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Attacking an Epidemic From All Angles

Research Shows Effective Interventions Key To Halting Diabetes

This article was originally published in Northwestern Medicine Magazine. It has been edited and abbreviated for the HealthBeat audience.

About 29 million people in the United States have type 2 diabetes. But perhaps more alarming is that another 86 million have prediabetes: higher than normal blood sugar levels likely to accelerate and become full-fledged diabetes in the next five to 10 years unless someone intervenes.

For the last decade, Northwestern Medicine scientist Ronald Ackermann, MD, MPH, has worked on implementing a method to halt diabetes. He and colleagues have focused on adapting an intervention called the Diabetes Prevention Program (DPP), which involves making small dietary changes, finding practical ways to increase physical exercise and receiving one-on-one encouragement and troubleshooting from a professional lifestyle coach. Dr. Ackermann’s group designed and evaluated a more inexpensive version of the DPP delivered at community YMCAs.

“Our intervention is based on the best evidence for how you help people lose weight,” says Dr. Ackermann, co-director of Northwestern Medicine Center for Diabetes and Metabolism. “We changed the program by offering it at the Y in a group format. Participants still have face-to-face coaching to keep them on track to meet their goals and to guide them through stumbles and falls.”

Matthew O’Brien, MD, assistant professor of Medicine, and Namratha Kandula, MD, MPH, associate professor of Medicine, both in the Division of General Internal Medicine and Geriatrics, are also exploring how versions of the DPP lifestyle intervention could benefit subgroups of patients. Dr. O’Brien concentrates on Latinos in the United States and Dr. Kandula, on South Asians.

Meanwhile, Bonnie Spring, PhD, director of the Center for Behavior and Health and a professor of Preventive Medicine, develops innovative interventions using technology such as cell phones and wearable devices to reduce unhealthy habits. Mercedes Carnethon, PhD, associate professor of Preventive Medicine, conducts epidemiologic studies to understand how factors like race/ethnicity, neighborhood resources and sleep affect cardiovascular risk factors like obesity and diabetes.

Combating societal norms is a challenge for all of these scientists. Dr. Ackermann points to the limited availability and higher costs of healthy foods, perceptions about what is considered “good” food, large portion sizes and using food as a social medium as examples of how the environment perpetuates diabetes in our country.

“The biggest challenges we face in adult primary care today are related to chronic diseases like diabetes,” explains Dr. Ackermann, who is also a professor of Medicine in the Divisions of General Internal Medicine and Geriatrics and Endocrinology. “Chronic diseases are tightly linked to behavior – smoking, physical inactivity, unhealthy diet. People know this, but actually changing their behavior is another thing, particularly when the world around them isn’t supporting healthier choices. Our research is about providing a supportive structure, accountability and a behavioral scheme to help them live healthier lives now. Until the world changes, we need programs that can help people succeed.”

Uniting Research Strengths

While the environment is a big factor behind diabetes, genetics is another. As Dr. Ackermann and his colleagues focus on behavior, policy and costs in clinical settings to prevent the disease from developing, another set of Northwestern Medicine scientists is at work in labs trying to understand the internal pathways that predispose people to diabetes, knowledge that can apply to prevention. All of this work – and more – is united within the Center for Diabetes and Metabolism, spearheaded by Dr. Ackermann and Joseph Bass, MD, PhD, chief of Endocrinology in the Department of Medicine.

“We’re a leading diabetes center in the Midwest, integrating patient care with a broad spectrum of research, extending from the biology of the disease to community-based interventions to clinical trials testing new therapies,” says Dr. Bass.

Dr. Bass’s own research centers on circadian and metabolic gene networks and their role in the development of diabetes and obesity. In one study, his lab pinpointed thousands of genetic pathways an internal body clock in the pancreas takes to dictate how and when the organ must produce insulin and control blood sugar, findings that could inform new therapies for people with diabetes.

Among additional basic scientists involved in the center, Grant Barish, MD, assistant professor of Medicine in the Division of Endocrinology, studies the molecular mechanisms that control metabolism. He’s already made the surprising discovery that a transcription repressor called BCL6 can prevent the fatty buildup that plugs arteries in atherosclerosis, and he has a new grant to explore how this “gene switch” can control body fat distribution to reduce the morbidity of obesity and type 2 diabetes.

With more than 70 members, the scope of the center extends far beyond prevention, from developing new treatments to managing the care of current patients. But nipping diabetes in the bud remains a crucial goal.

“About one in three adults have prediabetes. Somewhere in the neighborhood of 30 percent of those people will develop diabetes in the next five to seven years,” stresses Dr. Ackermann. “If we don’t act, we’re going to have a lot more type 2 diabetes in the health system in the next decade.”