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October 2000
VA
Research in Diabetes
An important element in VA’s
comprehensive effort against diabetes is research to advance care and
treatment of the disease. In fiscal year 1999, VA scientists were conducting
more than 400 diabetes-related research projects, which were supported
by more than $11 million in VA funds and $20 million in grants from other
sources.
Recent Research Advances
- VA researchers identified
the first genetic "on-off" switch for insulin production.
The gene they discovered triggers insulin production in rats, but stops
production before blood-sugar levels drop too low. The results offer
the potential for a genetic therapy that would automatically regulate
insulin levels without requiring diabetic patients to give themselves
injections or decide how much insulin they need.
- Another VA study showed
significant cost savings and no reduction in health benefits by giving
retinal exams less frequently to patients at low risk for blindness
but more frequently to those at high risk, based on age and blood sugar
control. The same group of researchers is now examining the effectiveness
of new cameras designed to detect abnormalities in the eye, which can
be operated by other vision-care specialists in regions where ophthalmologists
are scarce.
- A seven-year VA study showed
the drug gemfibrozil raises levels of "good" high-density
lipoprotein (HDL) cholesterol. Diabetes is frequently part of "metabolic
syndrome," a combination of abnormalities that often accompany
low HDL levels.
- An implantable insulin pump
that may help diabetics avoid daily injections proved successful in
a large-scale clinical trial. Patients with type-II diabetes who had
the computer-controlled pump implanted had better sugar and weight control
than patients receiving injections. Patients using the pump rated their
quality of life significantly better.
Ongoing Initiatives
- Eight diabetes research
projects are underway as part of the Quality Enhancement Research Initiative
(QuERI), led by VA’s Health Services Research and Development Service
(HSR&D). This effort will identify and evaluate diabetes care practices
and current gaps in diabetes care. HSR&D recently issued a VA
Practice Matters publication on preventing cardiovascular complications
in diabetes, available on the Internet at www.va.gov/resdev/prt.
- The VA Cooperative Studies
Program has begun a seven-year, $57 million clinical trial to determine
whether a more aggressive therapy for type-II diabetes will prevent
complications such as heart disease and stroke. The effort, also involving
the American Diabetes Association and four pharmaceutical companies,
will test higher doses of drugs currently used to lower blood-sugar
levels and help the body use insulin. Up to 1,700 veterans for whom
standard therapy is no longer effective will take part in the study.
- The VA Rehabilitation R&D
Center of Excellence for Limb Loss Prevention and Prosthetics Engineering
in Seattle studies ways to prevent amputation, improve prostheses and
improve patient outcomes. Researchers are studying 400 volunteers to
determine whether protective shoes can help prevent foot ulcers and
amputations in people with diabetes. The disease is the leading cause
of lower-limb loss not associated with injury.
- Three special centers funded
by the Medical Research Service and the Juvenile Diabetes Foundation
are making strides in several research areas. In Iowa City, researchers
are studying how blood vessels lose their ability to expand normally.
That kind of vascular complication, when severe, can lead to amputation.
In Nashville, investigators are seeking ways to reduce the side effects
of intensive treatment or exercise–such as low blood sugar–so
patients can receive their full complement of therapy. In San Diego,
VA scientists are analyzing why the body develops resistance to insulin
and examining the causes of diabetes-related complications, such as
vascular and kidney disease.
- VA scientists in Detroit,
supported by VA’s Research Enhancement Award Program, are examining
how genes are turned on and off by glucose and insulin. The ultimate
goal is to develop better diabetes therapies to disrupt the disease’s
cycle of high blood-sugar levels and insulin resistance.
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