November 2014 - Diabetes Research Connection

Diabetes Research News
November 25, 2014

Type 1 Diabetes Increasing As Medical Teams Shrink

Before heading off to swim practice, Brian Lybeck of Avon tests his blood glucose level, which will tell him how much food he needs to eat and also calculates the amount of insulin he needs from a pump he programs to deliver the medication. (John Woike)

By THERESA SULLIVAN BARGER, Special to The Courant

Type 1 diabetes can strike at any age

It takes a medical team to help type 1 diabetics stay healthy

In the 15 months since Brian Lybeck’s type 1 diabetes’ diagnosis, the seventh grader and his family have worked with four different diabetes educators at Connecticut Children’s Medical Center. Like their counterparts at other diabetes practices, the educators left for other jobs.

Jonathan Chappell, 38, developed the chronic disease, formerly called juvenile diabetes, at the age of 23. When the Wallingford resident sought to switch endocrinologists a decade ago, several practices were too full to take new type 1 diabetics unless they had aged out of pediatric care. Yale-New Haven Hospital’s Diabetes Center would take him, he said, but the office had such a backlog, he had to wait six months to see an endocrinologist.

Nationally, there’s a shortage of about 1,500 adult and 100 pediatric full-time equivalent endocrinologists, the Journal of Clinical Endocrinology & Metabolism reported in June. Several factors contribute to a national imbalance between the supply of doctors and the patients who need them: With medical advances in the treatment of type 1 diabetes, adults are living longer with the disease; the prevalence of type 1 diabetes in children has increased 21 percent in eight years; and as endocrinologists retire and leave clinical care, the number of new endocrinologists has remained static.

While some states with large rural swaths have starker shortages, Connecticut’s shortage is expected to grow as demand for endocrinologists outstrips supply. In Connecticut, nearly 7 percent of the adult population, about 186,000 people, has diabetes, according to the state Department of Public Health. Some 5 to 10 percent of those people, or 9,300 to 18,600, has type 1 diabetes.

The Connecticut shortage is most pressing among endocrinologists who treat adults. There is also a shortage of APRNs and diabetes educators who work with adults, teens and children.

Type 1 diabetes can strike at any age, and when it does, the person’s pancreas stops producing insulin, the hormone needed to turn food (also called sugar or glucose) into energy. Those with type 1 diabetes (T1D) need insulin, either through a shot or an insulin pump, with every meal and snack. Several factors affect blood glucose levels — including hormones, growth, stress, exercise, diet, illness and medications — so keeping levels in a healthy range is a daily, lifelong challenge.

To be effective, the medical team that cares for type 1 diabetics has to be knowledgeable, empathetic, patient and diplomatic. Not only are patients seen quarterly, but they often need to check in with a nurse, diabetes educator or endocrinologist between appointments.

“Diabetes educators, RNs, RDs, APRNs, they’re the blood and guts of a practice. Where we get a lot of turnover is in these critical team members,” says Karen Rubin, MD, chief, diabetes & endocrinology, Connecticut Children’s Medical Center. “They’re the ones who do a lot of the day-to-day management.”

While genetics and lifestyle factors cause type 2 diabetes, only 15 percent of people with type 1 have a family history. Scientists believe that environmental triggers play a role and the onset of type 1 is not caused by diet or lifestyle. Also, there is no known prevention or cure.

Demand Outstrips Supply

“Everybody’s booked out,” says Torrington-based endocrinologist Egils Bogdanovics, who expanded his clinical time from 8 to 10 hours a day to accommodate the demand.

Endocrinologists treat patients with metabolic diseases that are increasingly common, especially type 2 diabetes, osteoporosis and thyroid disease, said Sylvio Inzucchi, MD, medical director of the Yale Diabetes Center. “It’s difficult to get an appointment with an endocrinologist without having to wait, two, three or four months,” Inzucci said. “We can’t keep up with the demand.”

Rubin, at Connecticut Children’s, said the on-the-job training requirement feeds the dearth of diabetes educators. Colleges don’t offer diabetes educator courses, so nurses and registered dieticians learn on the job, logging at least 1,000 hours of patient care before they’re permitted to take the exam to become a certified diabetes educator (CDE).

“We get them; we train them. It could take a year or two to get them up to speed,” Rubin says. “They’re such critical members of the team; they’re implementing the demanding care. … It’s so emotionally heart wrenching working with these kids and families, trying to keep these kids safe.”

