Since Banting and Best’s discovery of insulin in Toronto in 1921, the scope of diabetes research in Canada has been vast and the numerous studies both varied and unique. There have been huge strides and key advances in mapping and understanding the physiology, biochemistry, and genetics of diabetes.
The Canadian Diabetes Association (CDA) understands funding of diabetes research is a crucial step in providing these advances. This is why we choose, each year, to fund Canada’s most renowned scientists and clinicians in their quest for new and innovative developments in the prevention, treatment, and management of diabetes. And although the research is diverse in its scope, covering a broad range of specialties, the key aspects of every study and researcher remain the same – to improve the quality of life of people living with diabetes and to find a cure.
Since Banting and Best’s discovery of insulin in Toronto in 1921, the scope of diabetes research in Canada has been vast. The innovative research funded by the CDA has contributed to key advances in mapping and understanding the physiology, biochemistry, and genetics of the disease. Although the topics of Canadian researchers are varied and unique, the objective of every study remains the same – to find a cure and improve the quality of life of people living with diabetes.
The known history of diabetes through the ages began in 1552 BCE, when an Egyptian physician first described diabetes and listed remedies to combat the “passing of too much urine.” The history of the Canadian Diabetes Association’s relationship with diabetes research is much more recent: Since 1975 and the establishment of the Charles H. Best Research Fund – named for insulin co-discoverer and CDA co-founder Dr. Charles H. Best – the CDA has awarded more than $120 million in research grants and awards to scientists who have dedicated themselves to the fight against diabetes.
Many people ask why research is “taking so long”. To a person with diabetes, it can seem like research moves at a snail’s pace, but the researchers who do this work tell us that information is being uncovered and added to at lightning speed. So how does research work and how long does it take?
Types of research
Research can be broken down into four big categories. The Canadian Institutes of Health Research defines these big categories as “pillars”. It is effective to imagine these pillars holding up the building of knowledge.
PILLAR 1: “Basic biomedical research”
Pillar 1 research involves studying molecules, cells and tissues to find out, at the microscopic level, how our bodies work in health and disease. Generally, this type of research takes 10 to 40 years before it impacts patients. This type of research is done by people who have a PhD and who have done extra training after their PhD in science (about 10-14 years of post-high school education).
PILLAR 2: “Clinical research”
Pillar 2 research involves studying people/patients, and taking that information and turning into treatments, diagnostic tests and cures. Generally, this type of research takes five to 15 years before it impacts patients. This type of research is done by basic scientists (as with pillar 1) and by clinician scientists (doctors who have an MD and an MSc or PhD and also see patients).
PILLAR 3: “Health services research”
Pillar 3 research involves measuring how treatments are being delivered to the population and whether they provide the promised benefit. Generally, this type of research takes one to five years before it delivers results that can be used to develop policy. How and when this type of research impacts patients depends on governments implementing the findings. This type of research is done by basic scientist and clinician scientists.
PILLAR 4: “Population and public health”
Pillar 4 research involves studying the health of whole populations and subgroups within populations, in particular, finding out if everyone is benefiting equally from advances in health services. Like Pillar 3 research, this type of research takes about one to five years before results can be used to develop policy, impact on patients depends similarly on governments implementing the findings. This type of research is most done by researchers with a PhD in population health.
The research pipeline
Each pillar of research interacts with the others to create a pipeline of research that goes from test tubes and microscopes to medications and treatments and even governments.
Research success: Discovering ways to treat type 2 diabetes
Canadian Diabetes Association researcher Dr. Daniel Drucker developed not one, but two diabetes drugs. Dr. Drucker is a researcher at Mount Sinai Hospital in Toronto. He studies a group of hormones that are made in the pancreas, the digestive tract, and the brain.
Insulin, the hormone that lowers blood glucose (sugar) when it gets too high, is made by special cells – called beta cells – in the pancreas. The opposite hormone, glucagon, is made by alpha cells in the pancreas and causes blood glucose to go up when it is too low. Type 2 diabetes develops when the body can’t properly use the insulin that it has or when the body doesn’t make enough insulin. As a result, blood glucose levels get too high, which can cause damage to the body. When we eat, our blood glucose levels go up based on the amount of carbohydrates in our food. A hormone called GLP-1 is made in the cells of the intestine, and it is released after eating. This hormone tells the pancreas to release insulin and stop releasing glucagon. As a result, blood glucose levels go down.
There is a molecule called DPP4, and it removes GLP-1 from the body quite quickly. Dr. Drucker realized, during the course of his CDA-funded research, that finding ways to mimic what GLP-1 does or to block what DPP4 does would both have the end result of lowering blood glucose levels. Dr. Drucker followed this line of reasoning, and through his research, his laboratory developed two new treatments for type 2 diabetes. The first type of treatments are called GLP-1 analogues (which means that they mimic the action of GLP-1), and they include drugs like liraglutide (Victoza) and exenatide (Byetta). The second type of treatments are called DPP4 inhibitors (which means they block DPP4 from removing GLP-1 from the body), and the include drugs like sitagliptin (Januvia), vildagliptin, and saxagliptin.
The Canadian Diabetes Association is proud to have funded the research that led to Dr. Drucker’s important discovery and to the development of two widely-used types of type 2 diabetes drugs.
Research Success: Transplantation
The beta cells of the pancreas make insulin (the blood glucose [sugar] lowering hormone). They are found in tiny patches in the pancreas called Islets of Langerhans. In the 1890s – even before the discovery of insulin – scientists knew that the pancreas played a role in diabetes. At this time, a scientist tried to cure diabetes by transplanting pieces of sheep pancreas into a 13-year-old with type 1 diabetes. This ultimately failed, but the idea of replacing beta cells that don’t work with ones that do was a good one. However, it wasn’t until 1970 that researchers finally successfully transplanted islets in mice; the first successes in people with diabetes weren’t until two decades later. At first, the transplants were rejected (the new cells were killed by the immune system). Immune supressing drugs (drugs that block the immune system from working and therefore from killing the new cells) were used to help improve the success of transplants, but the process was still very difficult and didn’t have much success.
In March 1999, a group of eight researchers (Drs. James Shapiro, Jonathan Lakey, Edmond Ryan, Gregory Korbutt, Ellen Toth, Garth Warnock, Normal Kneteman and Ray Rajotte) in Edmonton performed the first transplant using a new method. They had good success, and published their results the next year in the New England Journal of Medicine (a very prestigious journal). This became known as the Edmonton Protocol, and transplant centres around the world now use it. Two of those researchers (Drs. Korbutt and Lakey) were receiving Canadian Diabetes Association Scholar Awards as they did this research, and we are proud to have contributed to this major step forward in diabetes care.
Islet transplantation continues to face challenges. There aren’t enough donor islets, and islets are hard to remove from the pancreas for this procedure. Despite advances in research, immune-suppressing drugs are still necessary for people who have had transplants. But for certain people with type 1 diabetes, especially those who are prone to severe and hard-to-recognize low blood glucose, islet transplantation can allow them to have much better blood glucose control, sometimes even without needing insulin.
The Canadian Diabetes Association continues to view islet transplantation as an important tool to treat type 1 diabetes. Since 1997, we have funded nearly $5 million in research on islet transplantation. In addition, we have funded five of the eight researchers from the initial Edmonton transplant team in continuing diabetes research.