11/29/2018
20th Annual Frontiers in Diabetes Research Symposium:
The Biological Bases of Complications of Diabetes

Columbia University has awarded the 2018 Naomi Berrie Award for Outstanding Achievement in Diabetes Research to David M. Nathan, MD, Professor of Medicine at the Harvard Medical School and Director of the Diabetes Center at Massachusetts General Hospital in Boston, Massachusetts.

 

Dr. Nathan, who literally wrote the definition of diabetes for the encyclopedia, is an expert on the history, epidemiology and mechanisms of diabetic complications in patients with type 1 diabetes (T1D) and type 2 diabetes (T2D). 

The award was presented to Dr. Nathan during the 20thAnnual Frontiers in Diabetes Research Symposium held November 17, in a ceremony at the Russ Berrie Medical Science Pavilion at Columbia University Irving Medical Center (CUIMC).

The Naomi Berrie Award for Outstanding Achievement is Columbia University’s top honor for excellence in diabetes research. Dr. Nathan is the 20th winner since the award’s inception in 1999.

A goal of this year’s Diabetes Research symposium was to convene students, scientists, clinicians and other stakeholders to examine the latest insights regarding the biological bases for medical complications that affect patients with diabetes, and novel therapeutic approaches to these disorders. 

Specifically, while persistent hyperglycemia may cause microvascular (retinopathy, nephropathy and neuropathy) disease, knowledge of specific mechanisms is likely to enable more effective therapies to prevent significant morbidity. Further, a direct link between excess glucose per se and cardiovascular and liver disease is far less certain, implying that other comorbid metabolic abnormalities such as hyperinsulinemia/insulin resistance and dyslipidemia may contribute to these associated disorders. 

The daylong symposium brought many highlights. According to Berrie Center scientist and clinician Utpal Pajvani, MD, PhD, who helped plan the symposium, participants came away with, “an increased appreciation of how far we have come in the care of patients with diabetes.” Dr. Nathan said that there used to be a holding place in his clinic for seeing-eye dogs. “But that’s not the current treatment landscape for patients with diabetes,” said Dr. Pajvani, “due importantly to findings of Dr. Nathan and co-investigators demonstrating the benefits of intensive glucose control. It is not hyperbole to state that these data have saved countless patients from diabetes-related complications while extending lifespans to comparable to those of individuals without diabetes.”

For patients with Type 2 diabetes, Dr. Silvio Inzucchi, from Yale, discussed recent data showing that the new SGLT2i class of medications (called gliflozin) greatly reduce the risk of heart failure.  And surprisingly, this effect is virtually independent of changes in blood glucose – meaning that even if blood sugars don’t change very much, the risk of heart failure still decreases. Dr. Katalin Susztak, at Penn, showed a parallel benefit in kidney outcomes for this same SGLT2i class of medications. “Working out this mechanism will keep scientists and clinical researchers busy for some time,” said Dr. Pajvani, “but patients may benefit immediately.”

Avoiding diabetes-related complications remains the greatest therapeutic challenge—and one that is being met by Berrie Center investigators. Dr. Dieter Egli discussed the efficient generation of insulin-producing cells from a patient’s own skin cells. And Dr. Domenico Accili proposed the use of FoxO inhibitors (termed “Foxins”) to generate insulin-producing cells in the intestine, which may render a predicted immune attack in type 1 diabetes superfluous due to the short half-lives of these cells. Both therapeutic approaches have potential application in patients with type 2 diabetes as well.

“There is reason for optimism in the care of diabetic patients,” Dr. Pajvani summed up,  “currently to prevent complications, and in the future to cure the disease with beta cell replacement strategies.”