New Funding Supports Fight Against Greatest Challenges of Diabetes

June 29, 2011
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In 2008, an estimated 51 million adults had prediabetes in the U.S. Just two years later, that number had ballooned to 79 million. A proportion of these adults will soon join the 25.8 million people nationwide who already have diabetes.

In California, the statistics are equally troubling, where one in seven adult Californians has diabetes, at a total cost of approximately $24 billion a year.

"It is a tsunami that's going to hit us," said Matthias Hebrok, the Hurlbut-Johnson Distinguished Professor in Diabetes Research and director of the UCSF Diabetes Center. While more than 90 percent of the prediabetic in the U.S. are type 2, he added, referring to the variation typically associated with being overweight, the incidence of type 1 diabetes caused by an autoimmune response against insulin-producing beta cells is also on the rise.

In the face of this dire trend, a member of the Diabetes Center Leadership Council has funded UCSF to fight against the greatest challenges of preventing and treating diabetes, ranging from how to communicate better with literacy-challenged patients to discovering rare mutations of genes that contribute to type 1 diabetes.

The UCSF Diabetes Family Fund for Innovative Patient Care, Education and Scientific Discovery, created by one anonymous donor who is committed to diabetes research, seeks to stimulate and support creative, collaborative and imaginative innovations in diabetes clinical care, patient education, medical training and diabetes-related clinical and basic research through awards of up to $500,000 for one to three years.

The focus is to support projects that will produce outcomes and discoveries that are transformative, with particular emphasis on the adolescent population. The fund will also benefit the greater "family" of diabetes patients, whether part of UCSF and its affiliates, or of the broader at-risk community, including vulnerable and underserved or limited-English speaking populations.

This unique award funds not just research, but also efforts across the scope of patient care. According to Hebrok, the donor wanted the funding to be directed as broadly as possible, hitting every facet of a patient's life, from improving access and prevention to spurring scientific discoveries that could have broad implications down the line.

"Often donors have specific ideas about what they want to fund, like bricks and mortar, specific people or areas of research — all of which we very much appreciate," he said. "This funding is going out into the UCSF community to get the best ideas, to build relationships among people who have not previously worked together and to promote interactions between disciplines."

The team of Dr. Dean Schillinger, director of the UCSF Center for Vulnerable Populations (CVP) at San Francisco General Hospital (SFGH) and chief of the California Diabetes Program received funding for two projects centered on treatment and prevention for vulnerable populations.

The first project, titled "Bridging the Digital Divide in Diabetes among the Underserved, from Populations to Patients," supports the expansion of a proven multi-lingual, literacy appropriate automated calling system that provides weekly phone calls to patients in their native language, asking them about their self-care behaviors, such as medication adherence and diet, as well as their psychological and emotional well-being. Patients respond using touch-tone commands, and receive immediate, automated, tailored education based on their responses. Responses that raise red flags are immediately followed by a live call from a nurse care manager or health coach who speaks the patient's primary language. Schillinger will work closely in this project with Dr. Lisa Murphy, chief of Endocrinology at SFGH, and director of the Diabetes Clinic for High-Risk Populations.

"There is a clear need to communicate with patients, and language and literacy present a problem," said Schillinger, an expert in communication science. "We're leveraging an accessible form of health IT to create something that's effective, patient-centered and scalable, which is critical."

A second project will educate youth about diabetes through a collaboration with Youth Speaks, a San Francisco Bay Area-based community arts program that makes contact with more than 45,000 Bay Area youth annually. Titled "Brave New Voices: Empowering Minority Youth to Engineer a Diabetes Prevention Social Media Campaign," the project will develop a youth-targeted diabetes prevention campaign using youth-generated "spoken word" messages around key diabetes prevention targets. These messages, and an associated toolkit, will be broadly disseminated throughout the Bay Area using live performances, school-based workshops and social media platforms.

"Younger people, especially those raised in the inner city, are getting type 2 diabetes in the prime of their lives when they should be studying, working and raising a family," said Schillinger.

Because type 2 diabetes often has an incubation period of years to decades between exposure to risks and the development of illness, most young people are not aware of how their communities and local resources shape their behavior, and how that behavior can lead to diabetes at younger ages.

"Most youth don't know that the diabetes epidemic is clustered in certain neighborhoods, and very few ever get activated around it," Schillinger added. "The way society is structured is contributing to this epidemic. In low-income neighborhoods, it's much easier to make unhealthy choices." Getting youth to champion change through social media is a novel and promising approach.

