For almost 20 years, Antoinette Moran has been researching cystic fibrosis and diabetes at the University of Minnesota. The University was the first to characterize diabetes in cystic fibrosis and to explore the consequences of diabetes on nutrition in this population of patients, says Moran, who is an endocrinologist.
Patients with cystic fibrosis have a scarring of the pancreas, she says. Because their pancreases are significantly destroyed, these patients are partially insulin-deficient and have high blood-sugar levels. This can lead to diabetes, which is found in 40 percent of adults with cystic fibrosis, 25 percent of adolescents, and 9 percent of children.
Insulin also helps keep one’s weight at a healthy level. Cystic fibrosis patients who are insulin-deficient can be underweight and have low muscle mass. This decreases their chance for survival, Moran says. The average age of survival is 37 years for cystic fibrosis patients nationally, but 47 years for cystic fibrosis patients treated at the University of Minnesota, adds Moran, who practices at the University of Minnesota Children’s Hospital, Fairview.
Moran is attempting to determine the ideal point at which to begin aggressive treatment in cystic fibrosis patients with diabetes. She leads a multinational study of cystic fibrosis patients; all the patients have mild diabetes. The 120 patients are divided into three groups: one group was given insulin directly by shot, a second group received a pill to stimulate their bodies to make insulin, and the final group was given a placebo.
Researchers want to find out if patients in the second group have enough healthy pancreas left to respond to a pill.
“The body is smarter than we are when it comes to managing blood sugar,” Moran says.
But if too much of the pancreas is already destroyed, a pill might not make a difference, Moran says. A pill would be more convenient and less painful than a shot, she adds.
Moran also is a site coordinator in a 14-center cross-country diabetes prevention study. This study is tackling diabetes in four ways:
1. Positive antibodies are one of the first signs of diabetes. Researchers are screening relatives of those with Type 1 diabetes for positive antibodies to assess their risk of developing the disease.
2. Researchers will enroll those who have positive antibodies in further studies to determine what can be done about their condition.
3. There are also studies for people who have just developed diabetes. Typically, these people have 10 percent of pancreas function remaining. The normal course of Type 1 diabetes causes people to lose all of their pancreas functioning, Moran says. Researchers want to harness that last 10 percent and find out what it is capable of.
4. Sometimes a fetus or infant is at risk because the mother, father, or sibling has Type 1 diabetes. Type 1 diabetes develops when the body's own immune system attacks the beta cells of the pancreas; this inflammatory type of reaction that may have its roots early in life, when the immune system is still immature. Researchers are giving fish oil to mothers during their pregnancies and until they are finished breastfeeding the baby. Fish oil provides an anti-inflammatory environment that might help these babies.
By Naomi Scott