William E. Russell, MD, is director of the Ian M. Burr Division of Pediatric Endocrinology and Diabetes, professor of Cell and Developmental Biology, and holder of the Cornelius Vanderbilt Chair in Pediatrics.
Q; Can you share the difference between Type 1 and Type 2 diabetes? Are both seen in children?
A: Type 2 diabetes is by far the most common form of diabetes, and its onset is predominately in adults. It has a strong genetic component and begins with the body’s tissues becoming insensitive to the actions of its own insulin. This can often be managed with oral medications, but eventually, the patient’s beta cells, which produce insulin in the pancreas, become dysfunctional and insulin injections are often required.
Q: Type 1 diabetes is an autoimmune disease. We see Type 1 in infants through young adults, with peak incidence between ages 10 and 15. The patient’s immune system attacks the insulin-producing beta cells, and the patient cannot produce insulin. The only treatment for Type 1 diabetes is insulin from the onset. Type 1 diabetes, which is lifelong, is often seen in families and in patients with other autoimmune conditions.
A: Both forms of diabetes result in elevated glucose levels in the blood and can cause damage to multiple organs.
Q: What have been the biggest advancements in diabetes care since the first injection of insulin in 1922?
A: The greatest advancements include the development of analog insulins, insulin pumps and continuous glucose monitors (CGMs).
- Analog, or synthetic, insulins have been engineered to have either more prolonged or more rapid action times in the body than natural insulin.
- Insulin pumps provide automated delivery of insulin to the patient without the need for separate injections for each meal and for overnight control. Pumps can be programmed to give differing amounts of insulin during the day and night and to meet changing physiologic needs such as during puberty, around sports and illnesses and pregnancies.
- Continuous glucose monitors, worn on the skin, provide almost instantaneous readouts of the glucose levels in the tissue fluids throughout the day and night.
Q: What is on the horizon for diabetes treatment/care?
A: Great advances have been made in coupling insulin pumps with CGMs. The CGM can automatically modify the pump’s delivery to prevent low blood glucose emergencies (especially during a patient’s sleep) and rising blood glucose. However, keeping patients, especially adolescents, engaged with monitoring their glucose levels and adjusting their insulin doses can be challenging. New technology is extraordinarily useful but adds a considerable burden to the patient’s daily routine. Ultimately, the goal is to have the patient much less involved in the decision-making of insulin dosing.
Exciting new results are emerging about insulin-producing cells derived from the patient’s own stem cells. These cells are implantable into tissues that have free access to the bloodstream and therefore eliminate some of the shortcomings of injections and pumps.
Q: How has Vanderbilt played a role in the development of diabetes treatments?
A: The most consequential research study impacting the treatment of diabetes since the discovery of insulin was the “Diabetes Control and Complications Trial,” or DCCT, designed and led by Vanderbilt’s Dr. Oscar Crofford from 1982 to 1993. It showed unequivocally that the degree of blood glucose control in diabetes is directly related to the risk of developing later diabetes-related complications. The DCCT led to a redoubling of efforts to improve the tools for diabetes management.
In our division, Justin Gregory, MD, has highlighted major problems that result when we inject insulin under the skin rather than directly into the bloodstream. His research explores the development of insulin pumps that can release insulin into body compartments that have direct access to the blood. He also looks at developing new analogs that are only active in insulin-sensitive tissues such as the liver. Daniel Moore, MD, PhD, has an active research program to determine why the body begins to attack insulin-producing cells in Type 1 diabetes. His work aims to prevent the autoimmune process that leads to Type 1 diabetes. Vanderbilt is also a leading contributor to the NIH-funded Type 1 Diabetes TrialNet consortium, which is making great strides in the prevention/modification of the autoimmune attack on insulin-producing cells.
Critical diabetes research like this is made possible through the support of our generous donor community.