Transcript Research Highlights from the National Institute of Diabetes and Digestive and Kidney Diseases Griffin P.

Research Highlights from the
National Institute of Diabetes and
Digestive and Kidney Diseases
Griffin P. Rodgers, M.D., M.A.C.P.
Acting Director
National Institute of Diabetes and
Digestive and Kidney Diseases
The NIDDK conducts and supports basic and
applied research and provides leadership for
a national program in:
Diabetes, Endocrinology, and Metabolic
Diseases;
Digestive Diseases and Nutrition; and
Kidney, Urologic, and Hematologic
Diseases.
NIDDK’s Research and
Dissemination Spectrum
“Bench to Bedside and Beyond”
Organizational Structure of
NIDDK’s Three Extramural
Scientific Divisions
NIDDK
DDN
Division of
Digestive Diseases
and
Nutrition
DEM
Division of Diabetes,
Endocrinology,
and
Metabolic Diseases
KUH
Division of Kidney,
Urologic, and
Hematologic
Diseases
A Paradigm of NIDDK’s Integrated
Research Programs
Obesity
Type 2
Diabetes
Kidney
Disease
Overweight and Obesity
For Adults
BMI
BMI
BMI
BMI
below 18.5 – Underweight
between 18.5 and 24.9 – Healthy weight
between 25 and 29.9 – Overweight
30 and above – Obese
For Children and Adolescents
BMI below 5th percentile – Underweight
BMI between 5th and less than 85th – Healthy
weight
BMI between 85th and less than 95th – At Risk of
Overweight
BMI 95th percentile and above – Overweight
Health Complications of Obesity
Stroke
Pulmonary disease
abnormal function
obstructive sleep apnea
hypoventilation syndrome
Pancreatitis
Nonalcoholic fatty liver
disease
steatosis
steatohepatitis
cirrhosis
Gall bladder disease
Cancer
breast, uterus, cervix, prostate, kidney
colon, esophagus, pancreas, liver
Skin
Gout
Idiopathic intracranial
hypertension
Cataracts
Coronary heart
disease
Diabetes
Dyslipidemia
Hypertension
Gynecologic abnormalities
abnormal menses
infertility
polycystic ovarian syndrome
Osteoarthritis
Phlebitis
venous stasis
Obesity Trends Among U.S. Adults
1991
No Data
<10%
2004
10-14%
15-19%
20-24%
≥25%
Percent
15
20
15
6-11 years old
10
5
0
10
12-19 years old
5
0
Percent
20
Trends in U.S. Child and
Adolescent Overweight
Adipocity phenotype
(e.g., body mass index)
Obesity: Gene/Environment
Interactions
Current environment
Past environment
Genetic susceptibility
A Paradigm of NIDDK’s
Integrated Research Programs
Obesity
Type 2
Diabetes
Kidney
Disease
Two Major Forms of Diabetes
Type 1
Usually diagnosed in childhood, adolescence, or young adulthood
Body’s immune defense system mistakenly destroys insulinproducing cells in the pancreas (autoimmunity)
Results in lack of insulin to control blood sugar levels; insulin
therapy lifesaving but not a cure
Type 2
Historically diagnosed in adults; now in children and adolescents
Body has reduced sensitivity to insulin
Therapy increases insulin release/sensitivity; some insulin
administration may be required
Obesity is a serious risk factor
Can be prevented or delayed by diet and exercise as shown in
NIH clinical trials
Estimates of Diagnosed Diabetes
Among Adults in the U.S.
1994
No Data
2004
<4%
4-4.9%
5-5.9%
≥6%
Diabetes: Burden of Disease
20.8 million Americans (7 percent of the U.S.
population) have diabetes
90-95 percent of cases are type 2 diabetes
Minorities are disproportionately affected by
type 2 diabetes
1 in 3 Americans born in 2000 is predicted to
develop diabetes during his or her lifetime (for
Hispanic females: 1 in 2)
Diagnosed Diabetes in the U.S.
Diagnosed (1960-2004) and
Projected Diagnosed (2005-2050) Cases
People (millions)
50
40
30
Diagnosed cases
Projected
diagnosed cases
20
10
0
Year
Results from the Diabetes Prevention Program
15
Substantial Reduction in Diabetes
in All Race-Ethnic Groups
12
9
6
3
0
All participants
Caucasian
Lifestyle
African
American
Metformin
Hispanic
American
Indian
Placebo/Standard care
Asian
Complications Common to Both
Type 1 and Type 2 Diabetes
Acute complications
Dangerously high or low
blood glucose
→ coma, death
Chronic complications
Affect all major organs
Develop over time/ exposure
to high blood glucose
Tight control of blood
glucose can prevent or delay
Stroke
Blindness
Heart
Disease
Kidney
Disease
Atherosclerosis
Foot Ulcers
and Amputations
A Paradigm of NIDDK’s
Integrated Research Programs
Obesity
Type 2
Diabetes
Kidney
Disease
End-stage Renal Disease in the U.S.
