From Internal Medicine
A Message from the Michigan Diabetes Research Team and President-Elect of Medicine and Science for the American Diabetes Association
Today is World Diabetes Day. The theme for this year's Word Diabetes Day is "Access to Diabetes Care".
537 million people have diabetes worldwide. That’s one in every 10 persons, and unfortunately the prevalence continues to rise. This is placing excessive burden on both all people living with the disease and the health care systems, leading to staggering health care costs and less access to care.
Morbidity and mortality from diabetes is driven by the extent of chronic complications. These include cardiovascular disease (coronary artery disease, heart failure, cerebrovascular disease, and peripheral arterial disease), diabetic kidney disease, diabetic neuropathies, diabetic retinopathy and macular edema, and diabetic foot complications, as well as more recently recognized complications, such as uropathy, sexual dysfunction, cognitive decline and dementia, and diabetes-related oral complications.
Thus, in-depth understanding of the biology and pathophysiology of diabetes complications is crucial for unveiling and implementing optimal therapeutic strategies in the clinical care for all people with diabetes to prevent and/or reverse diabetes burden and to improve the lives for all.
Program for Clinical Research in Diabetes Care and Complications
The Program for Clinical Research in Diabetes Care and Complications is a dedicated team of researchers led by Rodica Pop-Busui, MD, PhD, Larry D. Soderquist Professor in Diabetes, Chair of Clinical Research for the Elizabeth Weiser Caswell Diabetes Institute, and President-Elect of Medicine and Science for the American Diabetes Association. Our team has been continuously at the forefront of diabetes research and care through seminal work that spans broadly the entire diabetes spectrum, including:
- managing type 1 and type 2 diabetes
- finding new targets and treatments for chronic diabetes complications
- preventing all diabetes-related amputation, using diabetes technologies and behavioral interventions to improve diabetes care and implementing the evidence unveiled by research into clinical care
- understanding the impact of social determinants of health that impact the access to optimal care in people with diabetes
We work as an united team of physicians-scientists from multiple specialties, other researchers, nurses and clinical coordinators, statisticians, and trainees. Importantly, this work is done in a strong partnership with all our research participants whose generous help is instrumental to the advancement of obtaining the best evidence and disseminating the knowledge into clinical care.
Our interactions with our research participants are as partners, while also trying to educate.
“During our clinical trial visits, we review each individual’s laboratory work, including their HbA1c. We discuss significance of HbA1c value, as well as any other abnormal labs. We educate patients on the importance of monitoring blood glucose, including when they should check it and how to use the various technologies, such as CGMs. Additionally, we educate them on the importance of following a healthy diet, exercise, and counting their food carbohydrates correctly. We also discuss the importance of monitoring their feet daily, wearing proper footwear, and being seen by podiatry at a minimum of once per year.” - Cindy Plunkett, RNC, CCRC, Clinical Study Nurse Coordinator
Highlights of our current projects
The Diabetic Foot Consortium (DFC), funded by a NIDDK U01 grant, is the first-ever multicenter network to study diabetic foot ulcers, a common and burdensome complication of diabetes and the leading cause of lower limb amputations in the United States. The DFC aims to lay the foundation for a clinical trial network to test how to improve diabetic wound healing and prevent amputations in all people with diabetes. View the current DFC studies and synopses.
Two “fast facts” about diabetic foot care and the importance of this work:
- More than 65,000 lower limbs are amputated annually due to complications from diabetes.
- Including a podiatrist in your diabetes care can reduce the risk of lower limb amputation up to 85 percent.
The Michigan Medicine DFC clinical center, led by corresponding principal investigator, Dr. Rodica Pop-Busui, and principal investigators, Crystal Holmes, DPM, CWSP and Brian Schmidt, DPM, works closely with the data coordinating center that is also housed at Michigan Medicine, led by principal investigator, Cathie Spino, ScD. The Michigan Medicine team hosted the entire DFC Steering Committee (around 50 members) in a productive 2-day meeting on November 6-8, 2022.
Left: Diabetic Foot Consortium (DFC) Steering Committee | Right: Michigan Medicine DFC Team
The JDRF Center of Excellence at Michigan Medicine is a cross-departmental center grant studying the heterogeneity in the risk of diabetes complications and beta cell dysfunction in people with type 1 diabetes. The JDRF Center of Excellence uses state-of-the-art metabolic profiles and metabotypes, as well as complex AI and reinforced learning methods, to identify predictive markers and new therapeutic targets for type 1 diabetes and its complications.
Michigan Medicine principal investigators include Thomas Gardner, MD, MS; Matthias Kretzler, MD; Joyce Lee, MD, MPH; Subramaniam Pennathur, MD; Rodica Pop-Busui, MD, PhD; Lonnie Shea, PhD; and Scott Soleimanpour, MD.
Our team is also currently engaged in several trials aiming to find disease modifying therapies for people with diabetic neuropathy and diabetic kidney disease and in studies targeting the understanding of the effects of COVID-19 in people with diabetes and the risks for long COVID, all funded by the NIH. We are also involved in multiple interventional trials using various diabetes technologies, including artificial pancreas or new agents to reverse cardiovascular disease in people with diabetes.
Our research team has many incredible early career faculty
- Kara Mizokami-Stout, MD, MSc - Dr. Mizokami-Stout has a NIDDK funded K23 grant that focuses on implementing continuous glucose monitoring (CGM) devices into primary care settings for insulin-requiring type 2 diabetes.
- Brian Schmidt, DPM - Dr. Schmidt has a NIDDK funded K23 grant that evaluates the diabetic foot ulcer (DFU) microbiome as a modifiable factor to prevent DFU infection and improve outcomes using novel metagenomic next generation sequencing techniques. The identification of the components of the DFU microbiome that predicts infection will directly lead to targeted therapies for those with a current DFU.
- Yu Kuei Alex Lin, MD - Dr. Lin has a NIDDK funded K23 grant that evaluates hypoglycemia risk and individuals’ beliefs regarding hypoglycemia and the use of technologies that could impact adherence to and achieving optimal diabetes care.
- Salim Hayek, MD - Dr. Hayek’s research focuses on the study of inflammation as the link between cardiovascular disease and kidney disease. Dr. Hayek and Dr. Pop-Busui have published several manuscripts on the impact of COVID-19 on persons with diabetes, as well.
Our program has extended collaborations with teams of researchers in the United States and internationally. We highlight our strong collaborations with the Steno Diabetes Centres in Denmark, as part of the Steno North American Fellowships, that fosters teamwork from scientists from Michigan Medicine and partnering Steno Centers. For example, our current visiting scholar, Dr. Jesper Fleischer from the Aarhus STENO Diabetes Center, is working with our team on several machine learning projects, as well as validating easier screening tests for diabetes complications at the point of care.
For more information about our research, visit the Program for Clinical Research in Diabetes Care and Complications website.
We are very fortunate and proud to call Michigan Medicine the home of the world’s top diabetes experts. We recognize that we are just one of many excellent disciplinary teams addressing diabetes care and research and we acknowledge the incredible support from many cross-departmental teams and resources. These include, but are not limited to, the Division of Metabolism, Endocrinology & Diabetes, Department of Internal Medicine, Elizabeth Weiser Caswell Diabetes Institute, Michigan Diabetes Research Center, Michigan Center for Diabetes Translational Research, and Michigan Collaborative for Type 2 Diabetes.
The American Diabetes Association has updated its Standard of Care Guidelines in 2022 - click here.
The International Diabetes Federation World Diabetes Congress has excellent educational materials on understanding diabetes and its management, as well as educational pamphlets for both clinicians and patients - click here.