These innovative efforts to reach out to the community will be joined by efforts to fight this disease through cutting-edge bench research.

Dr. Mark Anderson, the Robert B. Friend and Michelle M. Friend Endowed Chair in Diabetes Research, runs a basic science lab in the UCSF Diabetes Center, and with this new funding will explore the genetic underpinnings of diabetes. "One of the ways to understand complex diseases like this is to find genes that underlie the disease," Anderson said. "The funds will be used for a new and exciting technology that looks for rare mutations in genes that could contribute to diabetes."

By looking at families where the inheritance of diabetes is very strong, Anderson and his fellow researchers will use massive parallel sequencing — a revolutionary technique that can sequence billions of DNA molecules in one run to identify gene mutations. "We then bring it into the lab and start working on how this mutation is leading to diabetes," he said. "This work has the potential to open new avenues for both our understanding and treatment of diabetes."

These are just some of the 11 projects that received funding from the award, launching a new era of research and patient care at the UCSF Diabetes Center, which celebrated its tenth year in 2010.

For more than half a century, researchers at UCSF have been at the center of major developments in diabetes treatment and care. From the first to clone the human insulin gene that produced insulin, making possible the unlimited supply of human insulin available today, to the first to demonstrate that elevated blood sugar causes complications, helping to pioneer the intensive glucose control strategies now used worldwide, UCSF's history of innovation is recognized across the globe. Today, with the aid of this funding, the UCSF Diabetes Center will continue its singular mission to bring lasting improvements in quality of life to individuals with type 1 and type 2 diabetes.


Proposal Title: Improving Health Care Delivery for Adolescents and Young Adults with Diabetes: Creating a Multidisciplinary Diabetes Transition Program at UCSF

Applicants/Collaborators: Megumi Okumura, MD
Saleh Adi, MD, Stephen Gitelman, MD, Martha Nolte Kennedy, MD, Umesh Masharani, MD

Proposal Title: GlucoseDose

Applicants/Collaborators: Benjamin Parcher, CPhT
Vincenzo Melchiorre, Tejal Desai, PhD

Proposal Title: A Motivational Mobile Diabetes Prevention Program for Low-Income and Ethnic/Minority Populations

Applicants/Collaborators: Yoshimi Fukuoka, PhD

Proposal Title: Bridging the Digital Divide in Diabetes among the Underserved: From Populations to Patients

Applicants/Collaborators: Dean Schillinger, MD
Elizabeth Murphy, MD, PhD, Margaret Handley, PhD, MPH, Lauren Goldman, MD, MS, Umimata Sarkar, MD, MPH, Joy Graham, AHIP, MLS

Proposal Title: Brave New Voices: Empowering Minority Youth to Engineer a Diabetes Prevention Social Media Campaign

Applicants/Collaborators: Dean Schillinger, MD
Susan Lopez-Payan, James Kass, Marc Bamuthi Joseph, Rolando Brown, Susie Lundy, PhD

Proposal Title: Identification of Novel Diabetes Genes through Whole Exome Sequencing

Applicants/Collaborators: Mark S. Anderson, MD, PhD
Michael German, MD, Stephen Gitelman, MD, Umesh Masharani, MD

Proposal Title: A Hematopoietic Circuit Controls Cold-and Diet-Induced Thermogeneis

Applicants/Collaborators: Ajay Chawla, MD, PhD
Richard Locksley, MD

Proposal Title: Role of the Vitamin D Receptor in Controlling Insulin Secretion and Sensitivity

Applicants/Collaborators: David G. Gardner, MD
Wei Ni, PhD

Proposal Title: Using Nkx2.1 sf1cre Female Mice to Ask If Synthetic and Natural Estrogens Reduce the Risk of Obesity and Metabolic Defects in Postmenopausal Women

Applicants/Collaborators: Holly Ingraham, PhD
Stephanie Correa, Allison Xu, PhD

Proposal Title: Modeling the Functional Role of Microglia in Diet-Induced Neuroinflammation, Leptin Resistance and Obesity

Applicants/Collaborators: Suneil Koliwad, MD, PhD
Allison Xu, PhD, Nevan Krogan, PhD, Assen Roguev, PhD

Proposal Title: An In Vivo Screen for Small Molecules that Stimulate Pancreatic Beta-Cell Proliferation

Applicants/Collaborators: Didier Stainier, PhD
Nikolay Ninov, PhD, Daniel Yoo

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