Scary Days

Brian Lybeck’s diagnosis of type 1 diabetes began with three days in Connecticut Children’s Intensive Care Unit because of diabetic ketoacidosis, a life-threatening condition caused by his body using fat for fuel, releasing acids that made him sick in the process. His mother Susan Lybeck said Brian, now 13, is doing well using a monitor to keep him apprised of his blood glucose and a pump he programs to deliver insulin.

“I think the level of care is phenomenal,” the Avon resident said. “I’m very happy with everyone I’ve worked with.”

Between seeing patients, responding to a stream of calls and emails, lobbying insurance companies on behalf of patients and completing paperwork, nurses and diabetes educators can get burned out. Some leave because they’re lured away by better hours and higher pay working for pump or pharmaceutical companies, Rubin said, while others leave to raise their families.

Complicated Disease

Without proper disease management, a diabetic faces a host of long-term health complications and risks death if blood sugars go too low or too high. The American Diabetes Association recommends that even people like Trudi White, who has had diabetes for 51 of her 55 years, meet face-to-face with their diabetes healthcare team every three months. In Connecticut, most endocrinology practices have a team approach to care, with at least an endocrinologist, an APRN and a diabetes educator.

When White’s endocrinologist left the state, it took the Glastonbury woman a year to find an endocrinologist who fulfilled her preference for someone knowledgeable about therapy advances who would also see patients himself at each quarterly visit.

“I find that the difficulty in finding a doctor who you can sit down with and meet with is overwhelming in this area,” she says. She meets in a group of 15 people who wear insulin pumps, 12 of whom never see their endocrinologist; they see other team members instead. “Diabetes doesn’t fit the same way on each person and that’s why the care of medical professionals is so important.”

With the complicated nature of the disease, endocrinologists and APRNs must spend more time on these cases than with other patients.

Several endocrinologists say their practices couldn’t break even if they only saw T1D patients, so their other patients help supplement the practice. While practices can bill insurance for a doctor and an APRN visit, the paperwork involved in billing for a registered dietician’s time costs the practice more than the reimbursement rate, said Dr. Cem Demirci, director, type 1 diabetes program at Connecticut Children’s. And several practices’ staff said they don’t get reimbursed for diabetes educators’ or social workers’ time.

Connecticut Children’s, which, along with Yale Pediatric Specialty Center, sees the vast majority of the state’s children and teenagers with type 1 diabetes, has one social worker for about 1,000 patients. The social worker works full time but is paid a part-time salary, Demirci said. The practice is trying to add a part-time psychologist to help address the psychological challenges families face coping with a complex disease, he added.

“Every family struggles with the condition, even if they’re not struggling financially,” he said. “One person for a practice of 1,000 Type 1 Diabetics is clearly not enough.”

At some point in their lives, 50 percent of T1D patients face depression, said Jean Kostak, a registered dietician, CDE, and program coordinator with UCONN Health.

“There are a lot of people who need to be connected with mental health services,” she said.

Some doctors become endocrinologists because working with such a complex disease allows them to get to know their patients.

Endocrinologist Elizabeth Fasy, with Hartford Health Care Medical Group, herself a type 1 diabetic, says she works “part time” because she has a young family, but that means 25 to 30 hours a week seeing patients and 30 hours per week returning their calls, emails and doing paperwork.

“Part of that may be because I tend to want to call patients myself. I take advantage of doing that on my days off,” she said. “When you’re a diabetic, you’re your own doctor, and I have to be there to support people.”

Theresa Sullivan Barger is a freelance writer and mother of a son who has type 1 diabetes and is a patient at Connecticut Children’s.

Learn More +

Diabetes Research News
November 23, 2014

Dr. Donald F. Steiner, Diabetes Researcher, Dies at 84

Dr. Donald F. Steiner, a researcher whose discoveries transformed scientists’ understanding of insulin and other hormones and led to major improvements in the treatment of diabetes, died on Nov. 11 at his home in Chicago. He was 84.

A cousin, Steven Roess, confirmed the death. Until recent hip surgery, Dr. Steiner had continued to conduct diabetes research at the University of Chicago.

Dr. Steiner spent most of his career studying insulin, a hormone made by the pancreas that enables cells to take in sugar to use as fuel or to store. People who lack insulin, or cannot use it properly, develop diabetes, in which sugar builds up in the bloodstream and can cause an array of complications, including heart disease, strokes, kidney failure, blindness and amputations.

About 29 million Americans have diabetes, according to the Centers for Disease Control and Prevention.

