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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?

So physicians should understand that genetics is very important, but it’s not the answer to all the problems we’re dealing with, by a long shot. Personalized medicine is important, but just being able to bring information to the physician-patient relationship, is very important. And it’s not going to be very long before the kinds of information can be ground out by some really interesting and modern data mining and statistical programs, so that you can say, OK, if you’re this, and you have this record, and you live this way, and you’re this many pounds overweight, and you have this kind of regimen, these are your risks. Doctors will be able to share those kinds of predictive analytics with their patients.

And we’re not really certain how much is environmental and how much is genetic, in the explosion of diabetes right now?

For many, the idea of the increase in diabetes has to do with overweight, obesity, and over-nutrition of various kinds. Now, those will be important; but it can’t explain a lot of the increase in diabetes. It can explain some of it, but certainly not anywhere near all of it.

Might there be some environmental elements, as in the natural environment, at play here?

My favorite idea is that it has to do with a change in the microbial populations in humans, with shifts in the microbiome. We know that those can be causal, in mouse experiments. And we know that diabetes and changes in the microbiome can be causal in humans. We don’t know that changes in the microbiome can be causal in humans; we know it is true in mice. I have a strong suspicion that changes in the microbiome in humans can have a causal effect. And that would be great if that turned out to be true, because at least we’d have something to look very carefully at. We’re learning a lot, but we still don’t understand the balance of the microbiome and the ways in which that shifts things in humans, and how much the history of childhood through adulthood has an effect.

Do you believe that the two streams of information, from population health management, and from pure scientific research, can be complementary?

Absolutely. Just doing really good mining of data from patient records, can provide some absolutely key clues that one can use to try to identify fundamental causes.

I think it will be an interesting time in the next five years, as information will be flowing into physicians and healthcare organizations, from two different points.

Yes, and the shift from paper records to electronic records, and finally, to query-able data, will provide interesting and very powerful information for medical research. And there will be problems with privacy and those things, but things have changed so rapidly. So this is probably the best time ever to do biological research.

Is there anything you’d like to add?

I think that one of the things that we should realize is that the computational and the underlying mathematical approaches, to doing this kind of mining, and finding these clues in both the patient data as well as in research-level data—we need a lot more people to pay attention to developing new ways of doing this kind of thing. So getting computer scientists, mathematicians and other people who are trained, to work with both scientists and physicians, is a major new area that we should emphasize. The value of some of the more abstract and arcane mathematics and computer science will be really important for the future of human medicine. When you analyze all kinds of data from climate and agriculture, or whatever, those may be complex, but there isn’t anything I know that’s more complex than the human body; and that requires new approaches.




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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