Posted by Sandy Donchess on February 24, 2000 at 21:56:15:
Grant helps create U-M diabetes center
$6.6 million will combat destructive powers of the feared illness
Max Ortiz / The Detroit News
Rebecca Wilson underwent more than 20 operations, but doctors couldn't stop diabetes from savaging her vision. By May 1992, Wilson was a statistic -- one of the 24,000 new cases of blindness caused annually by diabetes.
ANN ARBOR -- As a student at Henry Ford Community College in 1991, Rebecca Wilson was surprised to glance blood droplets in her own eye while peering into a microscope -- droplets that soon spread like an explosion of red cobwebs through both eyes.
Fright flashed across the face of the first doctor who later examined Wilson, a lifelong diabetic who had worked diligently to control her blood-sugar levels.
"I knew I was going to lose my sight," said Wilson, now 27, of Garden City.
More than 20 operations followed, but doctors couldn't stop diabetes from savaging her vision. By May 1992, Wilson was a statistic -- one of the 24,000 new cases of blindness caused annually by diabetes.
Doctors have known too little about how diabetes wreaks this havoc to stop it, but that may change with the help of a $6.6-million grant from the Juvenile Diabetes Foundation to the University of Michigan announced today.
Researchers at U-M -- who will use the funds to create a Center for the Study of Complications in Diabetes -- have developed a promising new theory that may solve the mystery of how diabetes causes emotionally devastating and financially costly complications.
In addition to blindness, diabetes also results in 56,000 amputations, as a result of nerve damage; 27,999 cases of kidney failure; and 77,000 deaths from heart disease each year, the American Diabetes Association estimates. About 16 million Americans now live with some kind of diabetes-related complication, and the disease costs the nation about $100 billion annually.
U-M researchers, such as Dr. Douglas Greene, who is director of the Michigan Diabetes Research and Training Center and will head the new complications center, believe the same chemical process may be to blame for all of these diabetic complications -- meaning one key could unlock all of the problems.
If Greene and his associates are right, U-M may be able to develop a treatment to stabilize the progression of complications or halt them in their steps. Essentially, they could rob diabetes of its destructive powers.
"This could have a major impact on people with diabetes," said Dr. Bob Goldstein, chief scientific officer of the Juvenile Diabetes Foundation, the leading nonprofit backer of diabetes research.
"It's an important theory," he said. "We hope they're right."
The theory
Diabetes is a disorder in which insulin is not properly produced or used by the body, resulting in poor use of glucose, the fuel into which food is converted and the body needs. The disease, when not properly controlled by diet, exercise and drugs, triggers a series of complicated chemical reactions in the body that result in complications.
U-M's new theory focuses on how the chemical reactions triggered by diabetes cause certain toxins, called free-oxygen radicals, to accumulate on cells.
The build-up of these toxins essentially make the cells sick, robbing them of needed blood and growth factors, in a process called oxidative stress, said Dr. Eva Feldman, a U-M neurologist who will serve as associate director of the new center. Eventually, this suffocation leads to a cell death known as apoptosis,
Doctors have for some time suspected oxidative stress is a cause of complications, but U-M's theory is novel because it weds oxidative stress theories to apoptosis in explaining how complications might happen.
Understanding that process could lead U-M to find drugs or other compounds to eat the toxins as they build up on cells or otherwise render them inert, saving the cells from distress and death. One antioxidant, lipoic acid -- a compound that has long been used to treat diabetes in Germany but has gotten only modest attention in the U.S. -- already is being explored as a possible solution, Greene said.
"Our goal is to interrupt that process or make it less toxic," Feldman said.
U-M researchers believe this free-oxygen radical process is systemic in diabetes, causing the cell death in eyes and nerves in feet. Greene even thinks free-oxygen radicals build up in the cholesterol cells of diabetics, leading to the disparate amount of heart disease from which diabetics suffer.
"There are a number of people who agree with this theory," Greene said. "I would say (the theory) is getting some wider acceptance."
Researchers at the Mayo Clinic in Rochester, Minn., are among those who believe there might be validity in the theory, Greene said.
Theory is important
The importance of U-M's theory is evident in the grant, which Goldstein said is about 20 times larger than the typical grant from Juvenile Diabetes Foundation.
The grant also shows distinction because most diabetes research, in hopes of finding a cure, is focused on the causes of the disease and on how to control the disease -- not on complications.
Research on how to better control diabetes has been more of a priority in recent years because of studies that showed more precise control can minimize the risk of complication. But, Goldstein notes, despite advances in control, scientists have learned the risk of complication has not been eliminated.
More than half of diabetics will still suffer from complications during their lifetime.
"It's impossible to have perfect control," Feldman said.
Diabetics like Howard Ellison of West Bloomfield are excited about U-M's research and the possibilities it might hold.
"I think they're onto something," said Ellison, who is taking part in a clinical trial of a new drug at U-M for diabetic complications.
He was diagnosed with adult-onset, or type 2, diabetes, in 1987. A decade later, despite proper diet and exercise, he noticed tingling and pain in his feet, which signaled possible nerve damage.
Wilson said it was especially promising to think doctors might be able to intervene before complications arise. She lamented the seeming powerlessness they had in fighting the progression of her eye disease.
During her lifetime, Wilson said she has seen doctors learn a tremendous amount about her disease and she has faith that enormous strides are around the corner.
"I think they are starting to unlock the mysteries," she said.
Side bar
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Rebecca Wilson holds her son, Gabe, at their Garden City home. Besides blindness, diabetes leads to 56,000 amputations yearly.
Facts about diabetes
* With an estimated 600,000 diabetics, Michigan has the fifth-highest diabetes prevalence rate in the country. The disease costs the state an estimated $4.9 billion.
* About 60,000 Michiganians have juvenile (type 1) diabetes, while 590,000 people have the adult-onset form, or type 2. About 200,000 of those in the second category do not know they have the disease.
* Each year in Michigan, 7,000 people die from diabetes-related complications.
* Ten percent of the African-American population has diabetes, but one-third do not know it. Furthermore, 25 percent of African Americans ages 65-74 have diabetes, and one in four African-American woman over age 55 has the ailment.
* Nationwide, diabetes is on the rise because of the increasing prevalence of obesity, a contributing factor to type 2 diabetes. In recent years, the number of children diagnosed with what has traditionally been called adult-onset diabetes has been increasing. Six percent of the general U.S. population now has diabetes.
* "It's growing at an epidemic proportion," said Dr. Douglas Greene, director of the U-M Center for the Study of Complications in Diabetes and the Michigan Diabetes Research and Training Center.
Sources: The American Diabetes Association Serving Michigan and the Michigan Department of Community Health.
Warning signs
Type 1 diabetes
* Frequent urination
* Unusual thirst
* Extreme hunger
* Unusual weight loss
* Extreme fatigue
* Irritability
Type 2 diabetes
* Any type 1 symptoms
* Frequent infections
* Blurred vision
* Slowly healing cuts or bruises
* Tingling or numbness in hands or feet
* Recurring skin, gum or bladder infections
Source: American Diabetes Association
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Copyright 2000, The Detroit News