The disease, particularly in children, was a death sentence until the 1920s, when insulin injections became available. The hormone was extracted from the pancreases of animals, mainly pigs and cows, and daily shots saved millions of lives.

But in 1960, when Dr. Steiner became an assistant professor of biochemistry at the University of Chicago, fundamental questions about insulin had still not been answered. One concerned how it was made in the body.

Scientists knew that the insulin molecule consisted of two separate chains of amino acids, which are the building blocks of proteins. The chains were connected to one another, not end to end but crosswise at certain points along their length. Scientists wondered how the two separate chains were made.

“The thinking was that they were synthesized separately in the cell and then came together,” said Dr. Louis Philipson, a diabetes expert at the University of Chicago and a former student of Dr. Steiner’s.

But no one knew for sure. Working in a basement laboratory in an old research building, Dr. Steiner set out to find the answer.

He began working with tissue from a patient who had had surgery to remove an insulinoma — a tumor of the insulin-making cells of the pancreas. It was a rich source of human insulin and precisely the kind of cells Dr. Steiner wanted to study.

His research led to a landmark discovery, reported in a paper published in 1967: He showed that insulin started out not as two chains, but as one long chain, which was later broken into two.

This information was quickly put to use by insulin manufacturers, who were trying to purify the product made from animal pancreases.

“In the early days of insulin, people were injecting this horrible-looking mixture of stuff,” Dr. Philipson said. “It was not very pure. People would get reactions.”

Details from Dr. Steiner’s work helped the manufacturers produce much more highly purified cow and pig insulin, which was less troublesome to patients. His findings also informed later research that made it possible to produce human insulin in vats of genetically engineered yeasts or bacteria.

In addition, his work led to better ways of monitoring insulin production in patients and the body’s sensitivity to the hormone, factors important in treating diabetes and gauging its severity.

Some of the research could have been patented, but Dr. Steiner never considered doing that, said Dr. Arthur Rubenstein, a professor of medicine at and a former dean of the medical school at the University of Pennsylvania, who studied under Dr. Steiner and collaborated with him.

“There it was, one of the really, really great discoveries, and there was no patent,” Dr. Rubenstein said.

That decision was part of a pattern. “He shared everything with everybody,” Dr. Rubenstein said. Dr. Steiner, he said, gave his students ideas and time, made them first authors on scientific publications that would advance their careers, and even shared materials and data with competitors who did not always credit his contributions.

Dr. Steiner’s other passion was the arts — the Chicago Symphony, the opera and the theater. An accomplished pianist, he played classical music on a Steinway grand piano in his high-rise apartment overlooking Lake Michigan and Lincoln Park.

Donald Frederick Steiner was born in Lima, Ohio, on July 15, 1930. His father, Willis, one of five brothers who owned a machine shop that took up most of a city block, died when Donald and his older brother, Phares, were young. Their mother, the former Catherine Hoegner, was a homemaker.

Both sons studied at the University of Cincinnati. Phares became a musician and a builder of pipe organs. Donald earned a degree in chemistry and zoology and went on to the University of Chicago, where he earned a master’s degree in biochemistry and then an M.D.

Phares Steiner died last year. Besides Mr. Roess, survivors include other cousins as well as a niece and nephew.

The concept of precursor molecules had implications that extended beyond insulin to many other hormones that are also made of amino-acid chains, including some that affect growth, metabolism and signal transmission in the brain.

“It opened a window into a whole area of molecular physiology that people were not aware of,” said Dr. Rudolph Leibel, a director of the Naomi Berrie Diabetes Center at Columbia University College of Physicians and Surgeons.

Dr. Steiner’s later research involved various mutations that could disrupt insulin synthesis and cause rare forms of diabetes. He wrote hundreds of articles in scientific journals, which were cited more than 10,000 times by other researchers, according to the University of Chicago. He also received many scientific awards in the United States and other countries.

“He was very modest, and very concerned about young people — his students and his co-workers,” Dr. Leibel said. “He’s from that era, these great thinkers who were soft-spoken and gentlemanly and not in it for anything but the joy of doing the science. We don’t have as much of that now.”

By DENISE GRADY

NOV. 21, 2014

http://www.nytimes.com/2014/11/22/health/dr-donald-f-steiner-diabetes-re…

Learn More +

Diabetes Research News
November 19, 2014

Beta-O2 Testing Cure For Type 1 Diabetes

israeli implant Imagine if those with type 1 diabetes no longer had to worry about insulin injections.

