World Diabetes Day 2017

tumblr_inline_ofnq35sy4J1tq32mi_540.jpgDiabetes impacts an estimated 425 million people around the world, and that number is projected to rise to 693 million by 2045, according to the annual diabetes atlas released today by the International Diabetes Federation (IDF).

Diabetes develops as a result of having too much sugar in the blood. Over time, that imbalance can cause serious and costly health problems including heart disease, stroke, kidney disease and eye problems. The IDF diabetes atlas estimates that the world spends more than $720 billion on health care expenditures related to the disease.

November 14 marks World Diabetes Day – a day to raise awareness of the growing diabetes epidemic and the need for a cure as well as improved prevention and treatment methods.

Here are just a few examples of how Massachusetts General Hospital researchers are working to advance diabetes research and care:

  • Investigators have reason to believe that a vaccine originally used to treat tuberculosis could provide new hope for patients with type 1 diabetes.
  • People with type 2 diabetes are particularly prone to ulcers on the bottom of the foot, which can increase the risk of death and often result in a major amputation. Ulcers take months to heal, but a new discovery about mature B lymphocytes – best known for producing antibodies – could hasten wound recovery.
  • Researchers have developed a new method for measuring blood sugar levels in diabetes patients that could reduce testing errors by 50 percent.
  • Treatment guidelines for patients with type 1 diabetes have long called for yearly eye exams. But is there an alternative to this one-size-fits-all approach that could reduce patient burden and costs while providing a quicker diagnosis? Findings from a recent study lend insight into a possible new eye screening protocol.
  • Check out the Mass General Diabetes Unit, which seeks to advance the care of people with diabetes nearby and worldwide. U.S. News & World Report ranks Mass General Diabetes & Endocrinology among the best in the nation.

 

A Snapshot of Science: Detection of Alzheimer’s Disease, Development of Type 1 Diabetes, and Much More

We wanted to share some recent Mass General research that has been published in high impact, top-tier journals. This is just a small snapshot of the incredible research that takes place at Mass General each day — there’s lots more to find at massgeneral.org/research/news!

 

DETECTING AND TREATING STIFF TUMORS
Published in Nature Scientific Reports on August 14, 2017
(Summary submitted by Peter Caravan, PhD, of the Martinos Center for Biomedical Imaging)

In tumors, cancer cells are surrounded by a collection of proteins, enzymes, sugars, lipids, and minerals called the extracellular matrix (ECM). Many cancers have a fibrotic ECM, making the tumor stiff and preventing delivery of anti-cancer drugs. The presence of a fibrotic ECM is often associated with poor prognosis. We developed a new MRI method to detect tumor fibrosis non-invasively, and studied its effect in a mouse model of pancreatic cancer. The potential impact of this work is a new tool to stage the aggressiveness of tumors, guide treatment planning, and monitor the effectiveness of new tumor ECM altering treatments.

 

IMPACT OF BLOOD AND URINE FILTRATION IN LEAKY KIDNEY FILTERS
Published in Scientific Reports on August 16, 2017
(Summary submitted by Hua A. Jenny Lu, MD, PhD, of the Nephrology Division)

One major function of the kidney is filtering blood through an intricate “glomerular filter”. Disruption of any components of this highly sophisticated and dynamic filter’s structure leads to proteinuria (protein in the urine), a condition frequently seen in diabetic nephropathy and many other glomerular diseases. How blood filters though the glomerular filter and how proteinuria develops when the filter becomes leaky has not been well understood. This paper reports the application of a novel and powerful scanning microscopy technology, the Helium Ion microscopy (HIM) to identify previously unrecognized ultrastructural abnormalities of proteinuric glomerulopathy in animals. These newly discovered abnormalities provide important insight into the molecular and cellular mechanism underlying proteinuria kidney diseases.

 

OBSERVING THE DEVELOPMENT OF TYPE 1 DIABETES
Published in PNAS on August 24, 2017
(Summary submitted by Ralph Weissleder, MD, PhD, Director of the Center for Systems Biology)

Type 1 diabetes (T1D) is an autoimmune disease where insulin-producing cells are destroyed. Inflammation in islets of human patients has been hard to evaluate, given the challenging access to material. Now, our research team has discovered how the different cellular players interact. We created new reporter mice and new imaging agents where cells of interest (lymphocytes, macrophages, dendritic cells, beta cells) are fluorescent and can be observed by imaging. We were able to observe the intricate “dance” of different immune cells interacting with each other as diabetes develops. Throughout the process, Tregs (a unique type of T-lymphocyte) control the activation of many cell types. The “dynamic geography” of events uncovered here provide important clues to immunoregulation that underlies diabetes development.

