Day of events highlights past and current efforts to fight diabetes

Oscar Crofford, M.D., shook his head in wonder.

The man who brought the nation’s first diabetes research center to Vanderbilt University in 1963, and who led the national trial, launched a decade later, which revolutionized the treatment of the disease, said he is astounded that “40 years later, the problem still exists.”

“We’re coming face to face with a substantial shortage of individuals to solve the problem,” Crofford said. “We don’t have enough people being trained as medical scientists to deal with the problems of diabetes. We don’t have clinicians being trained to take care of people with diabetes.

“And the problem’s going to get worse,” he said. “So anything that can be done to encourage students to channel their career in the direction of research and care of people with diabetes I think is very important.”
Diabetes affects 26 million Americans, more than 8 percent of the population, and cost the country $245 billion in 2012, according to the American Diabetes Association.

Crofford spoke Nov. 21, 2013, during the annual Diabetes Day at the Vanderbilt Student Life Center, which drew about 200 attendees to lectures by four nationally known diabetes researchers and a poster session displaying more than 70 Vanderbilt research projects.

Two young Vanderbilt scientists, one a graduate student in Biomedical Engineering, the other a postdoctoral fellow in the Department of Molecular Physiology and Biophysics, were named the first “Scholars in Diabetes” in honor of Crofford and another diabetes pioneer at Vanderbilt, Daryl Granner, M.D.

The graduate student, Christopher Nelson, who is developing a biodegradable “scaffold” to enhance diabetic wound healing under the mentorship of Craig Duvall, Ph.D., was named the Oscar B. Crofford Scholar in Diabetes at Vanderbilt.

Arion Kennedy, Ph.D., who is studying immune cells and animal models of obesity and hyperlipidemia in the laboratory of Alyssa Hasty, Ph.D., was named the Daryl K. Granner Scholar in Diabetes at Vanderbilt.

Alvin Powers, M.D., currently director of both the Vanderbilt Diabetes Research and Training Center (DRTC) and Vanderbilt Diabetes Center, also announced the creation of lectureships in Crofford’s and Granner’s names.

Alisa Escue, administrative officer of the Vanderbilt Diabetes Center, received the Robert Hall Award for her service to the center.

The event was sponsored by the DRTC and the Vanderbilt Center for Diabetes and Translation Research (CDTR), both of which are funded by the National Institutes of Health.

In addition to the DRTC and the CDTR, which is led by Tom Elasy, M.D., MPH, the Vanderbilt Diabetes Center includes the Vanderbilt Eskind Diabetes Clinic, named for the late Nashville physician, philanthropist and VUSM alumnus Irwin B. Eskind, M.D., ‘48.

Shubhada Jagasia, M.D., associate professor of Medicine, is medical director of the Eskind Clinic, which also is home to Vanderbilt’s diabetes program for children and adolescents. That program is led by William E. Russell, M.D., Cornelius Vanderbilt Professor of Pediatrics and director of the Division of Endocrinology and Diabetes.

Attending Diabetes Day were the sons of Eskind and his widow, Annette—Jeffrey Eskind, M.D., and Steven Eskind, M.D., both Vanderbilt faculty members.

The DRTC also serves as the coordinating center for the nationwide, NIH-funded Medical Student Research Program in Diabetes, which Crofford and the late Phillip Felts, M.D., first launched as a prototype in the mid-1970s. In 2013, 115 medical students from more than 75 medical schools presented their research during an annual symposium at Vanderbilt.

Also attending Diabetes Day was Margaret Hargreaves, Ph.D., professor of Internal Medicine at Meharry Medical College and a member of the DRTC who has contributed significantly to research on the disproportionately high impact of diabetes and other diseases in minority communities.

Granner, who led and expanded the DTRC during much of the 1990s, said the rising cost of diabetes is “unsustainable.”

“The projections are that in a generation, maybe less, the annual cost of diabetes alone will be what the defense budget is today (more than $600 billion),” Granner said.

Cutbacks in federal funding for research are reducing incentives “for people to stay in diabetes research, even more to go into it, particularly clinicians,” said Alan Cherrington, Ph.D., who succeeded Granner as chair of Molecular Physiology and Biophysics and who, like Crofford, served as president of the American Diabetes Association.

“Now is not the time to pull the research-dollar rug out from under the enterprise,” agreed Kevin Niswender, M.D., Ph.D., associate professor of Medicine and of Molecular Physiology & Biophysics.

“We’re literally at a turning point in diabetes, in understanding a lot of these other influences on the brain, on other parts of the body,” Niswender said.
Vanderbilt’s far-flung diabetes efforts include studies of the pancreatic islet, recent advances in understanding the genetics of the disease, the role of oxidative stress, which is aggravated by obesity, and how parents can help increase the fitness and decrease the risk of obesity in their children.

Tight control of blood glucose levels, the lesson of the Diabetes Control and Complications Trial (DCCT), which Crofford led, revolutionized the treatment of type 1, insulin-dependent diabetes. Many people on insulin “do phenomenally well,” avoiding complications like diabetic neuropathy, retinopathy and nephropathy. But many others do not, Niswender said.
In addition, the tidal wave of diabetes hitting the country is of the type 2 variety, characterized by insulin resistance, and associated with obesity.

More than 120 Vanderbilt faculty members from 15 departments and three schools are affiliated with the Vanderbilt DRTC and are conducting a wide range of research to improve the understanding and treatment of all forms of diabetes.

Associate directors of the DRTC are Roger Cone, Ph.D., chair of Molecular Physiology and Biophysics and director of the Vanderbilt Institute for Obesity and Metabolism, and Owen McGuiness, Ph.D., professor of Molecular Physiology and Biophysics.

Other DTRC leaders include Maureen Gannon, Ph.D., who directs its enrichment, training and outreach program and helped organize Diabetes Day; Richard O’Brien, Ph.D., who coordinates the center’s research base; and Roland Stein, Ph.D., director of the center’s pilot and feasibility program.