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Dealing with diabetes. Clinical studies, education bring hope for the future. By Sherri Deatherage Green.

Diabetes isn't a quick-fix disease. Managing its effects becomes a lifelong, often life-saving goal for the growing number of Americans who suffer from it.

Treating today's patients means keeping blood sugar, cholesterol and blood pressure in check while watching for a host of other complications. It also means researching and developing new drugs and treatments that can improve their prognoses and those of future patients. The Diabetes Center at the University of North Texas Health Science Center at Fort Worth does both.

Testing new drugs

Medication and devices used to monitor and treat diabetes  
Staff at the Diabetes Center treat the unique problems of diabetes patients and research new drugs that can improve their prognoses.    

By treating only diabetes patients, the center can focus on their unique problems and educational needs. The staff also enhances medical knowledge of the disease through research in the examining room and the laboratory.

"Clinical research is the essence of what we're about," says Michael Clearfield, D.O., associate dean for clinical research at the Health Science Center. "Without research, you'll have no new therapies, no new knowledge."

Drug studies make up the vast majority of clinical research projects. The Diabetes Center regularly helps the world's leading pharmaceutical companies test new medications.

For example, last year Diabetes Center doctors and other specialists in diabetes treatment from around the world tested one blood pressure drug's ability to reduce and reverse kidney damage. Medications taken by diabetics to lower blood pressure, and thereby reduce kidney damage, often act on angiotensin II. The hormone causes blood vessels to narrow, increasing blood pressure. Diabetics often take angiotensin converting enzyme (ACE) inhibitors, but some patients develop coughs or allergies as a result of taking these drugs.

Patients at the Diabetes Center tested angiotensin receptor blockers (ARBs), which keep cells from taking up the hormone. ARBs not only reduce blood pressure, but also may do a better job than ACE inhibitors of facilitating cell repair with fewer side effects, explains Craig Spellman, Ph.D., D.O., Diabetes Center director.

Future treatments

Medical assistant Millicent Patterson and patient discussing importance of a balanced diet
Medical assistant Millicent Patterson, right, talks about the importance of a balanced diet in managing diabetes.  

Often, patients who enter clinical studies do so because generally available medications aren't helping them, Spellman says. Not only can the groundbreaking treatment they receive better manage their conditions, but participants also gain the satisfaction of knowing they are doing something to help future patients.

In most cases, medication, lab work and treatments are free, paid for by pharmaceutical companies, government grants, philanthropic foundations or the medical school itself.

"The patient has hope, the patient gets care, and new information is derived," Spellman says. About 200 patients a year participate in clinical research programs at the Diabetes Center.

Health Science Center researchers test drugs almost ready for market — and their laboratory work can influence medications and treatments that will be used 10 or 20 years from now.

For example, graduate student Paul Aoun, working under the guidance of pharmacology department chair James Simpkins, Ph.D., tested a class of drugs called thiazolidinediones (TDZs) on tissue samples. These drugs combat insulin resistance in people with type 2 diabetes, but Aoun's research showed that they might also help save dying cells.

"Most people thought they just brought down sugar levels," Spellman explains. "What Paul was able to show is that they were able to protect cells from death."

Educating patients

The dramatic potential for improving patients' health, even saving their lives, attracted Spellman to the research and treatment of diabetes. The key to successful treatment is managing patients' conditions and maintaining goals for things like blood sugar, cholesterol levels and blood pressure, he says. Eighty to 90 percent of the Diabetes Center's patients achieve those goals.

Researcher Enisa Arslanagic  
Health Science Center researcher Enisa Arslanagic reviews case report forms for the Diabetes Center’s studies.    

Treating this chronic and potentially life-threatening disease requires constant testing, regular immunizations and frequent foot, eye and dental exams. Ideally, primary care physicians carefully coordinate treatment with other medical professionals, keep up with cutting-edge developments and thoroughly counsel clients on how to best manage their conditions. Many, however, don't have the time or resources the Diabetes Center physicians have through specialization.

Education comprises a major component of the center's program, because successfully managing diabetes depends largely on what patients do outside the doctor's office.

"We're committed to the concept that patients must actively participate in controlling their own diabetes and its complications," Spellman says. "The days are gone when a physician simply tells a patient what to do."

Craig Spellman with patient
Craig Spellman, left, director of the Diabetes Center, explains that patients must actively participate in controlling their own diabetes.  

Three certified diabetes educators teach multilingual classes and work one on one with patients to help them better understand the disease and learn the importance of medication, blood-sugar testing, diet and exercise.

"The successful educator is probably closer to a minister than anything else," Spellman says. "Not a day goes by that they aren't out in the community doing programs on how to cook, how to eat, how to exercise."

Many are registered nurses or licensed dieticians who undergo an additional 2,000 hours of training and exhaustive tests to become CDEs. They translate medical jargon so patients can interpret their test results and understand why taking medication properly is vital to maintaining good health.

Spellman and his colleagues constantly work to improve the treatment of Diabetes Center patients and add to the scientific knowledge base.

Treating diabetes can be particularly rewarding for doctors because their efforts can have a huge impact on improving patients' lives and health.

"With the right intervention, you can essentially halt or reverse problems that can become complete life compromises — dialysis, blindness, amputation," Spellman says.


Diabetes 101  

Most people think diabetes is all about sugar. They may have heard it can lead to blindness or amputations, but that’s really just the beginning.

"Sugars are one component out of 20 things that are abnormal in diabetes," explains Craig Spellman, Ph.D., D.O., director of the Diabetes Center at the University of North Texas Health Science Center at Fort Worth. Cholesterol, fatty acids, blood pressure and weight also must be closely monitored and controlled. In fact, 70 percent or more of people with diabetes die from heart attacks and stroke, according to the American Diabetes Association. Research performed at the Texas Diabetes Institute in San Antonio proved someone with the disease faces the same risks of heart attack as a hospitalized patient recovering from one, Spellman says.

Diabetes develops when the body’s ability to deliver glucose to cells becomes impaired. Without glucose, or sugar, cells starve. Glucose enters the bloodstream through the food we eat and is broken down by the liver.

To enable cells to absorb sugar, the pancreas must produce insulin. This hormone acts as a key, unlocking cells so glucose can enter. If not enough insulin is produced, or if an imbalance of other hormones keeps insulin from doing its job properly, excess sugar builds up in the blood.

Left untreated, diabetes can devastatingly affect the entire body — from the kidneys to the heart to the eyes. Sores heal slowly, the immune system becomes impaired, and nerve damage may dull pain to the point that those affected don’t realize the severity of injuries. These complications can lead to damaged limbs that require amputation.

Most cases of diabetes fall into two categories. Type 1 often is called juvenile diabetes or insulin-dependent diabetes because it usually develops in childhood and is treated with daily insulin injections. With type 1, the body’s immune system malfunctions and attacks the pancreatic cells that produce insulin.

Much more common is type 2 diabetes, the type that 90 to 95 percent of people with diabetes have. Often referred to as adult-onset diabetes, type 2 results from the body producing too little insulin or cells becoming resistant to it. Type 2 is related to obesity and aging and often can be controlled through diet and exercise.

































































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