Number of Patients per Million Population
1993
2003
End-stage Renal Disease in the U.S.
All Values are for Calendar Year 2004
Prevalence: 472,099 patients were undergoing
treatment
Mortality: 84,252 deaths in patients undergoing
treatment for ESRD
Primary cause:
Diabetes: 45,871
High blood pressure: 28,132
Primary treatment:
Dialysis: 335,963 patients received dialysis
Kidney Transplant: 16,905 performed
Minorities are disproportionately affected
End-stage Renal Disease in the U.S.
Adjusted Incident Rates & Annual Percent Change
Progress in Combating the
U.S. ESRD Epidemic
After 20 years of annual increases from 5 to 10
percent, rates for new cases of kidney failure have
stabilized
Better disease prevention methods appear to be
responsible
Use of angiotensin-converting enzyme inhibitors and
angiotensin receptor blockers
Better glycemic control
Better blood pressure control
NIH research has established the value of these
interventions
But, progress has not yet been realized across all U.S.
populations
Incident Diabetic End-stage
Renal Disease in the U.S.
Age 20 to 29 Years
35
Per million population
30
25
Caucasian
African American
20
15
10
5
0
Year
More Insights into Preventing
Complications of Diabetes
Microvascular damage – retinopathy
Macrovascular damage – CVD
Preventing complications by
preventing diabetes - DPP
Eye Disease: Intensive Diabetes
Treatment Reduces Risk
Cumulative Percent
100
Cumulative Incidence of
> 3-Step Change
75
Conventional
p = 0.001
50
25
Intensive
0
0
1
2
3
4
5
Study Years
6
7
8
9
Cumulative Incidence of Nonfatal
Myocardial Infarction, Stroke, or
Death from Cardiovascular Disease
Heart Disease: Intensive Diabetes
Treatment Reduces Risk
0.06
Conventional
0.04
0.02
Intensive
0.00
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
Years Since Entry into DCCT/EDIC Study
18
19
20
21
NIH and NIDDK Strategic
Research Plans
Strategic Plan for NIH Obesity Research
Developed by the NIH Obesity Research Task Force with
critical input from external scientists and the public
Research Toward Preventing and Treating
Obesity Through Behavioral and
Environmental Approaches to Modify
Lifestyle, with an Emphasis on Childhood
Obesity
Research Toward Preventing and Treating
Obesity Through Pharmacologic, Surgical,
or Other Medical Approaches
Research Toward Understanding the
Relationship Between Obesity and Its
Associated Health Conditions
Cross-cutting Topics – Technology,
Multidisciplinary/Interdisciplinary Research
Teams, Translational Research, Training,
Education/Outreach
Although listed separately, the first two themes are interdependent. We seek to
create an interdisciplinary approach in which lifestyle interventions are informed
by an understanding of the basic biological and genetic factors and vice versa.
Conquering Diabetes: A Scientific
Progress Report on The Diabetes Research
Working Group’s Strategic Plan
Highlights of Program Efforts,
Research Advances and
Opportunities related to:
Genetics
Autoimmunity and the Beta
Cell
Cell Signaling and Cell
Regulation
Obesity
Clinical Research and Clinical
Trials of Critical Importance
Progress and Priorities:
Renal Disease Research Plan
Important scientific resources
needed to reach research
goals include:
Conducting More Epidemiological
Studies
Creating Centers and Cooperatives
Creating New Ways to Study Renal
Injury
Focusing More on Genetic
Susceptibility
Developing a Renal Genomics
Project
Increasing Research on Treatments
Examples of NIH and NIDDK
Education and Outreach Programs
Weight-control
Information Network
The Weight-control Information Network (WIN) is
an information service of the NIDDK. WIN was
established in 1994 to provide the general public,
health professionals, the media, and Congress with
up-to-date, science-based information on obesity,
weight control, physical activity, and related
nutritional issues.
WIN produces, collects, and disseminates materials
on obesity, weight control, and nutrition.
National Diabetes
Education Program
The National Diabetes Education
Program (NDEP) is a federally funded
program sponsored by the National
Institutes of Health and the Centers for
Disease Control and Prevention and
includes over 200 partners at the
federal, state, and local levels, working
together to reduce the morbidity and
mortality associated with diabetes.
Components of the National
Diabetes Education Program
Control Your Diabetes. For Life. - To promote the
importance and benefits of diabetes control
Be Smart About Your Heart. Control the ABCs of
Diabetes - Encourages control of blood sugar, blood
pressure, and cholesterol
Small Steps. Big Rewards. Prevent type 2 Diabetes Translate and promote the Diabetes Prevention
Program (DPP) clinical trial findings
National Kidney Disease
Education Program
The National Kidney Disease Education
Program (NKDEP) is an initiative of the
National Institutes of Health, designed to
reduce the morbidity and mortality caused
by kidney disease and its complications.
NKDEP
Aerial View of NIH campus in
Bethesda, MD