NIH Reports Progress in Diabetes Research
October 23, 2002 The National Institutes of Health (NIH) has issued a detailed progress report, "Conquering Diabetes: Highlights of Program Efforts, Research Advances, and Opportunities," on NIH-funded diabetes research.
The report describes research achievements and initiatives since 1999, when the Diabetes Research Working Group (DRWG), an independent panel of 12 leading scientists and four lay experts in diabetes, published its 5-year Strategic Plan. The congressionally established DRWG made scientific recommendations in five areas of extraordinary research opportunity: the genetics of diabetes, autoimmunity and the beta cell, cell signaling and cell regulation, obesity, and clinical research and clinical trials. The Group also made recommendations regarding the microvascular and macrovascular complications of diabetes, the special populations most affected by diabetes, and resource and infrastructural needs to further diabetes research.
"NIH has been vigorously pursuing the DRWG's scientific recommendations within the context of all available resources," said Dr. Judith Fradkin, director of the Diabetes, Endocrinology, and Metabolic Diseases Division of the National Institute of Diabetes and Digestive and Kidney Diseases. "In the past three years, we've begun exciting new projects that bring together scientists from across the nation and around the world to address major areas of scientific opportunity, and we've developed new approaches to prevent and treat diabetes and its devastating complications. However, the increasing prevalence of diabetes in all age groups underscores the urgency of translating discoveries from basic research into proven therapies that benefit patients," added Dr. Fradkin, who oversaw preparation of the NIH report.
The report reflects the advice of many scientists at the forefront of diabetes research and identifies new research opportunities that have emerged since the DRWG made its recommendations. It also outlines recent advances, both clinical and basic, in type 1 and type 2 diabetes and the pre-diabetic conditions, usually asymptomatic, that precede disease onset. For example,
- Researchers are now able to identify those at highest risk for type 1 diabetes years before the appearance of symptoms. This ability, coupled with advances in immune tolerance research and a better understanding of the autoimmune process that destroys the insulin-producing beta cells, have laid the groundwork for clinical trials to prevent type 1 diabetes and treat it in new-onset patients. These trials are now being planned.
- Survival rates for people with type 1 diabetes are improving. Improvements in insulin formulations and delivery together with better methods for monitoring glucose control have helped patients deal with the challenge of controlling blood glucose. Clinical trials have also led to new guidelines for managing blood pressure and lipids in people with diabetes to lower risk of cardiovascular complications. For those with type 1 diabetes, these advances are improving survival. According to a type 1 diabetes registry, death rates fell by more than half for those diagnosed between 1975 and 1979 compared to those diagnosed 10 years earlier.
- Islet transplantation, a procedure that can restore insulin production in patients with type 1 diabetes, is a highly promising area of research. Current studies are trying to develop immunosuppressive regimens with fewer side effects and, ultimately, methods for achieving immune tolerance, which would educate the immune system to accept donated organs or tissues without the need for chronic immunosuppressive drugs. NIH has also expanded efforts to learn how the beta cell develops and functions with the goal of developing viable sources of islets to supplement the limited supply currently available through donation.
- Scientists have identified several genes that contribute to diabetes susceptibility. Type 1 and type 2 diabetes are complex genetic diseases that arise from the interactions of various genes and environmental factors. About 85-90 percent of people with type 1 diabetes have HLA genotypes known as DR3 and 4, and people with those genotypes are more likely to develop type 1 diabetes. Several genes have also been identified that predispose people to type 2 diabetes. NIH is funding a vigorous, multi-pronged effort to identify all the genes that influence diabetes susceptibility through research consortia, large-scale genome-wide scans, and "knock-out" and animal models of diabetes. Once these genes are identified, scientists hope to find new molecular pathways that provide targets for therapies.
- A major clinical trial, the Diabetes Prevention Program, has clearly shown that type 2 diabetes can be prevented through modest changes in diet and exercise leading to a 5- to 7-percent weight loss in overweight people with pre-diabetes. About 16 million people in the United States have pre-diabetes, which raises the risk of developing type 2 diabetes and cardiovascular disease. Once a person has type 2 diabetes, the risk of heart and blood vessel disease is even greater-2 to 4 times that of people without diabetes.
- Obesity research is revealing that appetite and energy expenditure are regulated by a far more complex system of signaling and feedback loops than previously recognized. Reversing the rising incidence of obesity, which greatly raises the risk for pre-diabetes, type 2 diabetes, and other health problems, is a major challenge and the focus of a great deal of research aimed at understanding the biochemical and behavioral processes that regulate weight and at improving methods to prevent and treat obesity. By understanding this regulation and identifying key signaling molecules, scientists hope to find targets for therapeutic intervention and drug development.
The NIH has launched many new initiatives to stimulate productive avenues in diabetes research by - harnessing new technologies
- fostering full and immediate exploitation of research advances and emerging opportunities
- establishing fruitful research partnerships and collaborations
- improving researchers' access to tools and resources
- promoting cross-fertilization of research ideas
- attracting and sustaining talented researchers
- integrating and coordinating basic, preclinical and clinical approaches to diabetes, and
- translating research findings into more effective treatments and prevention strategies for the benefit of patients and their families.
Beginning in November, single copies of the report will be available free of charge from NIDDK's National Diabetes Information Clearinghouse at 1-800-860-8747. ###
Contact:
Joan Chamberlain
Jane DeMouy
(301)496-3583
Page last updated: April 19, 2010
