The article “Does Strongyloides stercoralis infection protect against type 2 diabetes in humans? Evidence from Australian Aboriginal adults”, introduced by Hays, Giacomin, Loukas, and McDermott was written for the journal Diabetes Research and Clinical Practice in 2015. It addresses the relationship that exists between two items: the infection known as Strongyloides stercoralis (S. stercoralis) and patients with type 2 diabetes.
The authors of the article aim at developing a cross-sectional survey, including the participation of Aboriginal adults in Australia during 2013. The main focus of this study is not to prove the possibility of the relationship between the infection and the diagnosis, but rather to explain this relationship and facilitate a discussion to see if there is a chance to develop a plausible immunological mechanism that can be used to help prevent and control the development of type 2 diabetes in the future (1).
The results of this study prove that the process of immunomodulation by the chosen infection can, indeed, be observed. It also highlights the necessity to engage future research in order to show how the proteins work in this infection and confirm the metabolic process. Several months before, Hays, with his team, introduced the investigation in which the researchers aimed to prove the connection between the infection and the disease using worms and less than 100 people, who agreed to participate in the study (2). It was necessary to answer one question: ‘Could Strongyloides stercoralis infection protect against type 2 diabetes in humans?’ It is this main goal that is under analysis.
The peculiar feature of this article is its role in a group of studies developed by Hays and his team. It is crucial to pay attention to different factors connected with the infection and the chosen disease, including eosinophil count, the role of secretary protein, and the importance of nutritional burden of the infection. At the beginning of 2016, Hays and a new team of researchers investigated the prevalence of eosinophilia in relation to the chosen infection (3). All three studies prove that Aboriginal communities are predisposed to both having type 2 diabetes and infection. Instead of treating patients with these two health problems, finding a solution using the characteristics of both issues is proposed.
After reading the abstract, it is possible to discern the objectives and methods of the study. The authors introduce a clear question and develop a methodology to find answers. The introduction of the article clearly establishes that developing countries suffer from such infections like S. stercoralis, in addition to additional health problems such as obesity and chronic diseases (1). The Aboriginal communities in Australia are defined as unique due to the fact they are affected by the two identified problems simultaneously. On the one hand, this territory and its people are under threat of having S. stercoralis infections (4).
On the other hand, the same group of people is characterised by having type 2 diabetes more frequently than other citizens on the same continent (5). Therefore, it is necessary to investigate the chosen field in terms of the specific population and find any solutions that can be offered to cope with the disease and related complications. Hays and his team introduce one of the best research groups, who are involved in the discussion of this topic and the development of new methods of treatment and prevention of serious health problems, such as type 2 diabetes and the complications caused by S. stercoralis infection.
There are three main aspects in regards to which the article should be analysed: innovation, strengths, and weaknesses. This study is not innovative because this topic has already been discussed in several previous studies, and there have also been articles specifically about S. stercoralis and its relation to different diseases among the Aboriginal people in Australia(2), (4), (5). At the same time, it is important to acknowledge that the authors of the article under analysis discovered a strong negative connection between the chosen infection and the Aboriginal population with type 2 diabetes. Such a correlation could be observed after an appropriate indexation of age, gender, and body mass (1).
Causality was not implied, and it may be defined as one of the main downfalls of the article. Regarding such an important relationship between infection and disease, causality can become a helpful tool to make conclusions and create appropriate conditions for future research. The investigations conducted by Hays have been frequently used by other researchers who dealt with type 2 diabetes and hygiene hypotheses defining the positive association with S. stercoralis (6), and who worked with immunomodulation by helminths among patients with type 1 and 2 diabetes (7). The fact that several other studies came to the same conclusions as Hays proves the appropriateness and worth of the chosen study.
The authors produced logical, coherent and appropriate information. There were no doubts and concerns about the chosen topic. The study design was clear, and data collection, as well as data analysis, was explained and supported by credible sources. Finally, the interpretation of the presentation of data clearly showed the awareness of the authors understanding of the key points and provided a sound basis for any conclusions.
In the chosen remote community, S. stercoralis is a common infection. The risks of having type 2 diabetes are also high. Therefore, the discussions about this type of relationship are well-grounded. The results and interpretations offered provided a direct link to the possible prevention of type 2 diabetes and other metabolic disorders that may be observed in those who live in the Aboriginal regions of Australia (1).
Overall, the research presented in the article has more strengths than weaknesses. In addition, it makes a good contribution to the innovative field of medicine in general and the explanations on how to treat patients with type 2 diabetes and those who are under threat of having complications because of the infection that is known as S. stercoralis specifically. At the outset, the authors clearly stated their goals and expectations, as well as describing their findings and interpretations. In order to explain the urgency of their research, they used descriptive statistics of Aboriginals who lived in Australia in 2013.
However, the article is also relevant and appropriate in terms of theory and practice that can be used in medicine to solve the questions of S. stercoralis and type 2 diabetes challenges globally. There are also clear opportunities for the improvement of the methodology in future work, as well as providing an impetus to develop new ideas on how to contain the infection and the disease.
References
- Hays R, Esterman A, Giacomin P, Loukas A, McDermott R. Does Strongyloides stercoralis infection protect against type 2 diabetes in humans? Evidence from Australian Aboriginal adults. Diabetes Res Clin. Pract. 2015;107(3): 355-361.
- Hays R, Esterman A, McDermott R. Type 2 diabetes mellitus is associated with Strongyloides stercoralis treatment failure in Australian Aboriginals. PLOS Negl Top Dis. 2015;9(8), e0003976.
- Hays R, Thompson F, Esterman A, McDermott R. Strongyloides stercoralis, eosinophilia, and type 2 diabetes mellitus: the predictive value of eosinophilia in the diagnosis of S stercoralis infection in an endemic community. Open Forum Infect Dis. 2016;3(1): ofw029.
- Miller A, Smith ML, Judd JA, Speare R. Stongyloides stercoralis: systematic review of barriers to controlling stronglyloidiasis for Australian indigenous communities. PLOS Negl Top Dis. 2014;8(9): e3141.
- Duong JK, Kumar SS, Furlong TJ, Kirkpatrick CM, Graham CG. Greenfield JR, et al. The pharmacokinetics of metformin and concentrations of haemoglobin A1C and lactate in Indigenous and non-Indigenous Australians with type 2 diabetes mellitus. Brit J Clin Pharm. 2015;79(4): 617-623.
- Ruiter K, Tahapary DL, Sartono E, Soewondo P, Supali T, Smit JW, Yazdanbakhsh M. Helminths, hygiene hypothesis and type 2 diabetes. Parasite Immunology [Internet]. 2017. Web.
- Surendar J, Indulekha K, Hoerauf A, Hubner MP. Immunomodulation by helminths: similar impact on type 1 and type 2 diabetes? Parasite Immunology [Internet]. 2017. Web.