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Research Snapshot: Complementary and Alternative Medicine use in Diabetic Adults

September 19, 2017 - 10:19am

Diabetes is a growing concern for people in the United States — over 29 million Americans suffer from this chronic disease today.

“Diabetes is a complicated chronic condition requiring intensive self-care management,” said Greg Rhee, Ph.D., M.S.W. The adjunct assistant professor at the College of Pharmacy believes complementary and alternative medicine (CAM) could be the key to maintaining the healthy lifestyle needed to combat diabetes.

Rhee has conducted CAM-related research on maintaining health and well-being in diverse populations, including racial/ethnic disparities issues. More recently, he found individuals who used acupuncture for both wellness and treatment had “higher odds of disclosing self-reported benefits.” This led him to wonder how CAM may have influenced the health and well-being of diabetic adults.

The national study, published in the Journal of Diabetes, interpreted self-reported data from the 2012 National Health Interview Survey on CAM usage. Rhee found that 26 percent of diabetic adults reported using some form of CAM in the past year. Of those adults, over half of them used CAM for both treatment and wellness. 28 percent used CAM for wellness only, and 15 percent used CAM for treatment only.  Rhee noted the adults who reported using CAM for both treatment and wellness had a “higher likelihood of reporting a better sense of control over this health.”

The study also covered the types of CAM used by diabetic adults. The most commonly used CAM types — regardless of reason for use — found in the study were herbal therapies, chiropractic care and massage therapy.

The results of the study show promise for CAM in the aid of diabetic adults. Because of the growing diabetic population, however, future studies need to be done to assess healthcare disparity issues related to CAM.

Diabetes is a serious condition, and while CAM shows promise as a support, it is important individuals with diabetes seek routine treatment with a primary care doctor, Rhee said.

“All patients should have conversations with their care team about complementary and alternative medicines they are using,” Rhee said.

Some therapies could affect blood glucose levels.  In addition, previous studies have shown some herbal medicines can interact poorly with certain medications.

“We need to continue studying this trend,” Rhee said. “Future research could help improve self-care management strategies among individuals with diabetes.”

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UMN Study: Bicycling Reduces Risk of Chronic Diseases; Could Lower Medical Spending

July 10, 2017 - 12:04pm

Riding a bicycle more often can lower your risk of developing chronic diseases like heart disease and diabetes, according to a recent UMN Study.

“This is the first study in the Minneapolis, St. Paul metro area that looks at how bicycling relates to specific diseases,” Aaron Berger, M.P.H., Ph.D. student at the University of Minnesota School of Public Health said. “Minneapolis, St. Paul has been hailed as one of the top biking communities in the country, and biking here is backed by major public investments. This study allows us to show policymakers how those investments are being paid back to the state through healthier residents.”

Berger and UMN colleagues Xinyi Qian, Ph.D. and Mark Pereira, Ph.D., M.P.H. surveyed 1,400 bicycle commuters from the Minneapolis, St. Paul area. Respondents reported frequency of bicycle trips to work and other destinations from April to September and October to March, how often they do other kinds of exercise, and their history of risk factors for heart disease and diabetes.

The researchers looked for associations between average weekly transportation bicycling and a history of obesity, high blood pressure, high cholesterol, low high-density lipoprotein (HDL) cholesterol, high triglycerides and diabetes.

The results showed people who took just three bicycle trips per week had 20% fewer risk factors for heart disease and diabetes.

Berger and his colleagues find these results particularly interesting for several reasons. First, they examined people within a population of bicyclists and found that those who bike more frequently are achieving better health than those who ride less frequently.

Second, they measured and adjusted for the other kinds of physical activity the respondents do aside from bicycling. “Our results suggest that bicyclists don’t just appear to be healthier because they’re more physically active in general than non-bicyclists, Berger said. “Because we adjust for the other kinds of physical activity people do, our findings mean that at any given level of physical activity, adding in bicycle trips reduces the risk of cardiovascular disease and diabetes.”

While this is good news for bikers, Pereira notes that policymakers and healthcare professionals should also pay attention to the findings.

“Our study findings may have broad public health implications,” Pereira said. “Indeed, most people do not live within walking distance to work or shopping centers, and therefore bicycling may play a unique role in an active lifestyle.”

Healthcare professionals often advocate for a more active lifestyle for their patients, and Berger suggests that biking could be a great method to recommend, “Once you own a bike, active transportation is very inexpensive, as well as a highly efficient way to combine healthful physical activity with time already spent commuting. For people who don’t live too far from work, biking instead of driving may not even take extra time, especially if they get stuck in traffic or have trouble parking.”

Read the full study, here.

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Research snapshot: Improved fitness linked to reduced type 2 diabetes risk

May 17, 2016 - 8:48am

The link between fitness level and developing type 2 diabetes has been commonly linked and hypothesized.

Until now, many studies have found that improved fitness can help reduce risk of developing diabetes, but many of those studies have been limited in scope, population or period of time studied.

In a new University of Minnesota Medical School study, researchers found that increasing fitness could slow the onset or reduce risk of prediabetes and type 2 diabetes.

The longest-running study of its kind, researchers looked at more than 4,000 participants from Minnesota, California, Alabama and Illinois, with data spanning over more than two decades. The study was published in Diabetologia.

“Current fitness level is the most important determinant for prediabetes and diabetes,” said Lisa Chow, M.D., lead author of the study and associate professor of medicine in the division of diabetes, endocrinology and metabolism. “Increasing fitness reduces the development of prediabetes and diabetes even when accounting for changes in weight.”

The study found that higher levels of cardiorespiratory fitness (CRF) reduced diabetes risk. CRF refers to the heart and respiratory system’s ability to bring oxygen to the rest of the body when exercising, or engaging in physical activity.

With an increase in CRF, pre diabetes or diabetes risk reduced by 0.1 percent. People need to engage in 30 minutes of vigorous physical activity for five days a week, or 40 minutes of moderate physical activity five days a week to achieve that level of CRF.

It’s a modest change at an individual level, but when compared to a population level, the increase is significant.

According to the CDC, more than 9 percent of the U.S. population has diabetes, and more than 25 percent of those people are undiagnosed. One in three Americans are expected to develop type 2 diabetes at some point in their lives.

“The findings from our study reiterate the need for programs and initiatives focused on improving fitness at a population level,” Chow said. “With resource to support more active lifestyles, we can reduce this major health burden and improve lives of those affected by the disease.”

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Intensive blood pressure lowering in patients with type 2 diabetes may have beneficial effect in preventing atrial fibrillation

December 11, 2015 - 10:37am

The most common heart rhythm abnormality, atrial fibrillation, is categorized by a rapid or irregular heartbeat leading to poor blood flow. In patients with type 2 diabetes (T2DM), there have been no proven strategies to prevent this condition, until recently.

In a new study from the University of Minnesota Cardiovascular Division, Department of Medicine, researchers found that as compared with standard blood pressure lowering, intensive blood pressure lowering in patients with T2DM was associated with a reduced incidence of atrial fibrillation and abnormal P-Wave indices (PWI).

