Lois Jovanovič, CEO and Chief Scientific Officer, was awarded a 3-year grant in 2005 to investigate the role of the hormones of pregnancy in the finding that some women with type 1 diabetes have decreased insulin requirements during pregnancy. Dr. Jovanovič observed that some women with type 1 diabetes develop some pancreatic function during pregnancy that goes away after the birth of their baby. If this is true, it would explain why they need less insulin. The growth hormones produced during pregnancy are probably stimulating this “reawakening,” and she hypothesizes that the same mechanism that prevents a woman from rejecting her growing fetus as “foreign” is responsible for not rejecting the new pancreatic cells.
In this study, SDRI will study 40 pregnant type 1 diabetic women, measuring pancreatic function and indicators of immune rejection during each trimester and 6-weeks after delivery. Insulin requirement and glucose control will also be measured. From this the proportion of women who have a reemergence of pancreatic function, whether they have lower indicators of immune rejection, and if they have demographic, health, or metabolic traits in common, can be determined. Co-investigators include Howard Zisser, M.D. and David Pettitt, M.D. The study coordinator is Uzma Khan. If it can be shown that a combination of anti-rejection drugs and growth-promoting hormones can stimulate regeneration of pancreatic function, we can develop treatment protocols to stimulate growth of patients’ own pancreatic cells.
The SEARCH for Diabetes in Youth Project
Dr. David Pettitt, SDRI Senior Scientist, in collaboration with the Department of Research and Evaluation at Kaiser Permanente Southern California, is participating in a nationwide research study of diabetes in children and adolescents funded by the Centers for Disease Control and Prevention and the National Institute of Diabetes and Digestive and Kidney Diseases. This program, entitled SEARCH for Diabetes in Youth, began data collection in June, 2002 with the goal of determining the prevalence and incidence of childhood diabetes and carefully documenting what proportion of childhood diabetes is type 1, type 2, and due to other rare causes. Other participating centers include the University of Hawaii, University of Washington, University of Colorado, University of Cincinnati, and University of South Carolina. Staff at Wake Forest University in North Carolina oversee the coordination of the project. The six clinical sites registered 6268 youth with diabetes as of the end of 2001 and have subsequently identified and registered 2497 new cases that developed in 2002-2003. The project funding was extended in 2005 to assess the changes in the incidence of diabetes through 2010
Identifying Risk Factors for Type 2 Diabetes in Santa Barbara Area Youth
This study has been generously funded by the American Diabetes Association, the Santa Barbara Foundation, the Cottage Hospital Research Program and Lilly Centre for Women’s Health. Under the direction of Dr. David Pettitt, this study has employed a simple screening method to identify adolescents who are at risk for type 2 diabetes and polycystic ovary syndrome (PCOS). Jessica St. John, Project Coordinator, administers a 10-minute study examination that includes a brief health questionnaire, height, weight and per cent body fat measurements, and a finger-stick blood sample for analysis. All students who appear to be at highest risk for diabetes or PCOS are invited to participate in follow-up diagnostic testing and, when appropriate, are referred for treatment.
This project has been extremely well received by the Santa Barbara and San Marcos High School communities and as a result has raised an overall awareness of diabetes and health management. Some teachers, for example, incorporated into their lesson plans a short unit on diabetes and associated risk factors. Others have encouraged their students to participate in this study and discussed in class the importance of learning about diabetes and taking control of one's health. The Career Counseling Center has been supportive as well by rewarding all participants with community service hours. During 2004-2005, 1240 students were screened, which is about 1/3 of the participating high schools’ student populations.
Sansum conducted a similar study during the 2000-2001 year in three local elementary and middle schools. The prior study identified a correlation between obesity and the number of soft drinks consumed per day and the number of hours of television watched per day: students who drank two or more soft drinks per day, diet or regular, were almost twice as likely to be overweight; students who watched two or more hours of television per day were also almost twice as likely to be overweight.
Bench to Bedside Research: The search for an ‘artificial pancreas’
Short of a physiologic cure, the best hope for diabetes management for type 1 diabetes lies in continuous glucose sensing and automated insulin delivery, thus simulating the glucose control loop that is automatically regulated in the non-diabetic person. Dr. Lois Jovanovic, CEO and Chief Scientific Officer, was awarded an NIH grant in October 2004 and is co-principal investigator on a second NIH grant to develop a computerized insulin-delivery algorithm that can maintain glucose in patients with type 1 diabetes within normal ranges.
These grants, jointly awarded to and conducted in collaboration with Francis J. Doyle III, Dale Seborg, and colleagues at the University of California, Santa Barbara, monitor subjects in steady state, following meal challenges, and in various states of stress to simulate real life variations. The data are then used to fit a model that can link changes in glucose to recommended changes in glucose infusion. The goal of this research is to develop a portable or perhaps implantable instrument that would calculate and deliver insulin based on continuous feedback of moment-to-moment glucose concentrations. Other staff on the project includes Howard Zisser, M.D., Co-investigator, Wendy Bevier, Ph.D., Project Coordinator,
Alison Okada Wollitzer, Ph.D., Joan Sullivan, M.T. (A.S.C.L.), Cesar Palerm, Ph.D., Post-Doctoral Fellow, and Daniel Finan, Ph.D. candidate.
GLP-1 levels in women with Gestational Diabetes
Glucagon-Like Peptide-1 (GLP) has received considerable attention as a treatment for type 2 diabetes. Replacement of this naturally-occurring hormone in people with type 2 diabetes appears to improve glucose tolerance and insulin production, reduce glucagons secretion and gastric emptying and suppress the appetite in many patients. With a grant from the Lilly Corporation, Dr. Jovanovic and Dr. Howard Zisser are investigating whether women with gestational diabetes have reduced levels of GLP during their pregnancy compared to after they deliver their baby and also compared to non-diabetic pregnant women. If it can be shown that gestational diabetes is associated with a defect in GLP production, the next step would be to propose treatment with GLP during pregnancy. The study coordinator is Uzma Khan.
This study has been generously funded by the American Diabetes Association, the Santa Barbara Foundation, the Cottage Hospital Research Program and Lilly Centre for Women’s Health. Under the direction of Dr. David Pettitt, this study has employed a simple screening method to identify adolescents who are at risk for type 2 diabetes and polycystic ovary syndrome (PCOS). Jessica St. John, Project Coordinator, administers a 10-minute study examination that includes a brief health questionnaire, height, weight and per cent body fat measurements, and a finger-stick blood sample for analysis. All students who appear to be at highest risk for diabetes or PCOS are invited to participate in follow-up diagnostic testing and, when appropriate, are referred for treatment.