Posted By Abigail Klein Leichman On November 17, 2014 @ 6:00 am

The ßAir bio-artificial pancreas, developed by Israel’s Beta-O2, was recently implanted in the first of eight diabetes patients in Sweden as part of a $1 million pilot human study on this groundbreaking treatment and potential cure for type 1 diabetes (T1D).

Chairman of the Board Dan Gelvan tells ISRAEL21c that the advanced implantable system is science-fiction-come-true for people with T1D, an autoimmune disorder — also known as insulin-dependent or juvenile diabetes – in which the immune system destroys the insulin-producing islet cells of the pancreas.

T1D patients (about three million people in the United States alone) must monitor their glucose and take insulin daily to do the essential job of converting sugar, starches and other food into energy – a task normally handled by about two grams of islet cells.

“Imagine if those with type 1 diabetes no longer had to worry about insulin injections or glucose levels. They could eat what they wanted, exercise as they wished and need not measure every step they took,” says Gelvan, also managing director of life sciences at Aurum Ventures, the company’s lead investor. “This is the future that Beta-O2 envisions ßAir will help to create.”

Oxygen makes the difference

The technique of transplanting cadaver islet cells into T1D patients has been practiced for nearly 30 years, Gelvan notes. However, patients must take immunosuppressant drugs for the rest of their lives. To get around this problem, several companies have developed encapsulation techniques that protect the transplanted cells from the immune reaction to foreign matter.

Beta-O2’s encapsulation has an added, unique feature that addresses the remaining problem: getting enough oxygen into the encapsulated cells.

“Islet cells are huge consumers of oxygen. If they don’t get enough, they won’t produce enough insulin,” Gelvan says. “This company has taken an engineering approach to finding a way to make sure there is an active supply of oxygen to the transplanted cells.”

People with the ßAir would need to refill the air in the tiny device via a replenishing system with a dedicated injector, once every 24 hours.

This device delivers the needed amount of oxygen to the implant.

“Ensuring consistent supply of oxygen has been a challenge of many encapsulation systems in the past,” according to Albert Hwa, senior program scientist in the Beta Cell Therapies Program of theJDRF, which awarded a $500,000 grant toward the pilot study.

“Beta-O2 has demonstrated their device can provide long-term immune protection of islet cells in several animal models, and the addition of oxygen helps keep the cells alive and functional, all in the absence of immunosuppression.”

Mimicking the pancreas

In 2012, ßAir was implanted in a 63-year-old patient in Germany and monitored for 10 months. A report on the promising results was published in the journal PNAS last year.

The present two-year pilot study, which will enroll eight participants at Uppsala University Hospital in Sweden, will evaluate the safety, survival and function of Beta-O2’s implanted system.

Dr. Per-Ola Carlsson, principal investigator of the ßAir study, said the first implant procedure took less than an hour. “The patient remained hospitalized for four days thereafter for observation and was then discharged. Until day 180 following implantation, the patient will, among other protocol duties, be required to return to the clinic for monthly check-ups. On day 181, ßAir will be explanted from the patient, who will continue to be followed for another 180 days.”

Because cadaver islet cells are not easy to obtain, Gelvan says the company intends to experiment with human stem cells provided by partners companies, as well as animal-derived cells.

“We can do this because the encapsulated islets are immune protected,” he stressed.

As for the lifespan of the implant, he adds: “We don’t know yet how long it lasts, but conventional islet transplants continue to function well for eight to nine years. We hope that because we’ve created a protected microenvironment fed by oxygen, it will last even longer.”

Hwa tells ISRAEL21c that if this proof of concept is successful, “we can envision using other types of islet cells in the device, and perhaps engineering an automated oxygen supply within the device.”

Gelvan explains that ßAir is entirely different than “artificial pancreas” devices that automate glucose monitoring and insulin injection, such as the Israeli product MD Logic developed at Schneider Children’s Medical Center.

“Ours is a biological device that is meant to restore the original effect of having islet cells, so you have all elements of a functioning pancreas in response to the body’s varying glucose levels,” he says. “We are actually simulating and emulating the functionality of an organ.”

The idea for the novel implant system originated with Dr. Pnina Vardi, director of the Laboratory for Diabetes & Obesity Research at Tel Aviv University. Starting in 2004, she did the initial development along with islets researcher Dr. Konstantin Bloch and serial medical-device inventor Yossi Gross. The company, based in Rosh Ha’Ayin near Tel Aviv, now is run by a professional management group.

For more information, click here.

