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Diabetes Research, Diabetic Care, and the New Informatics: One Eminent Scientist’s Perspective

October 24, 2013
by Mark Hagland
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How are advances in research into diabetes, diabetes patient care, and population health and clinical informatics, all coming together?

David J. Galas, Ph.D.  is principal scientist for the Pacific Northwest Diabetes Research Institute (PNDRI), a Seattle-based non-profit biomedical research organization founded in 1956 that is helping to lead global research into the disease that is diabetes. Dr. Galas, one of the world’s preeminent research scientists in the diabetes field, was responsible for discovering the gene that partly regulates bone metabolism. His breakthrough research has led to the development of a new medicine that may eliminate osteoporosis as a health problem.

Galas, 69, has had a highly distinguished career that has included service as director of health and environmental research at the U.S. Department of Energy, where he directed the Human Genome Project. These days, in addition to continuing to pursue basic research into diabetes, Dr. Galas serves as chairman of the Fannie and John Hertz Foundation board of directors. He himself was a Hertz Fellow, during the period 1968-1972, and benefited from the beneficence of that foundation, whose mission is “to provide unique financial and fellowship support to the nation’s most remarkable PhD students in the physical, biological, and engineering sciences.”

David Galas, Ph.D.
(photo by Story Motion Studios)


Recently, Dr. Galas spoke with HCI Editor-in-Chief Mark Hagland about what’s being learned in basic science around diabetes, how that research work is dovetailing with advances in diabetes patient care, and the connections between and among advances in those two areas and parallel advances in clinical informatics, population health management, and analytics. Below are excerpts from that interview.

What has been learned in the last 40 years, in diabetes research?

That’s a really good question. Diabetes is clearly one of the most complex of the diseases that we classify as diseases; and that is partly clearly due to the number of different biological systems it engages—metabolism, energy production, and regulation of so many things that are essential to bodily function. My research is very much focused on the most fundamental things driving both diabetes and other related processes; just trying to understand some of the processes involved is a major issue.

So what’s been learned? We have a lot of information about some of the genetic determinants that can predispose people to diabetes; and we also know a lot about the environmental factors connected to diabetes. We know that obesity and diabetes are connected, though we don’t know how. And we don’t understand why diabetes is increasing in almost all populations, not only in the U.S., but also in Asia and Europe. Type 2 diabetes, but not only type 1, is increasing. And the potential complexity is frustrating. We do know a lot more than we did 20 years ago about some of the fundamental metabolic processes.

But overall, in terms of the most common types of diabetes we see in the population—I’d say we haven’t made a lot of progress on the pure science of this. We’ve learned a lot about how to treat it, how to control glucose, for example; but the fundamental mechanisms are still a mystery. But the human genome project and the changes in technology have really revolutionized the kinds of research we can do around this and other problems; and the explosion of detailed molecular information has been so profound, just in the last five years or so, that it leads one to think that a really complex disease like diabetes, is going to yield to some of our investigations in the next few years.

So it’s very exciting to be in this area right now?

Yes, it’s very exciting. Well, it’s very exciting in all biology right now, because of the revolutionary changes that have been taking place.

What should physicians understand about the pure research, and where it’s taking us right now?

Before I would try to answer that, I would say that one of the great challenges we have with this tremendous explosion of basic capabilities is, how do we impact patients and doctors more rapidly than we have in the past? If you wait until some new drug goes through clinical trials, you’re talking about 10 to 15 years before you have an impact. And there, I think, the computational informatics will have a huge impact. We’re beginning to understand more about the genetic susceptibilities. And that’s very important; it’s a lot of what people talk about when they talk about personalized or genomic medicine. And while that’s really important, that’s just one aspect of where this revolution is going.

And the most important thing to realize, for those of us trying to make a difference, is that all of the types of data that one can keep track of with respect to patients, groups of patients, in healthcare systems, in geographic areas, etc., is that keeping track of medical records and any information we have about the environment, the diet, of individuals, can do a lot to help us understand the various risks that certain populations have, whether or not it’s determined fully by genetics or only influenced a little bit by genetics. So the integration of all this data, and the mining of this into informational relationships, is very important, even before we understand the biological basis of all of this.


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I am glad to know that there are such great advances being made to identify causal factors of diabetes, especially type 2. I have been diagnosed with type 2 diabetes for about one and a half years and through through my journey with the condition, I have learned of other causal factor that can be presently examined. There is now much information available that confirms that statin medications can create increases in blood sugar. I have been on lipitor for years and years. Until recently, it was never a thought that the lipitor could be contributing to my diabetes. With my doctor's approval, I have stopped the lipitor. I am now displaying blood sugars that are consistently within the normal range. I remain on my diabetes medications at this point and continue to eat in a healthy manner and exercise regularly. However, I will be discussing with my doctor if I can begin tapering off of the medications based on my next A1C and fasting blood sugar results. My doctor also said that there are other cholesterol lowering non-statin medications that he can prescribe if my cholesterol remains a problem.

Thank you very much for your comment here. What I think is particularly exciting is the potential for three different disciplines--core scientific research, patient care delivery, and informatics--to come together to improve and personalize the situations of individuals like yourself, and to truly optimize care delivery and care management for those with diabetes. The potential is very strong and very imminent. Thank you again for your comment.

People with Type 2 diabetes generally are put on a 1500-1800 calorie diet per day to promote weight loss and then the maintenance of ideal body weight.

Diabetes has grown to “epidemic” proportions and the latest statistics revealed by the US Centers for Disease Control (CDC) state that 25.8 million Americans have diabetes. Also, research from the ADA shows that 79 million Americans have pre-diabetes, which is 25% of the US population!
The cost of diabetes to our nation is a staggering $245 billion dollars a year as of 2012. That’s $176 billion in direct medical costs and another $69 billion loss in productivity