Health Talk spoke with Associate Professor Lin Yee Chen, M.D., M.S., whose research is focused on atrial fibrillation.

Health Talk (HT): What is PWI?

Lin Yee Chen (LYC): PWI indices are not only a surrogate or an intermediate phenotype for atrial fibrillation; PWI, in and of themselves, are associated with adverse outcomes including ischemic stroke.

HT: In terms of “intensive blood pressure lowering” what categorizes intensive?

LYC: The way doctors treat blood pressure is based on the report from the panel members of the eighth Joint National Committee. These guidelines recommend blood pressure goals of 140/90 mm Hg for those younger than 60 years of age and 150/90 mm Hg for those older than 60 years of age. However, our results showed that when systolic blood pressure was lowered to less than 120 mm Hg, there were potential benefits in terms of lowering the risk of atrial fibrillation.

HT: What does that mean in regards to patient care?

LYC: The recently published SPRINT trial—a multicenter, randomized, open-label trial of nondiabetic individuals—found that as compared with standard treatment (target systolic pressure <140 mmHg), intensive treatment (target systolic pressure <120 mmHg) reduced the rate of the primary endpoint, a composite of myocardial infarction, acute coronary syndrome, stroke, heart failure, or cardiovascular death. Our findings extend the results of SPRINT by showing a potential cardiovascular benefit from intensive blood pressure lowering in patients with T2DM.

 

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UMN experts: New cases of diabetes may be down but more work is needed

December 9, 2015 - 11:12am

A recent report by the Centers for Disease Control and Prevention (CDC) found new cases of diabetes dropped by roughly one-fifth from 2008-2014, from 1.7 million to 1.4 million. And while the investigators are unsure whether prevention efforts are working or if the disease peaked in the U.S., the findings were good news after decades of seeing numbers skyrocket.

According to a recent New York Times article, “there is growing evidence that eating habits, after decades of deterioration, have finally begun to improve. The amount of soda Americans drink has declined by about a quarter since the late 1990s, and the average number of daily calories children and adults consume also has fallen. Physical activity has started to rise, and once-surging rates of obesity, a major driver of type 2 diabetes, the most common form of the disease, have flattened.”

Health Talk spoke with Mark Pereira, Ph.D., associate professor of epidemiology and community health in the School of Public Health and Elizabeth Seaquist, M.D., professor of medicine in the University of Minnesota Medical School to help understand the numbers.

Health Talk (HT): How does prevention play a role in lowered number of diabetes cases?

Mark Pereira (MP): Type 2 diabetes is highly preventable through regular physical activity, which does not have to be intense or vigorous. Thirty-plus minutes of daily walking is effective at reducing the risk of diabetes.  Also, following the dietary guidelines in terms of fresh fruits, vegetables, whole grains, and avoiding fast food, highly process foods, refined starches and sugars, goes a long way towards preventing diabetes.

There is some evidence that diabetes awareness has increased over the past decade, and obesity prevalence has levelled off or may have declined in some groups in the U.S. It’s starting to look like we are achieving some real population level public health goals in terms of awareness, education, changing policies towards promotion of physical activity and healthful eating patterns. We still have a long way to go but this news is very encouraging.

HT: What is being done in a clinical sense to help prevent new diabetes cases?

Elizabeth Seaquist (ES): There is more emphasis on encouraging patients to exercise regularly and eat a well-balanced and healthy diet. In addition, lean patients are encouraged to remain lean and overweight and obese patients are encouraged to lose weight. The National Diabetes Prevention Program demonstrated that those focusing on these variables will reduce the incidence of diabetes in those at risk.

HT: How do we keep diabetes rates down?

MP: We must continue to make progress in all areas of education, environment, and policies. One local example includes the removal of fast food restaurants in hospitals. Breakfast and lunch programs in public schools have improved. We need to focus on our youth to improve their education and life course trajectory for healthful living habits and work together on these issues across academia, government, industry and community groups.

A great local example is how much our Twin Cities communities and governments continue to invest more in an environment that promotes physical activity through our park systems, transportation systems, nation-leading bicycling and active commuting infrastructure.​ Our local food environment and culture is also at the top of the nation as a model that is important for local economy, environment, culture and health.

HT: Do you trust the numbers or is this a fluke?

MP: I’m comfortable with the decrease in self-reported diabetes as a real trend, but there are some limitations with the data from the CDC. The data are based on self-report, rather than on measured blood sugar. Nonetheless, the survey methods have been consistent over time, so you would expect the steady downward trend in diabetes incidence, which is now statistically significant, to be real rather than artifact. However, we cannot use the self-report data to precisely estimate diabetes prevalence in the U.S. because many people have diabetes but do not realize they have the disease until they develop symptoms and then are eventually diagnosed. We need to look to other large studies of the population that have measured blood sugar. Those studies are more difficult to conduct, but they do exist, although on a smaller scale.

ES: I also trust the numbers and think this shows that diabetes prevention is beginning to get the attention it needs, but that more attention is needed. Everyone in the U.S. should understand the importance of diet, exercise and weight management in health.

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Research Snapshot: Blood biomarkers can predict successful intensification of glycemic control in patients with type 2 diabetes

March 2, 2015 - 12:29pm

When treating patients with diabetes, it is important to bring blood sugars down to a normal level. However, in doing so, patients can become hypoglycemic – meaning their blood sugar has dropped below the normal level. As hypoglycemia is often dangerous and scary, fear of hypoglycemia frequently limits the ability to lower blood sugars even to normal levels.

In a recent study from the University of Minnesota, certain blood biomarkers have been found that might predict whether lowering blood sugars to near-normal levels might be associated with severe hypoglycemia, hypoglycemia requiring treatment in patients with type 2 diabetes.

“Currently, there is no clear way to predict whether a patient with Type 2 diabetes will have problems with hypoglycemia if we try to be more aggressive with blood sugar control. Now, there is the possibility that blood biomarkers may predict whether they might have an issue with this or not,” said lead study author, Lisa Chow, M.D., an endocrinologist and assistant professor at the University of Minnesota.

The study analyzed patients who received intensive treatment for type 2 diabetes from the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study. Chow and her colleagues hypothesised that both insulin deficiency and islet autoantibodies would be associated with severe hypoglycemia and resulting in the failure to achieve near-normal glycemia.

After analyzing patients form the ACCORD study, Chow found that the C-peptide and islet autoantibodies may serve as biomarkers to predict the risk of severe hypoglycemia during the intensification of type 2 diabetes treatment.

“Certainly this will have to be validated in larger, more comprehensive studies. However, these findings raise the possibility blood biomarkers may help individualize Type 2 diabetes treatment to maximize outcomes for a specific patient”  said Chow.

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U of M study finds sit-stand workstations help improve blood pressure, reduce cardiometabolic risk

December 22, 2014 - 2:01pm

You’re likely sitting down as you read this, but perhaps you should stand instead.