 

NON-INVASIVE MEASUREMENT OF BRAIN ACTIVITY AND MEMORY ENCODING
Published in Scientific Reports on August 25, 2017
(Summary submitted by Meryem Yucel, PhD, of the Martinos Center for Biomedical Imaging)

Alzheimer’s disease (AD) is the most frequent cause of severe memory loss in the elderly. Early detection of AD is the key to preventing, slowing or stopping the disease. Near-infrared spectroscopy (NIRS) is a non-invasive neuroimaging technique capable of monitoring brain activation. Here, we investigated the utility of fNIRS in measuring the brain activity of healthy adults during memory encoding and retrieval under a face-name paired-associate learning task. Their study demonstrates that fNIRS can robustly measure memory encoding and retrieval-related brain activity. Future work will include similar measurements in populations with progressing memory deficits. Their approach, if successful, will introduce a non-invasive, inexpensive and easily accessible tool for identifying early stages of AD.

Raising Awareness of Belly Fat and Its Impact on Men’s Health

Body-Type-BannerDid you know that in addition to June being Men’s Health Month in the United States, this week (June 12th-18th) is Men’s Health Week in the UK? The focus this year is on belly fat which tends to be more prevalent in men than women.

Regardless of a person’s overall weight, belly fat—also called abdominal adiposity— can increase the risk for developing a number of health issues including colorectal cancer, stroke and sleep apnea.

A recent study by researchers at Massachusetts General Hospital also found that individuals who have a genetic disposition for belly fat were at a higher risk of developing both diabetes and heart disease when compared to individuals who store fat primarily in their hips and thighs.

While genetics are a big factor in where fat gets stored, proper diet and exercise can help lessen the risk.

 

Stay tuned for more posts about men’s health all this week leading up to Father’s Day.

Researchers Recommend New Eye Exam Screening for Patients with Type 1 Diabetes: Five Things to Know

12538332 - looking through the glasses at eye chartTreatment guidelines for patients with type 1 diabetes have long called for yearly eye exams. But is there an alternative to this one-size-fits-all approach that could reduce patient burden and costs while providing a quicker diagnosis? Findings from a recent study, published in the New England Journal of Medicine, lend insight into a possible new eye screening protocol. Here are five things to know:

  1. Diabetic retinopathy is the leading cause of blindness among adults. It occurs when chronically high blood sugar from diabetes damages the light-sensitive tissue in the back of the eye. Fortunately, screening can catch this disease before irreparable damage is done, and there are several therapies available to treat the condition. Guidelines currently recommend routine yearly eye exams within three to five years of a type 1 diabetes diagnosis, but these recommendations were based on now-outdated research.
  1. To reevaluate the current recommendations, David Nathan, MD, Director of the Diabetes Center and Clinical Research Center at Massachusetts General Hospital, and a team of researchers analyzed approximately 24,000 retinal exams obtained over 30 years from about 1,400 participants with type 1 diabetes.
  1. Based on their analysis, researchers developed new recommendations that suggest patients with type 1 diabetes should get eye exams to detect diabetic retinopathy based on the presence and severity of diabetic retinopathy, rather than on the automatic, annual schedule that is currently recommended. For patients with type 1 diabetes and a current average blood glucose level of 6 percent (within the American Diabetes Association’s recommended target range), researchers recommend the following eye exam schedule:
  • With no retinopathy, every four years.
  • With mild retinopathy, every three years.
  • With moderate retinopathy, every six months.
  • With severe retinopathy, every three months.
    Researchers suggest patients with higher current average blood glucose levels (for example, 8-10 percent as opposed to 6 percent) have eye exams more often, as they are at higher risk to develop the disease. The new recommendations also call for taking photographs of the back of the eye rather than physical examination with an ophthalmoscope, which is thought to be less accurate.
  1. Overall, researchers say the new, individualized schedule would result in earlier detection of the advanced retinopathy that requires treatment to save vision compared with annual exams, while at the same time reducing the frequency of eye exams by half. That would translate into an overall savings of $1 billion.
  1. Researchers are still questioning whether physicians would adhere to these new recommendations, if implemented. “The risk is that physicians may find it easier to schedule an annual eye examination compared with the new individualized schedule, which may be more difficult for physicians and patients to remember,” says Nathan. The next step is to discuss how to potentially incorporate the guidelines into patient care. They also plan to conduct further studies to investigate if this screening strategy could be applied to patients with type 2 diabetes.

Research Awards and Honors: April 2017

Massachusetts General Hospital’s talented and dedicated researchers are working to push the boundaries of science and medicine every day. In this series we highlight a few individuals who have recently received awards or honors for their achievements:

Joel HabenerJoel Habener, MD, MGH endocrinologist, has been awarded the Harrington Prize for Innovation – along with Daniel Drucker, MD, of Mount Sinai Hospital, Canada, and Jens Holst, MD, DMSc, University of Copenhagen, Denmark – for their discovery of incretin hormones and for the translation of these findings into transformative therapies for major metabolic diseases such as diabetes. The prize – established in 2014 by the Harrington Discovery Institute at University Hospitals in Cleveland, Ohio and The American Society for Clinical Investigation – honors physician-scientists who have moved science forward with achievements notable for innovation, creativity and potential for clinical application.

Our research is focused on the discovery of novel molecular and pharmacologic approaches for the treatment of obesity and diabetes. We are working toward increasing our understanding of the cellular and physiological mechanisms by which  glucagon-like peptide 1, a hormone in the pancreas that stimulates cells there to produce insulin, and its small peptide derivatives increase energy expenditure, burn body fat, and improve insulin sensitivity thereby lowering body weight and the risk for the development of diabetes.

