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Research: Who, What, and How Much?
Each year, the Canadian Diabetes Association funds key research programs across Canada. People who donate money to the Association hope that their contribution will go to the breakthrough project that leads to a cure. Donors often wonder where research money goes and to whom. Research is a very costly process in terms of time, human effort and money.
Who are diabetes scientists?
Most diabetes scientists in Canada are people with full-time academic positions at Canadian universities or scientists employed by major pharmaceutical companies. The majority of scientists currently funded by the Canadian Diabetes Association and other funding agencies such as The Medical Research Council (MRC) of Canada are medical doctors (MDs) and basic scientists (PhDs). Much of the research in their laboratories is done by graduate students and scientists who have recently completed their research training before opening their own laboratories. They are assisted by laboratory technicians, research nurses, dietitians and diabetes educators. It is also possible to conduct research outside of the setting of universities and major academic centres, but scientists need to have the time and resources available to conduct top-rate biomedical research. The competition for scarce research funds means that only the best research can be funded.
Both MDs and PhDs have numerous administrative duties, serving on hospital and university committees and committees of organizations like the Canadian Diabetes Association. They are responsible for teaching medical trainees and students in the basic science departments of their universities. MDs frequently take care of patients with diabetes and related medical problems and have clinical practices one or two days per week. MDs may also have other clinical responsibilities during the year, providing care for patients with diabetes who are admitted to hospital.
PhDs spend many years working in laboratories while they complete their formal university course work and are required to produce a major body of original scientific work (thesis) before they are awarded their doctorate (PhD). Even then, they are usually required to spend a further two to four years working in the laboratory of an established scientist before they can become truly independent. In the case of MDs, they will have spent an additional three or four years training in the laboratory of an established diabetes scientist, after completion of their medical and specialty training. The total duration of medical and research training for an MD who becomes a diabetes researcher is 10 to 12 years.
Many diabetes scientists develop their interest in diabetes as a result of mentors and role models during their training, who stimulate their interest in the field. There are also a substantial number of people who are drawn to diabetes research because either they or a close relative have diabetes. Once dedicated to this area of research, most scientists hope their research will improve the lives of people with diabetes. While the ultimate goal remains the prevention and cure of diabetes, most scientists work on very specific aspects of diabetes research. It is the pooling of knowledge from all research that leads to advances and discoveries.
What research is being done?
Most people with diabetes are familiar with the momentous discovery of insulin in Toronto in 1922. But what advances have there been since then? There have been huge improvements in the development and purification of insulin since 1922, culminating in the manufacture of human insulin in the 1980s. The development of home blood glucose monitoring and the continuous improvement in glucose meters have revolutionized the management of diabetes. The Diabetes Control and Complications Trial (DCCT), involving more than 1,400 patients with type 1 diabetes in the 1980s and 1990s, was a landmark study that showed that diabetes complications can largely be prevented by excellent blood sugar control. Prior to the DCCT study, there were still many physicians who were skeptical of this fact. There have been great advances in pancreas and islet cell transplantation techniques. While pancreas transplants are now a reality for some patients who are also receiving kidney transplants, islet cell transplants are still experimental. There have been great practical advances in the treatment of diabetes complications such as infections, blockage of the circulation, kidney, eye and nerve disease. Many of these problems are now very treatable, while only a few years ago they would have spelled almost certain death for the patient with diabetes.
Most exciting of all are the more recent advances in our understanding of the genetics, biochemistry and physiology of diabetes. Scientists all over the world are racing to find the genes that cause diabetes, and great advances are being made, particularly in type 1 diabetes. Only ten years ago, we understood very little about how insulin signals the machinery of the cells to use sugar. Now, using modern molecular biology techniques, there are new discoveries being made every day. Once we understand how the body works, at a very detailed level, we can design more effective therapies to correct the defects that cause diabetes. Our knowledge is rapidly increasing as more powerful research tools are developed and used. Canadian scientists are at the forefront of diabetes research and much of this research is funded by the Canadian Diabetes Association.
How is diabetes research money spent?
Most diabetes research in Canada is funded by grants from public (e.g., MRC) and private (e.g., Canadian Diabetes Association) funding organizations and from pharmaceutical companies. Grants may support individual laboratories or groups of scientists working in a common area and pooling their knowledge. Money may be directed to support laboratory supplies and technicians’ salaries or the salaries of diabetes scientists, enabling them to devote their time to diabetes research. Each granting agency has its own specifics on funding coverage.
Scientists write grant applications, which are reviewed by their peers who have expertise in the field. The competition for limited resources stimulates ideas and can serve to improve the overall quality of research. On the negative side, however, more and more time is required to write and review grant proposals, which generally must be renewed every one to three years. Unfortunately, there are a lot of good ideas that can never be tested because of limited research funds. In some situations the competition is so fierce that fewer than 10 percent of proposals are funded. Most scientists will try to obtain grants from a number of agencies in order to keep their laboratories functioning. The maximum grant from the Canadian Diabetes Association is $60,000 per year, and most grants awarded are less than that. A laboratory technician’s salary varies according to the experience and seniority of the individual and ranges from $30,000 and $60,000 per year. Laboratory supplies and service contracts for equipment are also very expensive. One can readily see that a grant of $55,000/year from the Canadian Diabetes Association can fund a technician’s salary of $40,000, leaving only $15,000 per year for supplies. Since ongoing funding is subject to a renewal process and continuing competition for new grants, researchers may find that their grant is not renewed. As such, there is always a high level of anxiety and uncertainty and minimal job security for laboratory technicians. Laboratory technicians are highly skilled individuals. It may take a year or more for a technician to develop the skills to perform a specific technique and technicians cannot be fired and hired at whim. When funding agencies like the Canadian Diabetes Association have to cut back on funding for research, as happened during the recent recession when fundraising targets were harder to reach, the consequences for diabetes research in Canada can be disastrous. One of the most frustrating things for a diabetes researcher is to have the ideas and the ability to conduct high quality research, but to be limited by lack of funds.
Summary
Diabetes scientists are aware that their research dollars are raised by hard-working volunteers and donated by generous individuals. There is a deep sense of gratitude to those who donate and raise the funds and a great feeling of responsibility to people with diabetes. The diabetes researcher is really only one part of a massive effort to fight this potentially devastating disease in Canada and throughout the world.