Diabetes research is continually advancing, resulting in new knowledge and treatments. With the support of the Canadian Diabetes Association (CDA), a number of initiatives currently underway are targeting the devastating complications caused by the disease.
Dr. Subrata Chakrabarti, professor and chair of the department of pathology and laboratory medicine at the University of Western Ontario in London, Ont., is researching the mechanisms that damage the retina in people with diabetes, one of the major causes of blindness in Canada. One promising focus is the recently discovered microRNA molecules, which regulate the production of some proteins in the cells lining the blood vessels. Diabetes reduces the number of microRNA molecules, allowing the proteins to make more of the same proteins, causing cells to proliferate and wreak havoc.
"These proteins are like foot soldiers," says Dr. Chakrabarti, "and they attack the retina by sending messages to the blood vessels to make new vessels that bleed, causing blindness." His team is looking at ways to stop the protein production by using these microRNAs and by finding substances that could block the cell receptors for these proteins.
Dr. Allison Dart, a kidney specialist at The Children's Hospital in Winnipeg, is studying the high rates of kidney disease in children diagnosed with type 2 diabetes.
"Children exhibit kidney injury at diagnosis," says Dr. Dart, "whereas adults don't usually show signs until five years later." The result is that up to 50 per cent of children with type 2 diabetes in Manitoba may go on to experience kidney failure by the time they reach their mid-30s.
Dr. Dart and her team are currently following 130 diabetes patients between the ages of 10 and 25 who live in Winnipeg and northern communities in Manitoba and Ontario. About 95 per cent of the patients are Aboriginal and are genetically at higher risk. Many are also obese and have been diagnosed with high blood pressure as a result of behavioural and environmental factors.
"Telling them to eat healthy, take their insulin or giving them pills doesn't work," Dr. Dart says. "We have to find other approaches, such as hiring more psychologists in the clinical care setting to help them with their mental health issues, increasing education in schools regarding diet and physical activity, and making fresh foods more affordable."
Dr. Ravi Retnakaran, an endocrinologist at the Leadership Centre for Diabetes at Mount Sinai Hospital in Toronto, is studying new treatments for type 2 diabetes to prevent weight gain and low blood glucose levels, complications of the medications now used to manage the disease.
In just the last decade, genetic studies have led researchers to discover the central role that beta cells play in preserving the ability of the pancreas to make insulin. Currently, doctors typically recommend weight loss for their newly diagnosed patients. When that eventually fails to control blood glucose levels, doctors prescribe medication. In the last stages, insulin is administered because the beta cells have deteriorated.
Dr. Retnakaran, on the other hand, believes that every effort should be taken to preserve the body's beta cells at the beginning of treatment rather than at the end. He is doing so by using combination therapies.
Three clinical trials at Mount Sinai and other centres are recruiting type 2 diabetes patients in the first five years after diagnosis to test the use of short-term insulin alone, and then together with liraglutide and similar drugs that mimic GLP-1, a naturally occurring hormone produced in the small intestine that helps the body balance the ratio of insulin to blood glucose.
"I believe the results of these clinical trials will make us look at diabetes in a completely different light," says Dr. Retnakaran. "We'll be treating it intensely upfront to improve and preserve beta cell function and then maintain that function for the rest of a patient's life."
Dr. Ravi Retnakaran
is an endocrinologist at the Leadership Centre for Diabetes at Mount Sinai Hospital
To learn more about CDA-funded researchers, such as Dr. Chakrabarti, Dr. Dart and Dr. Retnakaran, or how you can support groundbreaking diabetes research in Canada, visit www.diabetes.ca/research or call 1-800-BANTING (226-8464).
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