On average, adult Americans spend more than 7.5 hours per day sedentary (not counting sleep time), and employed adults in primarily office jobs spend up to 75 percent of their time at work sitting.

Recent studies also suggest that even modest decreases in sedentary time can help reduce your risk of obesity, cardiovascular diseases, diabetes and premature mortality.

Still sitting?

A recent study presented at the 2014 Obesity Week meeting in Boston from the School of Public Health at the University of Minnesota evaluated the effects of sit-stand workstations, with and without a worksite physical activity intervention, on risk factors for diabetes, heart disease, and stroke. Nearly 250 employees from Twin Cities office buildings, who spent most of their workday sitting, were randomly assigned to one of four groups for the six-month study.

The four groups were classified as General (usual behavior at work), Move (some intervention with a goal of at least 30 minutes of activity throughout the workday), Stand (standing at least 50 percent of the day using a sit-stand workstation), and Stand & Move (combined Stand and Move interventions).

The study found significant beneficial effects on blood sugar and triglycerides, and trends towards improvements in blood pressure for those in the intervention groups compared to control. More specifically, the Stand & Move group had the lowest six-month blood sugar, triglycerides, and blood pressure.

Now before you rush out and contact your company’s facilities staff to make the switch to a sit-stand workstation, Mark Pereira, Ph.D., associate professor of epidemiology and community health in the School of Public Health and co-author of the study, has some cautionary advice.

“If you are thinking of switching from a traditional sitting desk to a sit-stand workstation, you should start with an ergonomic evaluation of your workplace to determine the best sit-stand model for your office or cubical and also consider any physical limitations you may have,” said Pereira. “Never abruptly start standing at work, but rather, gradually increase your standing time so that after about four weeks you are standing at your desk for about half of your desk-time.”

Pereira added that the beauty of the sit-stand workstations is that they easily go up and down and take your computer monitor with them. Posture and footwear are also important.

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Health Talk recommends: Treating diabetes with beneficial bacteria

November 18, 2014 - 8:54am

Editor’s note: This article originally appeared on Inquiry.

University of Minnesota researchers are on a mission to treat diabetes, and they’ve enlisted a few trillion microscopic helpers.

In place of drugs or surgery, a team of researchers is studying how to improve diabetes patients’ insulin sensitivity by introducing trillions of beneficial bacteria into their intestines. Researchers believe this unusual approach, conducted through a fecal microbiota transplant, could improve how the body regulates blood sugar, the central problem in diabetics. The project is part of MnDRIVE (Minnesota’s Discovery, Research and InnoVation Economy), a $36 million biennial investment by the state that aims to solve grand challenges. As a part of MnDRIVE’s Transdisciplinary Research Program, the project will bridge multiple fields of research and bring together experts from across the U to work on the same clinical trial.

Patients with diabetes have too much glucose in their blood, which leads to a host of serious health problems, from heart disease to obesity. Dr. Alexander Khoruts, a gastroenterologist at the U of M and lead principal investigator on the project, said the right balance of bacteria has the potential to improve the body’s energy metabolism, in part by enhancing insulin function. Insulin drives glucose from blood into cells of the body.

“If we can improve insulin sensitivity, we will correct the central metabolic problem responsible for diabetes,” Khoruts said. “Diabetes is one of the main complications of metabolic syndrome, which is also associated with obesity, high blood pressure and liver disease. If we improve insulin sensitivity, we hope some of the other problems may also get better.”

To understand the composition of microbes present before and after the transplant, Khoruts is working with Michael Sadowsky, Ph.D., director of the U’s BioTechnology Institute. As a microbial ecologist, Sadowsky studies the complex science of how microbes interact in their environment. People who are diabetic or obese tend to have a less diverse microbiome – or microbial community – in their gut. In turn, they are less able to produce important short-chain fatty acids, which may regulate many functions in the body, including appetite, glucose production, metabolic rate and the immune system. Khoruts and Sadowsky believe that a more diverse microbial gut community should be able to produce more short-chain fatty acids that will have a number of beneficial effects for the patients.

Feeding the problem

How do people lose a healthy balance of bacteria in the first place? Khoruts said one of the main culprits is antibiotics. Widely used across the globe, antibiotics suppress many bacteria in the gut, often disrupting the rich microbial communities that co-evolved with their human hosts for millions of years. In fact, on average, gut microbial communities in our society are less diverse than those found in more ancestral cultures. With the balance of bacterial species thrown off, some types of microorganisms may actually become more harmful and prey on others or attack the lining of the intestine. Over time, the widespread use of antibiotics across the world may have caused the human gut to have less microbial diversity, creating an environment ripe for problems.

The other main contributor to the problem is energy-rich, processed foods. Products high in sugar or high-fructose corn syrup, refined grains and fast food are digested earlier on in the small intestine, leaving little food for bacteria that are located at the end of the digestive tract in the colon. Starving bacteria may send signals back to the brain, telling the person to eat more. However, in our society that person may turn right back to the same processed foods that are detrimental to health and do not satisfy the hungry bacteria. This leads to a vicious cycle resulting in obesity, metabolic syndrome and diabetes.

Replacing bad bacteria

The researchers’ approach to treating diabetes builds off the success of Khoruts and Sadowsky’s first “personal bioremediation” project together. The two teamed up in 2009 to take on the potentially fatal Clostridium difficile, a type of infectious bacteria that releases toxins and damages the lining of the intestines. This infection is typically triggered by antibiotics. Normal gut microbial communities can keep C. difficile in check, but this protective function is lost when these microbial communities are disrupted. When C. difficile infection is treated with more antibiotics, the problem becomes worse. Therefore, they turned to the largely overlooked practice, first documented some 1,700 years ago, of using a fecal transplant to correct a person’s microbiome. The treatment proved spectacularly successful, able to cure approximately 98 percent of patients that failed all other standard therapies.

“We’ve taken what we learned in the lab and used this knowledge to improve patients’ health,” Sadowsky said. “Personal bioremediation, transferring a healthy individual’s microbes to heal another’s imbalance, opens new doors that could potentially result not just in deeper scientific understanding, but lasting remedies to a wide range of serious health problems.”

Clinical trial

Now, with their sights set on diabetes and experts from a variety of disciplines working alongside them, Khoruts and Sadowsky are preparing to begin a clinical trial in early 2015 that focuses on patients with pre-diabetes – those who have blood sugar levels that are higher than normal but too low to be type 2 diabetes.

To help ensure that all subjects will have the right food with potential to produce short-chain fatty acids, Douglas Mashek, Ph.D., a Department of Food Science and Nutrition professor and a specialist in the role of fatty acids in energy metabolism, will provide a specific diet to all participants in this trial. The subjects will spend two weeks on the fixed diet before taking antibiotics to prepare them for the fecal microbiota transplant. Then, one group will receive their own microbes back, while the other will receive microbes from selected outside donors specifically chosen as having normal blood sugar levels and good microbial diversity. Drs. Lisa Chow and Elizabeth Seaquist, endocrinologists from the Department of Medicine will directly measure insulin sensitivity of the participants before and after the intervention.

