A new strategic plan to guide diabetes-related research over the next decade was announced today by the National Institutes of Health. The plan, developed by a federal work group led by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), identifies research opportunities with the greatest potential to benefit the millions of Americans, and ultimately nearly 250 million people worldwide, who are living with or at risk for diabetes and its complications.
"By setting priorities and identifying the most compelling research opportunities, the strategic plan will guide NIH, other federal agencies and the investigative community in efforts to improve diabetes treatments and identify ways to keep more people healthy," said NIDDK Director Griffin P. Rodgers, M.D. in a press release.
The promise of prevention, treatment, and cure for diabetes can only be realized through the vigorous support of scientific research. This research must be conducted through a multi-pronged effort that addresses the complex challenges posed by diabetes, from dysfunctions in the most fundamental molecular and cellular processes, to the need for new approaches to translate scientific findings into improved health for patients, the release states.
The purpose of this research plan - Advances and Emerging Opportunities in Diabetes Research: A Strategic Planning Report of the Diabetes Mellitus Interagency Coordinating Committee (DMICC) - is to serve as a scientific guidepost, identifying compelling opportunities for research on diabetes and its complications over the next decade.
The goal is to accelerate the discovery of: the relationship between obesity and type 2 diabetes, and how both conditions may be affected by genetics and the environment, the autoimmune mechanisms at work in type 1 diabetes, the biology of beta cells, which release insulin in the pancreas, development of artificial pancreas technologies to improve management of blood sugar levels, prevention of complications of diabetes that affect the heart, eyes, kidneys, nervous system, and other organs and the reduction of the impact of diabetes on groups disproportionately affected by diabetes including the elderly and racial and ethnic minorities.
The plan focuses on 10 areas of diabetes research with the most promise. The goal is to accelerate discovery on several fronts, including:
the relationship between obesity and type 2 diabetes, and how both conditions may be affected by genetics and environment
the autoimmune mechanisms at work in type 1 diabetes
the biology of beta cells, which release insulin in the pancreas
development of artificial pancreas technologies to improve management of blood sugar levels
prevention of complications of diabetes that affect the heart, eyes, kidneys, nervous system and other organs
reduction of the impact of diabetes on groups disproportionately affected by the disease, including the elderly and racial and ethnic minorities
Under the plan, NIH will continue to emphasize clinical research in humans, which already has led to highly effective methods for managing diabetes and preventing complications, Rodgers said.
The NIH strategy for fighting diabetes addresses type 1 and type 2 diabetes. Type 1 diabetes, which affects about 5 percent of individuals with diagnosed diabetes, is an autoimmune disease that most often develops during childhood. Type 2 diabetes accounts for 90 to 95 percent of diagnosed diabetes cases in the United States, and is strongly associated with overweight and obesity.
In addition, the plan addresses gestational diabetes, a condition that some women develop during pregnancy, but which usually goes away after their child is born. Women who develop gestational diabetes during pregnancy are at increased risk for developing type 2 diabetes, and the child of that pregnancy may also be at increased risk for obesity and type 2 diabetes.
The NIDDK plans to continue its emphasis on clinical trials in humans, "which already [have] led to highly effective methods for managing diabetes and preventing complications," Rodgers said.
Within each broad area, the strategic plan lists some specific areas of focus.
For instance, in the area of beta cell research, the plan includes five areas: integrated islet physiology, beta cell dysfunction and failure, prevention and treatment of diabetes through restoration and preservation of beta cell function, cellular replacement therapies, and imaging the pancreatic islet.
Obesity is another focus of the plan because of its status as a major risk factor for diabetes.
Areas of interest in obesity include:
Obesity, inflammation, insulin resistance, and macrophage function: "Macrophages and inflammation appear to be activated by excess nutrients and subsequently play a role in eliciting insulin resistance as a consequence of obesity," the report authors noted. "Research is needed to clarify the mechanisms and outcomes of tissue-specific inflammation in obesity."
Mechanisms underlying energy homeostasis: "Untangling the complex networks of hormonal and neural mechanisms that control energy balance in the body could point to new therapeutic targets to prevent or treat obesity," according to the report.
Central nervous system control of thermogenesis: "New technologies are needed to facilitate study of the complex control of energy expenditure and how it contributes to weight maintenance and obesity in people," the authors wrote.
Discovering genetic and intrauterine determinants of obesity susceptibility that predispose people to developing diabetes.
Adipose tissue biology: "Adipose tissue research is key to the development of treatments for obesity and type 2 diabetes," the authors noted. "Understanding the mechanisms that regulate fat cell number, size, distribution, and signaling, and developing new technologies for studying adipose tissues are urgent research goals."
Obesity prevention and treatment: "Behavioral strategies are needed to prevent inappropriate weight gain and promote or maintain weight loss in individuals across the lifespan, as well as in communities or large populations," the authors wrote. "The development and testing of such strategies would be supported by research on the nonbiological determinants of obesity and obesity prevention and the use of technologies to tailor the delivery of interventions to individuals."
Currently, about 1 in 10 adults in the United States has diabetes, according to the Centers for Disease Control and Prevention. About 1.9 million Americans aged 20 years or older were newly diagnosed with diabetes in 2010. In addition, an estimated 79 million American adults have pre-diabetes, a condition in which blood sugar levels are higher than normal but not high enough to be diagnosed as diabetes.
By 2050, as many as 1 in 3 adults could be diagnosed with diabetes if current trends continue, according to the CDC.
The projection assumes that recent increases in new cases of diabetes will continue and people with diabetes will also live longer, which adds to the total number of people with the disease.
Diabetes eventually damages nearly every organ system in the body. People with diabetes are at increased risk for blindness, kidney failure, and lower limb amputation. Overall, the risk for death among people with diabetes is about twice that of people of similar age without diabetes.
In addition, it is a very expensive disease to manage. Total costs of diabetes, including medical care, disability, and premature death, reached an estimated $174 billion in 2007 in the United States.
The plan was developed by the Diabetes Mellitus Interagency Coordinating Committee (DMICC), a congressionally authorized workgroup chaired by the NIDDK. Established in 1974, the DMICC facilitates cooperation, communication, and collaboration on diabetes research across the federal government.
Key elements of the report were identified by multiple public and private stakeholders, including representatives of DMICC member agencies, health advocacy groups and external scientists who are leaders in the diabetes research field.
To ensure broad input, a draft of the strategic plan was also posted for public comment prior to publication. The strategic plan is available electronically here. Printed copies can be requested from the National Diabetes Information Clearinghouse beginning April 1, 2011, at 1-800-860-8747 and by email at ndic@info.niddk.nih.gov. Single copies are free.
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