Diabetes challenges unmet

At the moment, technology for the artificial pancreas is a bit cumbersome, and teens may not like to wear it, diabetes expert Robert Goldstein, MD, PhD, told a congressional hearing. However, he said, "If we can package that and shrink it and make it more user friendly and get more widespread use, we will be able to take advantage of current technology."

"We need improvements. We are funding work that is going ahead full blazes in terms of understanding how to set an algorithm to describe exercise situation or sleeping at night situation or the infinite variety of details that a person might go through," testified Goldstein, senior vice president for scientific affairs for the Juvenile Diabetes Research Foundation (JDRF).

"Our notion is that to whatever extent we can automate the technology, we will get those tough-to-treat patient populations like adolescents and teenagers to use the technology," Goldstein said. For all types of diabetes patients, he said, "The idea is, while we are waiting for a cure, we want people to implement very high quality control of their diabetes so that they will be in good enough health when the cure does appear."

The hearing, held on July 1 by the House Energy and Commerce Committee health subcommittee, focused in part on the proposed bill (HR 3668, S.3058) to renew the Special Diabetes Program that funds type 1 diabetes research, among other purposes. The bill's sponsor, Rep Diana DeGette (D-Colorado) is a subcommittee member whose daughter has type 1 diabetes. DeGette is known as a fierce advocate on the subject.

Also at the hearing, Ann Albright, PhD, RD, a top diabetes expert from the Centers for Disease Control and Prevention (CDC), noted that the agency has developed the National Diabetes Surveillance System, the world's first system for monitoring diabetes, which looks at risk factors, levels of care, and complications. In the last 2 years, it has also developed a methodology to estimate diabetes and obesity levels at the county level, said Albright, director of CDC's Division of Diabetes Translation.

The agency is also funding the SEARCH for Diabetes in Youth study, the largest system to track diabetes in people under 20 years old, Albright noted.

Judith Fradkin, MD, of the National Institute of Diabetes and Digestive and Kidney Disease (NIDDKD), testified, "Because genetic and antibody tests can predict with great accuracy which children will develop type 1 diabetes, we can now test prevention strategies."

Under The Environmental Determinants of Diabetes in Young (TEDDY) study, funded by NIDDKD and other entities, clinical centers screened more than 400,000 newborns to find 8,000 with genes that put them at particularly high risk of type 1 diabetes, she noted. Now, they are being followed until age 15 to try to identify environmental triggers.

"For example, if we could find an infectious trigger, we might develop a vaccine to prevent the disease," Fradkin told the committee. She testified, "To date, the number of children who have developed autoimmunity in type 1 diabetes are exactly as predicted in the study, showcasing the tremendous power of these predictive tests.

Calling gestational diabetes one of the most important problems in the diabetes arena, Fradkin said it not only causes problems at the time of birth for mother and child and puts the mother at higher risk of type 2 diabetes, but data also suggest that the interuterine environment puts the offspring at increased risk of diabetes and obesity. She stressed that a vicious cycle can occur because children have both genetic risks from the parents and the increased risk conferred by that adverse metabolic environment in pregnancy.

In addition, Fradkin cited the Hyperglycemia and Adverse Pregnancy Outcomes study that has provided "extremely important information" showing that adverse effects of hyperglycemia in pregnancy occur at much lower levels of glucose than previously realized.

Asked about the importance of multiyear funding that the Special Diabetes Program provides, Fradkin said that it has allowed, for example, the institute to create a program of 5 years of career-development funding helpful for recruiting researchers studying childhood diabetes. That effort has now been stopped, she said, because there are now less than 5 years of funding remaining. Further, programs like the TEDDY study, which follows children for years, also require sustained funding, she stressed.