Before and after the transplants, Kelvin Lim, Ph.D., will scan patients’ brains while showing them pictures of food, recording the brain response triggered by microbes in the gut. Lim, a professor with the U’s Department of Psychiatry, will use the imaging to help Khoruts and Sadowsky better understand how microbial balance affects communication between the brain and gut – signals that scientists are only beginning to investigate, but that could give critical insight to the eating behaviors of patients at risk for diabetes. The team, which also includes David Bernlohr, Ph.D, from the Department of Biochemistry, Molecular Biology and Biophysics, will conduct exploratory studies to identify the molecules involved in these signals.

When the study is finished, the results will inform trials for other diseases that could benefit from this form of therapy. We may learn why diets by themselves may not be quite sufficient without the right microbes in place. Ultimately, this work should help development of new types of therapies that benefit the relationship we have with our own microbes and lead to better health.

“If the study is successful the impact will be huge,” Khoruts said. “It can affect how society views obesity and related problems and how to take steps to treat the problem in a more comprehensive way.”

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Can this drug for Tylenol overdose make inroads with Type 1 diabetes?

October 1, 2014 - 9:00am

A low-cost Tylenol overdose drug already available for cystic fibrosis use will soon enter clinical trials aimed at discovering whether it can aid in treating an additional condition: Type 1 diabetes.

The drug, a natural supplement, is thought to have potential use in the treatment of hypoglycemia, a condition in which too little blood sugar is present in the body.

Also known as “insulin shock”, hypoglycemia sometimes occurs when the insulin treatment used to alleviate diabetes symptoms over-performs in the body.

“Fear of hypoglycemia can keep people from taking care of their blood sugars as well as they should to avoid the long term complications of diabetes,” said Elizabeth Seaquist, M.D., who is leading the new study. Seaquist is a professor of medicine in the University of Minnesota Medical School and 2014 president of medicine and science at the American Diabetes Association.

“Hypoglycemia can kill you, so that is a big problem,” said Seaquist.

Diabetes treatment can be a balancing act. If medicine underperforms, the body is unable to convert sugars and starches from food into energy; and if medicine overperforms issues like hypoglycemia can arise.

Hypoglycemia unawareness is a common problem in diabetes treatment. The name of the disorder itself spells out a unique conundrum: patients are often unaware they are experiencing hypoglycemia until it’s too late.

This unawareness occurs when the brain of an individual with frequent hypoglycemia adapts and is left unable to detect low blood sugar before the point of losing consciousness. Repeated fainting as a result of hypglycemia can lead to accidents or injuries in the short-term and brain damage or heart problems long-term.

University of Minnesota researchers are investigating whether they can restore the brain’s ability to detect hypoglycemia prior to fainting with n-acetylcysteine, the formal name for the Tylenol overdose drug.

“We’re hoping that n-acetylcysteine will be able to prevent blunting of the epinephrine response,” said Lisa Coles, Ph.D., a project collaborator of Seaquist’s and a biochemical pharmacologist with the U of M College of Pharmacy. “That’s important because the stress hormone epinephrine is required to detect and communicate to the body that you have low blood sugar.”

The basic concept behind the drug is that when “insulin shock” occurs, so does oxidative stress. N-acetylcysteine is a well-known antioxidant, and it’s a powerful one to boot. By preventing the oxidative stress from occurring, the hope is that insulin shock (and it’s resulting tissue and cell damage) can be prevented, too. If this mechanism works, N-acetylcysteine could help patients with diabetes know about hypoglycemia sooner, taking the “unaware” out of hypoglycemia unawareness and helping patients take care of low blood sugar right away, before further damage occurs.

U of M research has already proven the Tylenol overdose drug works well to alleviate Type 1 diabetes-related hypoglycemia in an animal model. Clinical trials to test drug success in humans are up next. Researchers will first test whether an intravenous (IV) dose of the drug can help patients with diabetes. The next step will be to give patients an oral medication.

Interested in helping the project move forward? Recruitment for clinical trials begins this month. Visit studyfinder.umn.edu to learn more.

Image: Acetylcysteine/Public Domain/Wikimedia Commons

University of Minnesota researchers James Cloyd, Ph.D., Amir Moheet, M.B.B.S., and Lynn Eberly, Ph.D., are additional contributors to Juvenile Diabetes Research Foundation-funded research.

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In The News: The burden of diabetes

July 23, 2014 - 10:13am

By 2050, the United States Centers for Disease Control and Prevention (CDC) estimates that one in three people in the U.S. could have diabetes. Each year, the number of people with type one and type two diabetes increases.

Elizabeth Seaquist, M.D., Medical School, recently spoke with KSTP-TV about diabetes research and how the disease’s prevalence can be decreased.

Seaquist also wrote an article for The Journal of the American Medical Association (JAMA) titled, Addressing the Burden of Diabetes.

“Addressing the epidemic of diabetes will involve reducing the effects of the disease on patient outcomes and quality of life, as well as lowering cost to the health care system,” Seaquist wrote. “Ultimately, this will require new strategies to prevent the disease in those at risk and cure those who have already developed diabetes.”

Not only is diabetes a serious health concern, but it’s also harmful to the economy. In 2012, 20-percent of health care funding was spent to care for diabetes patients — $245 billion in total.

To learn more about diabetes and the University of Minnesota’s role in stopping the disease, click here.

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U of M, Harvard partner in search for answers to diabetic kidney disease

March 28, 2014 - 10:07am

Last October, Health Talk told you about a new University of Minnesota and Harvard University partnership involving a clinical trial called Preventing Early Renal Loss in Diabetes (PERL) that will help researchers gain a better understanding around improving the health of people with diabetes and kidney complications.

As part of National Kidney Month, which wraps up at the end of March, Health Talk wanted to revisit the PERL study in an effort to raise awareness on the prevalence and public health concerns that kidney disease in type 1 diabetes causes on the American public and its health system.

Michael Mauer, M.D., a professor of pediatrics and medicine at the University of Minnesota Medical School and Alessandro Doria, M.D., Ph.D., M.P.H., an associate professor of medicine at Harvard Medical School and associate professor in the Department of Epidemiology at the Harvard School of Public Health, will lead this multi-center international trial. Luiza Caramori, M.D., M.Sc., Ph.D., an assistant professor of medicine and pediatrics at the University of Minnesota Medical School, will direct the study locally.

The PERL study is funded by a $23.5 million grant from the National Institutes of Health (NIH) which is supplemented by funding from the Juvenile Diabetes Research Foundation (JDRF). The collaboration between the U of M and Harvard researchers will bring great experience and leadership to the research study.

“Since type 1 diabetes often starts early in life, significant diabetic kidney disease may be present at a relatively young age, often in the most productive years of someone’s life, said Caramori. “From our previous work, we know that changes in kidney structure can be detected as early as five years after type 1 diabetes onset.”

