NIH Unveils 10-Year New Strategic Plan to Combat Diabetes

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.

Social but Safe? Diabetes Patients Warned About Safety on Internet

In this digital age, many individuals who receive positive HbA1c tests for diabetes turn to the internet for answers to their questions about the condition. However, a new study has found that this may be a dangerous practices, as many community sites for people with the condition contain unqualified information that may be misleading and even dangerous.

Nearly one-half of U.S. adults who use the Internet participate in social networks. While these increasingly include health-focused networks, not much is known about their quality and safety. In one of the first formal studies of social networking websites targeting patients, researchers in the Children's Hospital Boston Informatics Program performed an in-depth evaluation of ten diabetes websites.

Their audit found large variations in quality and safety across sites, with room for improvement across the board. As reported online January 24 in the Journal of the American Medical Informatics Association, only 50 percent of the sites presented content consistent with diabetes science and clinical practice. Even fewer offered both scientific accuracy and patient protections such as safeguarding of personal health information, effective internal and external review processes and appropriate advertising.

For instance, seven of the ten sites did not allow members to restrict the visibility of their profiles. Five carried advertisements that were not labeled as such. And three sites went as far as to advertise unfounded "cures."

"We saw that people are sharing incredible amounts of personal health information on these sites, including highly identifiable information," says Elissa Weitzman, ScD, MSc, lead author on the study and an assistant professor in the laboratory of Kenneth Mandl, MD, MPH. "They are eager to accelerate their understanding of the disease, obtain support, find treatments and see if their experience is common or different."

"There is on the one hand an enormous focus in the U.S. on health information privacy," Mandl adds. "But privacy in a social network is somewhat of an oxymoron. On the whole, these networks tend to be about exposing your information online."

The team evaluated diabetes websites that appeared prominently in Google searches and allowed members to create personal profiles and interact with each other. They looked at four key factors:

(1) agreement of content with diabetes science and clinical practice standards,

(2) practices for auditing content and supporting transparency,

(3) accessibility and readability of privacy policies, and

(4) the degree of control members had over the sharing of personal data.

The average number of members per website was 6,707. Activity ranged widely among the sites, from over 100 new posts per day to less than 5 new posts per day.

The majority of sites studied did not include a "disclaimer" encouraging patients to discuss their care regimen with a healthcare provider. Many sites also missed opportunities to communicate essential diabetes information, such as the definition of "A1c"—a biomarker commonly used by diabetics to access blood glucose levels.

In addition to recommending improvements in these areas, the authors saw a need for increased moderation, for the credentials of moderators to be more visible and for periodic external review. Further, potential conflicts of interest—such as ties to the pharmaceutical industry—needed to be more clearly disclosed, and privacy policies easier to understand.

Diabetes is only one illness in the rapidly growing list for which there are online social networks with thousands of users. The researchers chose to study diabetes-related networks because they were among the earliest to emerge and remain among the most active. They and colleagues in the Children's Hospital Informatics Program are further studying how these sites are used—how people choose to interact with them and how specifically they share their medical information.

Last year, Mandl and Weitzman developed an application for the social networking website TuDiabetes that allows users to submit their A1c levels to be displayed in a worldwide map, as part of an effort to encourage diabetes management and inform public health efforts and research.

The two believe that the emergence of online health communities and their large number of participants reveal unmet needs for information and support of patients and families. "Social networking activity is clearly replacing or adding value that is missing in the standard healthcare system," Mandl says.

"We sought to jump start a conversation about how to balance patients' safety with their autonomy," Weitzman says, "as we're in an era where terrific levels of healthcare communication are happening outside of the usual channels."

This study was funded by the Centers for Disease Control and Prevention and the National Institutes of Health, including the National Institute on Alcohol Abuse and Alcoholism.

Safety Tips for Patients Using Online Social Networks
1. Look for sites where the basic description of the disease and how to care for it is consistent with information provided by your doctor. Be very cautious of sites that advertise miracle "cures."

2. Find the privacy policy of any website where you register as a member, and make sure that you understand it.

3. Try to use sites where you have maximal control over the sharing of your health data—where you can designate whether the information you disclose will be available to anyone online, members only or members who are "friends."

4. Look for websites that clearly label advertisements and disclose conflicts of interest.

5. Try to use sites that have moderators and at least periodically undergo external review.

6. Always remember that going online is not a replacement for visiting your doctor.


SOURCE: Children's Hospital Boston