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 Canadian Diabetes Association 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. Here are some of the Association-funded researchers who have made progress toward that goal.
Diabetes in special populations
Dr. Donna Koller’s (Toronto) research highlighted the importance of sharing information with children about their diabetes in order to facilitate greater self-care. One emerging theme from Dr. Koller’s research is how knowledge of diabetes provides the basis upon which self-care can evolve over time. Although children and adolescents showed varying degrees of knowledge, the majority of participants had a marginal understanding of diabetes and wanted to learn more. In particular, young children lacked basic knowledge and many held misconceptions. However, all children believed it was important to know how to take care of your body. Even children who were doing minimal self-care reported they would like to do more. Children also discussed strategies for improving self-care, such as consistent encouragement from parents and the need to start at an early age. The majority of children wanted to participate in discussions regarding their care. Living with diabetes elicited strong emotions, particularly fears concerning ‘lows’ and the hope that one day there would be a cure. The implications of this research show the need for more effective educational strategies and the significance of child participation in discussions regarding diabetes and plans for self-care.
Search for new treatments
Dr. Paul Fernyhough (Winnipeg) has demonstrated that treatment with an anti-inflammatory medication helps repair damaged nerve endings in the skin of rats. Nerve disease severely affects the quality of life of many people with type 1 and type 2 diabetes. In diabetes-related nerve disease, nerve endings die, leading to loss of sensation, pain, poor wound healing, development of ulcers and, in many cases, lower limb amputation. Currently, there is no effective treatment. It is believed that high levels of blood glucose and/or low levels of insulin cause inflammation that ultimately leads to the destruction of the nerve endings. Dr. Fernyhough’s research may lead to the use of anti-inflammatory medications for nerve disease in humans in the near future.
Prevention & management
Dr. Ron Sigal (Calgary) has found that aerobic exercise and resistance exercise (i.e., weight training) were each effective in improving blood glucose control in type 2 diabetes, but the combination of both types of exercise was at least twice as effective as either type of exercise alone. The DARE (Diabetes Aerobic and Resistance Exercise) trial has provided the strongest evidence available for the value of both aerobic and resistance exercise for most people with diabetes. The DARE trial and other smaller trials have led to changes in clinical practice guidelines regarding physical activity/exercise from both the Canadian and the American Diabetes Associations. The guidelines now recommend both aerobic and resistance exercise for most people with diabetes, and provide specific recommendations regarding type, intensity, and quantity of exercise.
More than 63% of children and youth in Canada and the United States are insufficiently active to obtain health benefits. One of the main reasons why teens do not consistently follow exercise programs is lack of enjoyment of physical activity and the increasing availability of enjoyable sedentary activities, such as TV and video games, both of which compete with physical activity. Drs. Gary Goldfield and Kristi Adamo (Ottawa) demonstrated that stationary cycling while playing video games is just as effective as stationary cycling to music at improving fitness, body composition, and cholesterol profiles in obese teens. While capitalizing on their attraction to video games could eventually help increase physical activity and fitness levels in youth, further investigation and research is needed to evaluate the health benefits of this medium.
Dr. Brian B. Rodrigues (Vancouver) has developed and tested a novel heart-specific drug delivery system that could help protect people with diabetes from heart disease. Dr. Rodrigues demonstrated that when a drug is attached to very small magnetic beads, the drug will localize specifically to the heart when a magnet is placed directly above it. These results show great promise for the development of a new way to deliver drugs to specific places in the body where the drug is most needed, such as the heart or kidney.
Problems with insulin
Dr. Peter E. Light (Edmonton) has discovered a potential link between diet and genetics in people with diabetes. He has found that people who eat a high-fat diet or are overweight may be at increased risk for developing type 2 diabetes if they carry a genetic variation in a gene that encodes for a specific potassium channel in the pancreas. When activated, this channel reduces insulin secretion, which results in increased blood glucose. This effect is greater in the “variant” potassium channel. As it turns out, saturated and trans fats – the so-called ‘bad’ fats – activate this “variant” potassium channel much more than polyunsaturated fats (the ‘good’ fats). This information could lead to the development of a screening tool to identify people at risk and then advise them about their diet. Furthermore, there are also anti-diabetes drugs that target this potassium channel and Dr. Light has now discovered that the variant channel is more sensitive to certain drugs that could be prescribed selectively to people with this genetic variant to optimize treatment.
Biology of diabetes
For many years, scientists have been hunting for the way that high levels of fat in obesity kill the beta cells of people with type 2 diabetes. Dr. James Johnson (Vancouver) is the very first scientist to show that high levels of fat in the blood destroy insulin-producing beta cells in the pancreas by reducing a protein called CPE - a process that leads to type 2 diabetes. He is the first to link the important diabetes risk factor (obesity) to this important protein (CPE) that controls beta cell function and survival. Understanding the pathway of beta cell death in people with type 2 diabetes, how it is initiated and how it progresses, will lead to the design of new therapies for type 2 diabetes
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