“One of the really scary and alarming things about kidney disease is that oftentimes many of the symptoms do not appear for up to 25 years and by then it could be too late,” Mauer adds. “The sooner you’re able to catch it, the better your chances will be down the road.”

Mauer also emphasizes the dramatic increase in the amount of very serious kidney disease due to diabetes in the last 20 years. In fact, the annual incidence of new cases of kidney failure due to diabetes has increased by 270 percent over this time. And kidney disease poses one of the greatest burdens for people with type 1 diabetes, with 15 to 20 percent of patients developing end stage renal disease (ESRD), meaning that they need a kidney transplant (hemodialysis) to survive.

According to Mauer, diabetes is responsible for more than 45 percent of the more than 115,000 new ESRD cases in the U.S. With a kidney transplant a likely conclusion if not treated in time, there are major human suffering, public health and health cost implications involved.

“If we see a positive benefit from the generic medication used in the study in slowing the progression of diabetic kidney disease, this will likely then become a standard addition to the treatment of diabetic kidney complications, especially given the medication we are studying is inexpensive and safe for users,” said Caramori. “However, to draw firm conclusions from this study, we need to make sure a sufficient number of people is included and followed, so that we can compare the outcomes of subjects allocated to active treatment to those of subjects allocated to placebo.” Thus, Caramori stresses the need for more research participants for their study.

Mauer and Caramori said that if the PERL study is successful, inexpensive medications will be available to provide a safe addition to current treatment which might delay ESRD for many years.

If you have type 1 diabetes and have been told that you have kidney involvement, or increased protein in the urine (proteinuria), or increased albumin in the urine (microalbuminuria) or decreased kidney function, even if your kidney function is just slightly decreased, you may be eligible for this study.

If you’re interested in learning more about the study, please call 612-301-2103 or email the PERL research staff at PERL-T1D@umn.edu. You can also visit the study website at http://perl-study.org.

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Are you at risk for type 2 diabetes? Take the test and find out

March 25, 2014 - 8:00am

Today is American Diabetes Association Alert Day, a one-day “wake-up call” asking Americans to take the Diabetes Risk Test to find out if they are at risk for developing type 2 diabetes.

According to the ADA, 79 million Americans, or one in three adults, have prediabetes, putting adults at an increased risk for developing type 2 diabetes. Oftentimes a diabetes diagnosis comes up to 7-10 years after disease onset causing major medical complications and even death. That’s why early diagnosis is vital to successfully treat and possibly delay or prevent type 2 diabetes complications including heart disease, blindness, kidney disease, stroke and death.

The Diabetes Risk Test is simple and you only have to answer questions like weight, age, family history and other potential risk factors for prediabetes and type 2 diabetes.

“It’s extremely important to participate in Alert Day to see if you’re at risk for developing type 2 diabetes,” said Elizabeth Seaquist, M.D., University of Minnesota professor and endocrinologist, who was recently named President of Medicine and Science of the American Diabetes Association.

People identified as being at high risk are encouraged to see their doctor to learn if additional testing is needed. Some high risk people will be found to have prediabetes – a condition that can turn into diabetes if changes in activity and eating habits are not changed – or will be found to already have diabetes.

People with newly diagnosed diabetes will need additional treatment to remain healthy. “Newly diagnosed people may qualify to participate in a research study we are doing at the University of Minnesota called GRADE (for Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study). This study will help us determine the best treatments to use in newly diagnosed patients. Study participants will get free medications, lab tests, and diabetes care for up to 7 years,” said Seaquist.

Interested people can learn more about the study here, by emailing grade@umn.edu or calling 612-626-0143.

Seaquist encourages everyone who thinks they are at risk for type 2 diabetes to take the Diabetes Risk Test today!

Did you miss taking the test on Alert Day? Don’t worry, the test is available year-round.

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U of M study finds pancreatectomy and islet autotransplantation provides significant sustained pain relief in children with chronic pancreatitis

February 13, 2014 - 2:19pm

Researchers in the University of Minnesota Medical School’s Department of Surgery have found that total pancreatectomy and islet autotransplantation (TP-IAT) can provide significant, sustained pain relief and improve the quality of life in children with chronic pancreatitis (CP). Traditionally, surgeons would refrain from operating on younger patients, especially children, however this research shows that younger children actually fared better after surgery and had fewer complications than their counterparts.

The study was led by Srinath Chinnakotla, M.D., associate professor of surgery and pediatrics at the University of Minnesota and was recently published in the Annals of Surgery.

“As surgeons our primary goal for CP treatment in children is to relieve pain and get them back to doing the things they love as quickly as possible,” said Chinnakotla. “Our research shows that this procedure provides sustained pain relief while simultaneously, the islet cell transplant prevents diabetes. The procedure also potentially prevents pancreatic cancer in the group with hereditary etiology. We believe this study will help pave the way to help younger patients as pediatricians shouldn’t be as reluctant to explore this as a treatment option with their patients with and their families.”

Chinnakotla and his team studied 75 children from 1989 to 2012 in a subject pool of 484 patients who had chronic pancreatic surgery performed at the University of Minnesota and the University of Minnesota Amplatz Children’s Hospital.

Study results also found that:

  • 41 percent of patients achieved complete  insulin independence  and most patients had partial function
  • Younger patients (under age 12) were more likely to achieve insulin independence than older children
  • Pancreatitis pain and its severity improved over time and nearly all pain improvement was shown in the first three months
  • Quality of life studies revealed more than 90 percent returned to school and enjoyed improved quality of life
  • This is the largest study in children published to date

The University of Minnesota surgeons involved with the study are excited about the results and are already performing the procedure minimally invasively via laparoscopic methods.

Islet autotransplantation was pioneered at the University of Minnesota by David Sutherland, M.D. in 1977 and the University has played an integral role in the development and advancement of this procedure. Children from all over the country come to the University for this procedure.

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U of M professor and endocrinologist named President of Medicine and Science of the American Diabetes Association

January 13, 2014 - 12:38pm

[Adapted from American Diabetes Association]

University of Minnesota professor of medicine and endocrinologist Elizabeth Seaquist, M.D., was recently named President of Medicine and Science, on the Board of Directors for the American Diabetes Association, the nation’s largest voluntary health organization leading the fight to Stop Diabetes®.

As President of Medicine and Science, Seaquist will serve as the co-principal spokesperson with the President, Health Care and Education of the Association on science, health care and educational matters, and will assist with oversight of the Association’s business affairs. Additionally, she will work closely with the Association’s volunteers and staff on activities and initiatives in support of the organization’s mission during her tenure.

“As a researcher and clinician, my professional goal has been to improve the lives of people with diabetes,” said Seaquist. “As the President of Medicine and Science, I will be able to advance this goal on a national and international basis. I look forward to serving people with diabetes as an Association leader.”

