It’s been known for nearly a decade that type 2 diabetes can be prevented or delayed with diet, exercise and medical care. So why is the diabetes epidemic in this country only getting worse?
It’s not the doctor’s fault, or the patient’s either, said Tom Elasy, medical director of the Vanderbilt-Eskind Diabetes Clinic at Vanderbilt University Medical Center.
The problem is one of translation, Elasy said. Scientific breakthroughs in diabetes management and prevention have not been “translated” into practices that can easily be applied in the doctor’s office or the patient’s home.
That’s about to change with the establishment this fall of a Center for Diabetes Translation Research at Vanderbilt. Supported by a five-year, $3.5 million grant from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), it is one of seven such centers in the country.
“[lquote]In diabetes, we are fortunate to have a fairly rich evidence base that guides us with regards to optimal care,” said Elasy, the grant’s principal investigator. But “we’ve struggled as a nation to deploy that information into routine practice.[/lquote]”
26 million diabetics
Since 1980, the incidence of diabetes has doubled, according to the federal government.
Today nearly 26 million Americans have the disease. The financial impact also is huge — $174 billion in excess medical expenditures, disability and reduced national productivity in 2007, according to the American Diabetes Association.
“Diabetes is the major health problem facing us today,” said Nancy Brown, chair of the Vanderbilt Department of Medicine. “Vanderbilt faculty have made significant contributions to understanding the molecular biology of diabetes. The Vanderbilt Center for Diabetes Translation Research has the potential to have a huge impact on health through diabetes prevention and treatment.”
Other centers are being established at the University of California, San Francisco; the University of Colorado in Denver; the University of Chicago; the University of Michigan in Ann Arbor; Washington University in St. Louis; and the University of North Carolina at Chapel Hill.
The creation of this new award by the NIDDK, particularly during a time of extraordinary fiscal constraints, “speaks volumes” about the urgency of this public health crisis, said Elasy, the Ann and Roscoe R. Robinson Professor of Clinical Research and director of the Division of General Internal Medicine and Public Health.
Collaborative effort
To meet the challenge, the center will draw expertise from the Schools of Medicine and Nursing and from the Departments of Psychology and Biomedical Informatics.
It also will partner with Meharry Medical College to develop methods that best serve diverse populations.
“The involvement of Meharry is critical because it has long been dedicated to improving health outcomes in underserved populations that experience health disparities in a variety of diseases, including diabetes,” said Margaret Hargreaves, a core leader in the center and professor of internal medicine at Meharry.
Vanderbilt also has a long history of contributions to diabetes care. In the 1980s, a Vanderbilt professor, Oscar Crofford, led the landmark Diabetes Control and Complications Trial, which established the value of rigorous blood glucose control.
“Much of the seminal and ground-breaking work by Dr. Crofford and others on the understanding the metabolic abnormalities associated with diabetes was conducted in Vanderbilt’s Clinical Research Center, which has long provided unique facilities and expertise for the study of diabetes,” said Gordon Bernard, associate vice chancellor for research.
In 2002, another national study, the Diabetes Prevention Program, showed that losing weight and exercising can prevent or at least delay development of type 2 diabetes.
Problem is, “we’ve given (providers) a proof of concept, but we’ve not given them a practical method to deploy (it),” Elasy said.
