Diabetes Research and Advancements in Care

By Richard Wall

The cure for diabetes is a good way off, partly because the explosive growth of the disease has turned attention to its early detection, halting its progression and preventing complications. “If you identify the problem early enough, exercise and weight loss can be thought of as a partial cure,” says J. Gary Evans, M.D., who is involved in research for Northeast Florida Endocrine and Diabetes Associates.

While prevention holds the greatest promise, Dr. Evans and others are looking into the different pieces of the diabetes puzzle. “There are various classes of diabetes medications, each of which work slightly differently than the others,” says Dr. Evans. “In combination they often compliment each other.”

Diabetes is a dynamic progressive disease and often requires the addition of one or more medications to achieve insulin control. Data shows that some medications, such as Metformin, reduce the risk of progression. “Where Metformin reduces sugar output from the liver, another class of medications, such as Sulfonylureas, stimulate insulin production from the pancreas,” explains Dr. Evans. “Another class of medications called TZDs, such as Actos, is an insulin synthesizer. It helps the tissue, muscles and blood cells respond more effectively to the patient’s own insulin.”

DPP-4 inhibitors, such as Januvia, are a new class of medications that boost insulin production and safely lower blood sugar. Dr. Evans says research on medications that could preserve the function of the islet cells that produce insulin in the body is also very promising.

Other research efforts involve reducing the effects of complications. Mark Joyce, M.D., lead principal investigator for CNS Healthcare in Jacksonville, is currently doing a clinical trial on a compound to treat diabetic peripheral neuropathy, the nerve damage to extremities that can result in amputations. Patients develop symptoms like numbness, tingling, feelings of pinpricks and pain. “It’s very uncomfortable. Sometimes they lose sensation and can’t tell if they develop a wound down there until it is too late,” says Dr. Joyce. “So this trial is studying a compound that hopefully will relieve the discomfort of neuropathy, though it won’t help identify a wound any sooner.”

The compound Dr. Joyce is studying is similar to drugs in clinical use, such as Ketamine and Dextromethorphan, which are controversial and highly controlled. “This compound under research can hopefully give the benefits of pain relief without the side effects of addiction, tolerance, withdrawal, those kinds of things,” says Dr. Joyce.

This September, Mayo Hospital in Jacksonville rolled out a new pre-filled insulin pen with retractable needles. Sara Aton, M.S.N., R.N., C.D.E. and nurse educator for the hospital says it will greatly reduce needle sticks that are dangerous to patients and caregivers, while lowering costs. That and other technological advances improve care.

“We have sensors that patients can put on their arms that take 300 readings during the day and tell the patient when their blood sugar is very low or very high,” says Aton. “We have insulin pumps that deliver insulin to a patient, particularly with type 1 diabetes, on a 24-hour basis, much like the pancreas does.” She adds that development of an artificial pancreas will probably happen in our lifetime.

These are wonderful advances, yet prevention remains a big target. “I think we need clinical trials that study populations of people to find those in the state of metabolic syndrome,” says Dr. Joyce, speaking of the cluster of conditions such as elevated insulin, high blood pressure and excess fat around the waist that some people at risk exhibit before they are classified as pre-diabetic. “We need to study those people with metabolic syndrome, find ways to intervene and find ways to diminish the onset of diabetes. That’s the better investment in health.”