Seaquist has been a member of the American Diabetes Association since 1987 and has served at the national level on the Research Policy Committee, the Research Grant Review Committee and the Scientific Sessions Meeting Planning Committee. She currently serves on the editorial board for Diabetes Care. At the local level, she served a two-year term as co-chair of the American Diabetes Association EXPO in her home city of Minneapolis and leads a successful Tour de Cure team.

Seaquist is a clinical investigator interested in the complications of diabetes. She was awarded a Distinguished Clinical Scientist Award by the American Diabetes Association in 2009. Her research focuses on the effect of diabetes on brain metabolism, structure and function. She also directs the University of Minnesota site for two NIH-funded clinical trials, including the GRADE study that is currently enrolling patients with newly diagnosed type 2 diabetes into a study that will determine the best drug to add to a metformin-based regimen (http://grade.bsc.gwu.edu or grade@umn.edu).

Seaquist is also the principal investigator on the NIH training grant for fellows in endocrinology and diabetes at the University of Minnesota, and maintains an active clinical practice. Seaquist also holds the Pennock Family Chair in Diabetes Research at the University.

“Dr. Seaquist has served the Association for many years and has always been an asset,” said Larry Hausner, M.B.A., chief executive officer of the American Diabetes Association. “We are looking forward to her more prominent role on the board and the expertise she will bring to help us move our mission forward.”

Diabetes is a serious disease that affects the body’s ability to produce or respond properly to insulin, a hormone that allows blood glucose to enter the cells of the body and be used for energy. Recent estimates project that as many as one in three American adults will have diabetes by 2050, unless we take steps to Stop Diabetes.

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Time to see the specialist? Medication woes might call for pharmacist

January 13, 2014 - 10:43am

For the millions of Americans with chronic conditions like asthma, high cholesterol, high blood pressure and diabetes, taking all the right medications at the right times can be a challenging, if not impossible, task.

With the insight that comes from seeing several thousand patients each year, Allyson Schlichte, Pharm.D., understands the medication challenges facing many Americans. But by some accounts, she’s an unusual “doctor” to meet in the hospital exam room.

Schlichte is a doctor of pharmacy, not a medical doctor (M.D.). But, similar to any medical doctor who follows medical school with a medical residency, Schlichte followed up pharmacy school at Drake University with a residency at the University of Minnesota College of Pharmacy’s Ambulatory Care Residency Program.

While you shouldn’t bring your questions about heart surgery to her exam room, Schlichte’s arguably the best type of health care provider you could see while experiencing medication woes.

“You’d see a podiatrist for a foot problem, you’d see a cardiologist for a heart problem. Why wouldn’t you see a pharmacist for a drug problem?” asked Schlichte.

Schlichte and other medication experts specialize in improving patient health by improving how patients use their medicine. Alongside a team of 23 pharmacists, Schlichte provides care directly to patients at Fairview Health Services, the site where she once completed her residency. Together, the pharmacy team sees around 4,000 patients each year at 27 clinics across the Fairview Health System.

While Schlichte sees patients two days a week, many of her fellow clinical pharmacists visit patients daily. They keep a schedule of appointments, and when patients arrive for their initial hour-long visit, they check in at the front desk just like they would to see any other doctor. The process is all part of a growing trend to allow pharmacists to provide frontline health care.

“We [pharmacists] get a little more time to sit down and talk about what’s working and what’s not,” said Schlichte. “We have a unique ability to get to the bottom of medicine-related problems.”

Educating patients on the disease they’re trying to manage is a big part of the job. Often patients are taking multiple medications, but aren’t seeing the kind of results their pills promise to deliver. Clinical pharmacists are charged with learning what roles medication cost, effectiveness, convenience and dosage play in how a patient uses her medicine.

“It might sound strange to say this as a pharmacist, but helping someone get off some of their medications is one of the best parts of the job,” said Schlichte. “Sometimes it’s about a change in diet, exercise or lifestyle that helps patients feel better on their own.”

Reworking patient medication regimens is health-improving, cost-saving news. Reforms encouraging more high-risk patients to visit a medication expert could save the nation an estimated $240 billion annually. The Institute of Medicine attributes more than one-third of American health care costs to patients with uncoordinated medication management.

More pharmacists in hospitals and clinics is where the industry is heading, according to Jon Schommer, Ph.D., a pharmacy workforce expert in the University of Minnesota’s College of Pharmacy. “We’re moving away from the pill-counter [pharmacy] business model,” he said.

So don’t be surprised if your next visit to the doctor’s office ends with a referral to the pharmacist. It might not be such a bitter pill to swallow after all.

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Health Talk Recommends: 6 tips for an enjoyable and diabetes-healthy Thanksgiving

November 27, 2013 - 8:00am

Thanksgiving is a wonderful time of year that brings together friends and family and officially kicks off the holiday season. But because the holiday primarily focuses on food enjoying Thanksgiving in a healthy way can present challenges for people with prediabetes or type 2 diabetes.

Fortunately, the American Diabetes Association offers these helpful tips for diabetic patients who want to enjoy Thanksgiving without putting themselves in an unhealthy situation:

Think about the timing of your meal. Many families eat large meals at odd times on holidays. For example, Thanksgiving dinner may be served in the middle of the afternoon. Plan in advance for how you will handle making changes if your meal does not line up with your regular meal schedule.

If you take insulin injections or a pill that lowers blood glucose, you may need to have a snack at your normal meal time to prevent a low blood glucose reaction. Check with your health care team about this.

Be physically active! The best way to compensate for eating a little more than usual is to be active. Start a new tradition that involves moving around away from the food. Ideas include taking a walk with the whole family or playing Frisbee, soccer, or touch football with your children, grandchildren, or the neighborhood kids.

Have foods to nibble on while you are cooking or waiting to eat. Make sure the foods you choose won’t sabotage blood glucose levels before the meal. Bring a platter of raw or blanched veggies with your favorite low-calorie dip or have a few small pieces of low-fat cheese. Don’t indulge on high-calorie or fried appetizers.

Make selective food choices. Many traditional Thanksgiving foods are high in carbohydrates: mashed potatoes, sweet potatoes, stuffing, dinner rolls, cranberry sauce, pumpkin pie, and other desserts. Don’t feel like you have to sample everything on the table. Have a reasonable portion of your favorites and pass on the rest. For example, if stuffing is your favorite, pass on rolls. Choose either sweet potatoes or mashed potatoes. If you really want to try everything, make your portions smaller.

Eat smaller portions. Because high carbohydrate foods are plentiful at most Thanksgiving feasts, watch your portion sizes. If you can’t decide on one or two carbohydrate foods to eat, take very small portions or “samples” of several dishes. Overall, try to keep your total carbohydrate intake like a regular day.

Eat your vegetables! Vegetables are important for everyone. Unfortunately, the vegetable selection on holiday menus is usually limited. We all want to dress up the table with tempting treats. Why not add some colorful vegetable dishes? Veggies come in all colors and are very nutritious. Offer to bring a green salad or a side of steamed veggies that have been seasoned. Non-starchy veggies are low in carbs and calories. They will help fill you up and keep you from overeating other high-calorie and high-fat foods on the table.

