ke. “A few of my residency supervisors recommended I speak with Dr. Nadia Khan, a researcher at St. Paul’s Hospital and a very experienced general internist.”
It was this casual conversation and connection with Dr. Khan, an Associate Professor with UBC’s Department of Medicine, that set Dr. Ke down the research path. Two years, and hours of analysis later, he has become first author of a new study that shows Type 2 diabetes has dramatically increased in people under 30 in B.C., even surpassing Type 1 diabetes.
“The increase has been very drastic,” says Dr. Ke. “Twenty years ago, most individuals in their adolescent years with diabetes had Type 1. When we look at the rates now, the majority of people with diabetes under the age of 30 in B.C. have Type 2.”
The research team, which included Dr. Khan, as well as, Dr. Parmjit Sohal, a Clinical Associate Professor in the UBC Department of Family Practice, Hong Qian (Centre for Health Evaluation and Outcome Sciences) and Dr. Hude Quan (University of Calgary), also uncovered significant differences in rates of Type 2 diabetes across patient populations. South Asians were found to have higher incidences of Type 2 diabetes compared with both Chinese and White people. In fact, in those aged 20 to 29, new cases of Type 2 diabetes were 2.2 times higher in South Asians than in White people and 3.1 times higher in South Asians compared with Chinese people.
And while the study, which was recently published in Diabetic Medicine, focused on the rates of Type 2 diabetes in B.C., Dr. Ke says there’s reason to believe this trend is taking place across the nation and other areas of the world.
“From other studies that have looked at other jurisdictions in Canada, and smaller studies that have looked at the US, and the UK and other parts of the world, I think it is reasonable to believe that this is happening everywhere — and that the diabetes epidemic in young people is not just a B.C. phenomenon.”
Study results point to need for earlier screening
Nadia Khan, Associate Professor, Department of Medicine
Type 2 diabetes, caused mostly by obesity and physical inactivity, has generally been considered a disease of older adults, typically occurring in people 35 years and older.
With new evidence that Type 2 diabetes has overtaken Type 1 in young people in B.C., Dr. Ke says there’s a need to act — and urgently.
“Currently Clinical Practice Guidelines recommend that screening for Type 2 diabetes should start at age 40, but if we look at the data in our study, it would suggest that South Asians, who are at particularly high risk, might need to be screened as early as age 20,” says Dr. Ke.
In addition to recommending that screening for Type 2 diabetes needs to happen at a much younger age in high-risk populations, Dr. Ke and his research colleagues believe more needs to be done when it comes to understanding the root causes and exploring ways to prevent the development of the disease altogether.
“Type 2 diabetes is a disease that has so much to do with how we live, and what we eat and how we move,” says Dr. Ke. “Over the last few decades, lifestyles have changed dramatically. Many now live in urbanized environments where people are generally less active, and eat more high-calorie foods. In order to combat this issue, we really have to look at the greater society and see how our lives our organized.”
While investigating the root causes for the increased rate in Type 2 diabetes in youth was outside this study’s scope, Dr. Ke hopes the findings will not only serve as a wake-up call for British Columbians, but inspire a sustained effort to turn the trend around.
Balancing residency and research
For Dr. Ke, who will be wrapping up his residency in a couple of years, having the opportunity to not only conduct, but publish important research findings has been an incredible experience.
“Residency is a very demanding time in one’s training, and while there’s often not very much time to be involved in research, taking on extracurricular activities can also be very productive and valuable,” he says, noting how grateful he is to Dr. Khan for the opportunity to pursue research that overlapped with his interests.
Dr. Khan and Dr. Ke examine study findings.
According to Dr. Roger Wong, Associate Dean of Postgraduate Medical Education at UBC, research opportunities are a great way for residents to develop new skills and advance their knowledge base while completing training to become expert practitioners in their chosen specialties.
For Dr. Ke, the publication of the study during his residency training has not signaled the end, but only the beginning of his research journey and career.
Long-term, he hopes to expand his research on diabetes and gain a better understanding of what may be causing the increased prevalence of Type 2 diabetes in South Asians.
“If we’re going to get control of this epidemic, we need do more research to better understand the physiology, and examine what medical therapies work best particularly for South Asians,” he says.
The study — Diabetes in the young: a population-based study of South Asian, Chinese and White people — was funded by the Canadian Institutes of Health Research.