I am honored to receive the Harrington Prize in Innovative Medicine – shared with my colleagues Daniel J. Drucker and Jens J. Holst. The goal of our research program at the MGH is to identify new, more effective methods to treat obesity-related diabetes and its associated metabolic disorders.

 

Steven LubitzSteven Lubitz, MD, MPH, of the Cardiology Division, has received a Doris Duke Clinical Research Mentorship award from the Doris Duke Charitable Foundation (DDCF). The program supports a dedicated year-long research effort between a medical student and a DDCF-funded clinical investigator and role model. Lubitz will mentor a visiting medical student from the University of California, San Francisco on a project that leverages the electronic health record to assess patients at greatest risk of morbidity from atrial fibrillation.

Our overall goal is to minimize strokes and other complications caused by an irregular or rapid heartbeat, otherwise known as atrial fibrillation (AFib). In many individuals, AFib occurs in the setting of reversible clinical triggers, such as surgery, pneumonia, or hyperthyroidism. The long-term risks and optimal management of such patients once the trigger is resolved are unclear. The specific objective of this project is to better understand the clinical triggers that cause AFib, as well as the risks of recurrent AFib and other complications after the triggers are resolved. This project will leverage the electronic health record, which is a unique and well-powered resource for addressing such questions.

I’m delighted to have received this award. The Doris Duke Clinical Research Mentorship award provides a bright and dedicated medical student with the opportunity to experience an immersive research experience, acquire foundational clinical research skills, and study a disease of immense public health importance.

 

Laurence RahmeLaurence Rahme, PhD, from the Center for Surgery, Science and Bioengineering, has been elected to Fellowship in the American Academy of Microbiology. This academy is an honorific leadership group within the American Society for Microbiology recognizing excellence, originality and leadership in the microbiological sciences. Rahme is well known for the development of alternative therapies to fight bacterial infections designed to disarm pathogens from their ability to be virulent, an approach that could reduce antibiotic use, decrease the development of antibiotic resistance and preserve beneficial flora. Recently, her group developed tools and identified prognostic biomarkers that could identify individuals at risk for multiple infections prior to the onset of the infection – enabling a more precise personalized medicine approach to infectious disease that would improve treatment outcome.

I am greatly humbled and honored to be receiving this honor!  I am excited to join the many outstanding Fellows of the Academy and continue to contribute to the fight against antibiotic resistance.

 

Hanna GagginHanna K. Gaggin, MD, MPH, FACC of the Cardiology Division, has been named a member of Cardiology Today’s Next Gen Innovators – a group of early career cardiologists have been identified as innovators in their field. These leaders represent the next generation of cardiologists who are working to educate their colleagues, conduct research on new and novel strategies to advance cardiovascular care and innovate the unique aspects of the cardiology specialty. The Next Gen Innovators list will be announced in the April issue of Cardiology Today.

I study the clinical application of novel and established cardiac biomarkers to better understand and personalize a patient’s medical management beyond traditionally available methods. My focus has been on three patient groups: heart failure with reduced ejection fraction, heart failure with preserved ejection fraction and type 2 myocardial infarction.

I was super-excited to be named a NextGen Innovator! To receive recognition from a source with a broad general cardiology reach is such a nice affirmation of the importance of these topics in the field of cardiology. I am looking forward to serving as a member of this group to guide their editorial coverage and get involved in media communications of significant research findings at meetings through Cardiology Today. It’s a great opportunity for a junior faculty, such as myself, to have a voice in the field.

 

New Method for Testing Blood Sugar Levels Could Improve Diabetes Monitoring

Researchers at Massachusetts General Hospital have developed a new method for measuring blood sugar levels in diabetes patients that could reduce testing errors by 50 percent.

The new method, which uses a mathematical formula that factors in the average age of a person’s red blood cells (RBCs) in addition to the cells’ overall blood sugar content, could help to improve the accuracy of most commonly used test, known as A1C.

The A1C test is designed to measure the amount of sugar absorbed by RBCs in the body over a period of time. The problem with getting an accurate diagnosis is that older RBCs tend to absorb more blood sugar over time, while newer RBCs soak up less.

Blood cells can live in the body for roughly 90 to 120 days, and cell lifespan varies from one patient to the next.

By incorporating a mathematical formula that accounts for the average age of RBCs in the body, researchers can reduce the errors caused both by older, more glucose-dense blood cells in someone whose RBC lifespan is longer than average, and by the younger, less glucose-dense blood cells in someone whose RBC lifespan is shorter.

An accurate measure of blood sugar levels is crucial for diabetes patients, as persistently elevated levels can damage the heart, brain, kidneys, eyes, nerves and other organs.

John Higgins, MD, of the Center for Systems Biology, is corresponding author of the study.

MGH Diabetes Quest Takes A Big Step

Massachusetts General Hospital researcher Denise Faustman, MD, PhD, has made a promising advance in her 20-year quest to cure type 1 diabetes by receiving FDA approval to test an old tuberculosis vaccine that may also treat diabetes.

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