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U of M doctor helps change diabetes care in Africa, gains valuable perspective

November 26, 2013 - 10:30am

It’s not often a doctor has the opportunity to help mold the health care system of an entire country, but since 2007 Antoinette Moran, M.D., a professor and pediatric endocrinologist at the University of Minnesota, has supported a dramatic shift in how Uganda, Tanzania and Kenya approach the fight against pediatric diabetes.

Moran made her first trip to African in 2007, visiting Mulago Hospital in Kampala, Uganda, where the University has a resident exchange program. After seeing a call for faculty volunteers interested in providing teaching assistance Moran signed up. However, due to the sophistication of diabetes care in the U.S., she was worried about the level to which she’d be able to contribute.

“When I arrived and observed the state of pediatric diabetes in Uganda, to say things were bleak would be an understatement,” recalled Moran. “Children with diabetes were seen in the same clinic as very ill adults. They did not have medical records so we didn’t know their histories, there was no equipment to weigh them and there were no trained staff to provide diabetes education or educational materials.”

Moran recalls that the children had all the physical signs of poorly controlled diabetes combined with issues accessing treatment.

In the clinic, Moran found children had problems getting enough insulin and none of them had the ability to test their blood sugar levels at home. Worse, without access to treatment most children died shortly after diagnosis. At the time, there were less than 100 active cases of diabetes in the country. Burdened by the cost of treating diabetes, many families simply could not afford the necessary supplies. In one particular heart-breaking patient case, a 10-year-old diabetes patient named Michael was abandoned by his mother shortly after his diagnosis because she had no way to pay for his care.

Paving a path forward

In 2007, Moran recalls there wasn’t a single pediatric endocrinologist in sub-Saharan Africa outside of South Africa.

Grace Buwule, M.D., a pediatrician at Mulago Hospital, was assigned to care for children with diabetes. She’d learned about the condition via textbook and tried to obtain any available information about the disease. She asked Moran for help in developing a pediatric diabetes program and together they developed a plan.

Buwule identified two nurses, a junior physician and a pharmacist to form the Mulago Pediatric Diabetes team. Moran helped train this team while she was at Mulago Hospital in 2007 and 2008, and even brought the team to Minnesota for further training. Together they developed protocols and came up with a plan to help children receive insulin.

Since then, things have improved considerably for children with diabetes in Uganda. The Chairman of Pediatrics identified a new, child-friendly space for the clinic with private exam rooms. A charting system is in place and all children are weighed and measured. Diabetes education materials are available with protocols in place. Through the Changing Diabetes in Children (CDiC) program, Novo Nordisk Pharmaceuticals, working with the Ugandan Ministry of Health, is providing free insulin and test strips to children with diabetes. Importantly, there are now trained pediatric endocrinologists in Uganda.

In another positive step, in 2009, the European Society for Pediatric Endocrinology (ESPE), together with the International Society for Pediatric and Adolescent Diabetes (ISPAD), established a pediatric endocrinology fellowship program in Nairobi, Kenya.  Since then, more than 30 pediatric endocrinologists and their medical team members have been trained.

Moran has participated in these training programs in Kenya, Tanzania, and South Africa, and three physicians from Uganda are now trained pediatric endocrinologists.

Recently Moran returned to Uganda to put on a conference to help implement the CDiC insulin program. Now more than 400 children are known to have diabetes in Uganda, showing that treatment is extending their lives. However, the majority of these are adolescents, and many young children with diabetes are still dying without ever being diagnosed.

Acknowledging that there is still much more work to be done, Moran did say that she’s noticed things have improved dramatically over the last few years. She’s even seen a few familiar faces in the clinic.

“In 2007, I diagnosed diabetes in a 2.5-year-old boy named Shafik. Because of his young age he was not expected to live. I just saw him again last month and he is a healthy, thriving 9-year-old,” said Moran. “That was a really great moment for me and for everyone involved. I also saw Michael, the now 16-year-old boy whose mother abandoned him at age 10. While Michael and his father struggle financially, he is overall doing well and plans to become a doctor.”

Through all her travels to Africa Moran has gained valuable perspectives on diabetes care and treatments. Where she once had concerns about her ability to translate care into such a different health care environment, now she sees ways to take action and solve problems on a global level.

“We had to start at a very basic level of care and understanding of what diabetes is and how we can treat it,” Moran said. “From how to work in multidisciplinary teams to how to use test strips and insulin, it was a learning experience for everyone. Patients and care providers in Africa are eager for information, and once they have it they embrace it and use it well. It reminded me of how lucky Americans are to have what we have.”

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What is prediabetes?

November 19, 2013 - 8:45am

Most Americans are fairly familiar with type 2 diabetes. But did you know that before someone is diagnosed with type 2 diabetes they almost always have a condition known as “prediabetes”?

According to the American Diabetes Association, prediabetes is evident when blood glucose levels are higher than normal but not yet high enough to be diagnosed as diabetes. For an individual with elevated blood glucose levels, this is a dangerous time because you are at an increased risk for developing type 2 diabetes and cardiovascular disease.

One of the many troubling aspects of prediabetes is that individuals may not know their blood glucose levels are crossing into the danger zone, allowing their condition to progress undiagnosed into type 2 diabetes.

“Many problems with diabetes are related to how high the blood sugars are and how long they are elevated,” said Elizabeth Seaquist, M.D., an endocrinologist and professor of medicine within the Division of Endocrinology and Diabetes at the University of Minnesota. “If someone has prediabetes it tells us they are at risk for the cardiovascular problems associated with the disease and may go on to have an increased risk of diabetes-related eye, kidney, and nerve diseases.”

So, how do you stop prediabetes before it develops into type 2 diabetes?

This is a difficult question but Seaquist offers a few suggestions:

Consult your doctor – If you’ve been told that you have elevated blood glucose levels or if type 2 diabetes runs in your family, it is advised to speak with your doctor for more information and to get tested. Early treatment of prediabetes can return levels to their normal range.

Get active – Exercise can make a noticeable difference in the progression of prediabetes. Losing weight, even 10 to 15 pounds, can help stabilize and lower blood glucose levels. Start slowly and gradually build up your endurance when walking, biking, running, etc. Try activities that are fun for you and don’t be afraid to switch up your routine so you don’t get bored. Ask a significant other, friend or family member to join you.

Change your diet – A poorly balanced diet that provides more calories than a person needs is often at the center of the problem for people with prediabetes. Work with your care provider or dietician to come up with a diet plan that works for you. Simple but often difficult things like reducing portions sizes and limiting snacks, soda and other unhealthy food items will help.

Seaquist also recommends utilizing a trusted support network to keep you motivated and stay on track with your new lifestyle.

“Changing poor habits, especially diet and exercise, is never easy but absolutely necessary. Type 2 diabetes is a life-changing event and something that can be postponed until later in life or even prevented altogether.”

