Advances In Diabetes Research, Treatment Promising, But Concerns Over Funding, Childhood Obesity Remain, Says Columbia Expert

WASHINGTON—Diabetes costs the U.S. economy hundreds of billions of dollars each year through both indirect costs such as lost productivity and direct costs (up to 30 percent) for home care and hospitalization, according to Dominico Accili, M.D., an expert in diabetes and endocrinology research.

“Increased interest and funding for research from the government and private companies have helped address the issue of diabetes awareness and discovering new medications for treatment,” said Dr. Accili, professor of medicine and director of the Columbia University Diabetes and Endocrinology Research Center at Columbia University Medical Center in New York, N.Y. “At this time, a person with diabetes takes insulin and pills to lower blood sugar. The problem with these types of treatments is that they all help a patient cope with the disease, but none of them cures diabetes. People are forced to deal with lifelong treatments that are not nearly as good as they should be.” Dr. Accili spoke October 13 at an American Medical Association’s 23rd Annual Science Reporters Conference in Washington D.C.

“We currently estimate that 16 million Americans have diabetes and roughly five million of them don’t even know they have the disease,” Dr. Accili said. “Each year 800,000 new cases of diabetes are diagnosed of which about 30,000 are in children.”

The latest advances in drug technology and research are related to new drugs that combat diabetes and cholesterol disorders at the same time and insulin sensitizers. In addition, there are new ways to deliver insulin or boost insulin production, according to Dr. Accili. Developments include delivering insulin by injections through an implantable pump or a spray and improving the functioning of the beta cells in the pancreas. Beta cells are what the body uses to produce insulin, which helps the body move sugar out of the blood and turn it into energy.

Replacing insulin through genetic therapy remains a high priority in the research agenda of the diabetes community. One potential approach involves the use of stem cells. “Stem cells are being considered as an alternative to insulin treatment in type 1 diabetes. If the application of stem cell technology for diabetes were to succeed, it could be applied to or even be more successful for type 2 diabetes,” Dr. Accili said. “People with diabetes are extremely hopeful of stem cell research as a source of developments in treatment and a possible cure. A lot of exciting work is going on with both embryonic and adult stem cells, however at this point it looks like the adult stem cells are just not going to work for diabetes treatment purposes. Embryonic stem cells can be chemically coaxed in the laboratory to become insulin-producing cells while we are not certain that adult stem cells have this capability.”

According to Dr. Accili, the most common form of diabetes is adult-onset diabetes, also called type 2 diabetes. In type 2 diabetes, the patient has insulin resistance, a disorder in which the cells do not use insulin properly. It is commonly associated with older age, obesity and a family history of diabetes, but is increasingly being diagnosed in children and adolescents. “We think the cause for the rise of adult-onset diabetes in children is increased obesity, decreased physical activity and changes in the diet. Children are developing complications such as heart, kidney and vascular disease at an earlier age than physicians are used to seeing or treating them. This is the most costly aspect of diabetes care and will impose a tremendous burden on the American health care system in the future.”

“There is a general sense of optimism among diabetes researchers because we are making inroads, but we don’t want to give a false sense of hope,” Dr. Accili concluded. “The outlook for government funding of diabetes research over the next few years is not especially positive so we need to make sure diabetes is given the necessary attention and adequate funding.”

Editor’s Note: Dr. Accili has received grant support from the NIH and the American Diabetes Association. He has received honoraria from and/or serves on speakers bureaus for Amgen, Eli Lilly and Co., Roche, Abbott Laboratories, Pfizer Pharmaceutical, Johnson & Johnson and Merck & Co. Dr. Accili has received an honorarium from the American Medical Association to speak at the October 13 conference.

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*Located in New York City, Columbia University Medical Center provides international leadership in basic and clinical research, medical education, and health care. The medical center includes the dedicated work of many physicians, scientists, and other health professionals at the College of Physicians & Surgeons, the School of Dental & Oral Surgery, the School of Nursing, the Mailman School of Public Health, the biomedical departments of the Graduate School of Arts and Sciences, and allied research centers and institutions. The pioneering tradition of Columbia University health scientists, who have achieved some of the 20th century's most significant medical breakthroughs, continues today.