Article printed from ISRAEL21c: http://www.israel21c.org

URL to article: http://www.israel21c.org/headlines/beta-o2-testing-cure-for-type-1-diabe…

Learn More +

DRC & Research News
November 17, 2014

Dr. Todd Brusko’s Project Fully Funded on Day 1

Welcome! Today, we are going to explore an exciting field of research, potentially game-changing for the millions living with Type 1 Diabetes. We are diving into the world of Dr. Todd Brusko and his ground-breaking research. This research, fully funded on day one with a whopping $60,000, aims to engineer a patient’s immune cells, trying to halt the autoimmune attack causing Type 1 Diabetes. Intriguing, right? Let’s delve into it!

Understanding Type 1 Diabetes with Dr. Todd Brusko

Understanding Immune System’s Role

In a nutshell, Type 1 Diabetes is an autoimmune disorder where the body’s immune system mistakenly attacks the insulin-producing beta cells in the pancreas. But, what if we could tweak this misbehavior?

Symptoms and Complications

From frequent urination, constant hunger to blurry vision, the symptoms can be severe. If left unchecked, long-term complications such as heart disease and nerve damage can occur.

Dr. Todd Brusko and His Research

Research Background

Enter Dr. Todd Brusko. A respected figure in the field, Dr. Brusko has dedicated his career to understanding the role of T-cells in autoimmune diseases like Type 1 Diabetes.

The $60,000 Project

Backed by a strong team and fueled by a $60,000 funding that was fully pledged on day one, Dr. Brusko’s research has gained significant attention and momentum.

Can We Engineer Immune Cells?

Theoretical Background

But, how can we engineer immune cells to fight an autoimmune disorder? It’s like attempting to teach a dog not to fetch, right?

Mechanism and Research Findings

Actually, not quite. Dr. Todd Brusko’s research is based on a breakthrough concept of reengineering T-cells to prevent them from attacking the pancreas. Excitingly, early research findings are promising.

Implications of Dr. Todd Brusko’s Research

For Diabetes Treatment

Should Dr. Todd Brusko’s project succeed, it could potentially revolutionize diabetes treatment, turning it from management to cure.

For Autoimmune Disorders

And it’s not just diabetes. The implications could extend to other autoimmune disorders, offering hope to millions.

The Path Forward for Dr. Todd Brusko

Despite the excitement, the path forward is not without its challenges.

Potential Challenges for Dr. Todd Brusko

Scientific Challenges

The biggest hurdle is the scientific challenge. How do we make the immune cells stop their destructive behavior without suppressing their protective roles?

Regulatory and Ethical Challenges

Beyond the scientific obstacles, regulatory and ethical issues need careful navigation.

The Role of Funding

With research of this nature, funding plays a critical role.

Importance of Early Funding

This is where the $60,000 project comes in. Early funding, like the full pledge on day one, helps to kickstart the research and keep it going.

Crowdfunding and Medical Research

Crowdfunding, as demonstrated in Dr. Todd Brusko’s project, has become a game-changer in medical research funding.

Conclusion

Dr. Todd Brusko’s pioneering work is a beacon of hope for people living with Type 1 Diabetes. The road to a potential cure is fraught with challenges but backed by the unwavering support of donors, promising early results, and a dedicated research team, the prospect of engineering a patient’s immune cells to halt the autoimmune attack seems within reach.

FAQs

What is the main focus of Dr. Todd Brusko’s research?
- Dr. Todd Brusko’s research focuses on engineering immune cells to stop them from attacking the pancreas, the cause of Type 1 Diabetes.
How was the $60,000 project funded?
- The $60,000 project was fully funded on its first day, demonstrating significant support and belief in Dr. Brusko’s research.
What potential impact could Dr. Todd Brusko’s research have?
- If successful, the research could revolutionize the treatment of Type 1 Diabetes and potentially other autoimmune disorders.
What are the challenges ahead?
- The challenges ahead include scientific hurdles, regulatory issues, and ethical considerations.
What role does funding play in this type of research?
- Funding is crucial in such groundbreaking research. It helps kickstart the project and sustains it throughout its course.

Donors were so excited to read about Dr. Brusko’s project, “Can we engineer a patient’s immune cells to stop the autoimmune attack that causes type 1 diabetes?” that they plunked down the whole $60,000 at The Diabetes Research Connection’s website launch party on Friday, 11/14/2014.

We are thrilled by this unexpected but welcome response to our website, and invite you to look at and consider supporting the other two meritorious and novel projects posted on our site under SUBMIT A PROJECT. Contributions of any amount are greatly appreciated. Let’s get these projects up and running!

Dr. Todd Brusko'