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NIH awards $24.3M to U of M, Harvard partnership for a new trial to combat diabetic kidney disease

October 8, 2013 - 12:34pm

The University of Minnesota and Harvard University will partner on a new clinical trial to study a potential treatment for kidney disease in people with type 1 diabetes; a study that will be funded by a $24.3 million grant from the National Institutes of Health (NIH).

Researchers believe the findings from this study – both from the perspective of public health and that of individuals with diabetes – will be significant as researchers seek a better understanding around improving the health of people with diabetes and kidney complications.

The five-year trial, part of the Preventing Early Renal Function Loss in Diabetes (PERL) consortium, is designed to evaluate the possible benefits of allopurinol in reducing kidney function loss in people with Type 1 diabetes. Allopurinol is an FDA-approved drug that can lower uric acid, and previous research from the Joslin Diabetes Center and other investigators has linked higher levels of uric acid to the risk of kidney complications in diabetes.

Michael Mauer, M.D., a professor of pediatrics and medicine at the University of Minnesota Medical School and Alessandro Doria, M.D., Ph.D., M.P.H., an associate professor of medicine at Harvard Medical School and associate professor in the Department of Epidemiology at the Harvard School of Public Health, will lead the trial. Luiza Caramori, M.D., M.Sc., Ph.D., an assistant professor of medicine and pediatrics at the University of Minnesota Medical School, will direct the study.

“Smaller studies have suggested the benefits of slowing kidney function decline in patients with chronic kidney disease, but PERL is positioned to provide a much more definitive answer to this important question,” said Mauer.

Kidney disease poses one of the greatest burdens for people with type 1 diabetes, with 10 to 15 percent of patients developing end stage renal disease (ESRD), meaning that they need hemodialysis or a renal transplant to survive.

According to Mauer, diabetes is responsible for more than 45 percent of the more than 115,000 new ESRD cases in the USA, and the number of people with diabetes and kidney failure rose by 61 percent between 2000 and 2010.

“This study has large human suffering, public health and health cost implications,” said Mauer, “because currently, tight control of blood sugar and blood pressure are the only prevention tools we have. But as many as 50 percent of people with diabetes cannot achieve optimal blood sugar control and blood pressure control is only partially effective.”

“The goal of this study is to see if we can slow down the decline of kidney function by decreasing uric acid levels and find a new way of preventing kidney complications in people with diabetes,” added Doria. “Data indicates that moderately high serum uric acid levels predispose to diabetic kidney disease. However, we don’t know whether this is due to uric acid itself or to something else that goes together with it. That’s why this study is important – to determine if uric acid is the culprit or not.”

This study will include approximately 500 patients with type 1 diabetes who are at increased risk of losing kidney function. Half of the patients will be randomly assigned to take allopurinol and the other half will be assigned to placebo for three years. Study recruitment could begin as early as this month.

If the PERL consortium can demonstrate that allopurinol is capable of halting or slowing down loss of kidney function in people with type one diabetes, there will be a generic and safe medication to prevent or delay kidney failure by intervening at the early stages of kidney disease.

“If we see a significant benefit of allopurinol on slowing progression of diabetic kidney disease, this will become a standard addition to the treatment of diabetic kidney complications especially given that allopurinol is relatively inexpensive and safe,” said Caramori.

Prior to being awarded this grant, Doria and Mauer together with Peter Rossing, M.D., head of research at the Steno Diabetes Center and Affiliated Professor at Aarhus University in Denmark, conducted a small pilot of this study with the support of the Juvenile Diabetes Research Foundation (JDRF). From this, they have already established the infrastructure and procedures, which allows them to start recruiting patients for the study as early as October.

The research will be conducted at institutions in the PERL consortium, composed by the Joslin Diabetes Center, University of Minnesota, the Universities of Colorado, Toronto, and Michigan, Northwestern University, Albert Einstein College of Medicine and the Steno Diabetes Center in Denmark. The funding will be distributed to the eight clinical centers, plus a data center in Michigan and a central laboratory in Minnesota.

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Can submarine technology transform islet transplantation?

September 19, 2013 - 5:00pm

Editor’s note: This story originally appeared in the Fall 2013 edition of the University of Minnesota Foundation e-publication Discoveries in Diabetes and was written by Karin Miller.

Research collaborators working with the University of Minnesota and University of Arizona embarked on a unique experiment in August. A donor pancreas, chaperoned by a graduate student, was flown by commercial jet from Minneapolis to Tucson, Arizona. The goal: to see if a new organ preservation technique could extend the life of the donor pancreas. It did.

Generally, a donor pancreas must get from its origination city to its destination—sometimes across the country—in just eight hours to be suitable for transplantation. After that, the organ has spent too much time without oxygen to be used. But a new oxygen preservation technology developed by U adjunct professor Klearchos Papas, Ph.D., in collaboration with Giner Inc., would extend the life of this organ up to 24 hours.

With this technology, Papas estimates that the percentage of usable pancreas organs could jump from 42 percent to 60 or 70 percent. The better-preserved pancreases will result in higher quality islet cells as well, he says, increasing the number of people who could become insulin independent with a first pancreas transplant.

But because the donor organ supply is inadequate to meet current demands, Papas and U imaging expert Mike Garwood, Ph.D., are working towards the goal of creating an artificial, implantable pancreas, where human, pig, or stem cell islets could be implanted and protected, meeting the needs of people with type 1 diabetes. This work is championed by the Schott Foundation, which made a recent gift of $100,000 to fund it—bringing its historic U diabetes research support to more than $385,000.

“We are a small foundation, so we tend to work with startup projects that aren’t yet eligible for national grants,” says foundation principal Owen Schott, adding the gift is in part personal—several members of his wife’s family have diabetes. Also, he appreciates Papas’s creative approach.

Papas began this work by teaming up with Giner Inc. and tapping oxygenation technology designed for nuclear submarines—converting water into oxygen. By miniaturizing that process, he was able to extend the viability of a donor pancreas. Now, Papas and Garwood plan to adapt this technology and further miniaturize it, so that it can preserve islets inside an implantable, artificial pancreas.

Garwood says putting the islets into the device solves two problems: “We can monitor the oxygen”—helping islets remain optimal posttransplant—“ and we can use human islets without immunosuppression, because the artificial device separates the islets from the body,” which would otherwise reject them.

This approach with human islets could alleviate the need for immunosuppressive drugs, which can cause serious health issues, and could have applications for use in treating children.

“This is an extremely promising approach for eliminating type 1 diabetes and getting people back to normal lives,” says Garwood, who calls the Schott Foundation’s gift “critical.”

Owen Schott and his brother, Dell Schott, believe that their family foundation’s continued support for U diabetes research it just one part of the puzzle. “We can’t all be 3M Foundation or the McKnight Foundation, but we can all do our part and help,” says Owen Schott.

Papas says that he and Garwood couldn’t achieve their goals without this kind of seed funding. “These gifts are invaluable. Without them, our work would in no way be doable.”

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