Research Highlights from the Research Highlights from the National Institute of Diabetes and National Institute of Diabetes and
Digestive and Kidney DiseasesDigestive and Kidney Diseases
Griffin P. Rodgers, M.D., M.A.C.P.Griffin P. Rodgers, M.D., M.A.C.P.
Acting DirectorActing Director
National Institute of Diabetes and National Institute of Diabetes and Digestive and Kidney DiseasesDigestive and Kidney Diseases
Diabetes, Endocrinology, and Diabetes, Endocrinology, and Metabolic Diseases;Metabolic Diseases;Digestive Diseases and Nutrition; andDigestive Diseases and Nutrition; andKidney, Urologic, and Hematologic Kidney, Urologic, and Hematologic Diseases.Diseases.
The NIDDK conducts and supports The NIDDK conducts and supports basic and applied research and basic and applied research and provides leadership for a national provides leadership for a national program in:program in:
NIDDK’s Research and NIDDK’s Research and Dissemination SpectrumDissemination Spectrum
““Bench to Bedside and Beyond”Bench to Bedside and Beyond”
Organizational Structure of Organizational Structure of NIDDK’s Three Extramural NIDDK’s Three Extramural
Scientific DivisionsScientific Divisions
NIDDKNIDDK
KUHKUHDivision of Kidney,Division of Kidney,
Urologic, andUrologic, andHematologicHematologic
Diseases Diseases
DDNDDNDivision ofDivision of
Digestive DiseasesDigestive Diseasesandand
Nutrition Nutrition
DEDEMMDivision of Division of Diabetes, Diabetes,
Endocrinology, Endocrinology, and and
Metabolic Metabolic Diseases Diseases
A Paradigm of NIDDK’s Integrated A Paradigm of NIDDK’s Integrated Research ProgramsResearch Programs
ObesityObesity Type 2Type 2DiabetesDiabetes
KidneyKidneyDiseaseDisease
Overweight and ObesityOverweight and Obesity
BMI below 18.5 – UnderweightBMI below 18.5 – UnderweightBMI between 18.5 and 24.9 – Healthy weightBMI between 18.5 and 24.9 – Healthy weightBMI between 25 and 29.9 – OverweightBMI between 25 and 29.9 – OverweightBMI 30 and above – ObeseBMI 30 and above – Obese
BMI below 5th percentile – UnderweightBMI below 5th percentile – UnderweightBMI between 5th and less than 85th – Healthy BMI between 5th and less than 85th – Healthy weightweightBMI between 85th and less than 95th – At BMI between 85th and less than 95th – At Risk of OverweightRisk of OverweightBMI 95th percentile and above – OverweightBMI 95th percentile and above – Overweight
For AdultsFor Adults
For Children and AdolescentsFor Children and Adolescents
PhlebitisPhlebitisvenous venous stasisstasis
Coronary heart Coronary heart diseasedisease
Pulmonary diseasePulmonary diseaseabnormal functionabnormal functionobstructive sleep apneaobstructive sleep apneahypoventilation syndromehypoventilation syndrome
Gall bladder Gall bladder diseasedisease
GoutGout
DiabetesDiabetes
OsteoarthritisOsteoarthritis
Nonalcoholic fatty liver Nonalcoholic fatty liver diseasediseasesteatosissteatosissteatohepatitissteatohepatitiscirrhosiscirrhosis
HypertensionHypertensionDyslipidemiaDyslipidemia
CataractsCataracts
SkinSkin
PancreatitisPancreatitis
CancerCancerbreast, uterus, cervix, prostate, kidneybreast, uterus, cervix, prostate, kidneycolon, esophagus, pancreas, livercolon, esophagus, pancreas, liver
Gynecologic abnormalitiesGynecologic abnormalitiesabnormal mensesabnormal mensesinfertilityinfertilitypolycystic ovarian syndromepolycystic ovarian syndrome
StrokeStrokeHealth Complications of ObesityHealth Complications of Obesity
Idiopathic intracranial Idiopathic intracranial hypertensionhypertension
Obesity Trends Among U.S. Adults
No Data <10% 10-14% 15-19% 20-24% ≥25%
1991 2004
00
55
1010
1515
2020
00
55
1010
1515
2020
Perc
ent
Perc
ent
Perc
ent
Perc
ent6-11 years old6-11 years old
12-19 years old12-19 years old
Trends in U.S. Child and Trends in U.S. Child and Adolescent OverweightAdolescent Overweight
1963
-1967
1963
-1967
1999
-2000
1999
-2000
2001
-2002
2001
-2002
2003
-2004
2003
-2004
1971
-1974
1971
-1974
1976
-1980
1976
-1980
1988
-1994
1988
-1994
Obesity: Gene/Environment Obesity: Gene/Environment InteractionsInteractions
Current environment
Past environment
Genetic susceptibility
Adip
ocity
phe
noty
pe(e
.g.,
body
mas
s ind
ex)
ObesityObesity Type 2Type 2DiabetesDiabetes
KidneyKidneyDiseaseDisease
A Paradigm of NIDDK’s A Paradigm of NIDDK’s Integrated Research ProgramsIntegrated Research Programs
Two Major Forms of DiabetesTwo Major Forms of Diabetes
Usually diagnosed in childhood, adolescence, or young Usually diagnosed in childhood, adolescence, or young adulthoodadulthoodBody’s immune defense system mistakenly destroys Body’s immune defense system mistakenly destroys insulin-producing cells in the pancreas (autoimmunity) insulin-producing cells in the pancreas (autoimmunity) Results in lack of insulin to control blood sugar levels; Results in lack of insulin to control blood sugar levels; insulin therapy lifesaving but not a cureinsulin therapy lifesaving but not a cure
Historically diagnosed in adults; now in children and Historically diagnosed in adults; now in children and adolescentsadolescentsBody has reduced sensitivity to insulinBody has reduced sensitivity to insulinTherapy increases insulin release/sensitivity; some insulin Therapy increases insulin release/sensitivity; some insulin administration may be requiredadministration may be requiredObesity is a serious risk factorObesity is a serious risk factorCan be prevented or delayed by diet and exercise as Can be prevented or delayed by diet and exercise as shown in NIH clinical trialsshown in NIH clinical trials
Type 1Type 1
Type 2Type 2
No Data <4% 4-4.9% 5-5.9% ≥6%
1994 2004
Estimates of Diagnosed Diabetes Among Adults in the U.S.
Diabetes: Burden of DiseaseDiabetes: Burden of Disease
20.8 million 20.8 million AmericansAmericans ((7 percent 7 percent of the of the U.S. population) have diabetesU.S. population) have diabetes90-9590-95 percent of cases are type 2 diabetes percent of cases are type 2 diabetesMinorities Minorities are disproportionately affected are disproportionately affected by type 2 diabetesby type 2 diabetes1 in 31 in 3 Americans born in 2000 is predicted Americans born in 2000 is predicted to develop diabetes during his or her to develop diabetes during his or her lifetime (for Hispanic females: lifetime (for Hispanic females: 1 in 21 in 2))
0
10
20
30
40
50
1960
1970
1970
1980
1980
1990
1990
2000
2000
2010
2010
2020
2020
2030
2030
2040
2040
2050
2050
Peop
le (
mill
ions
)Pe
ople
(m
illio
ns)
YearYear
Diagnosed Diabetes in the U.S. Diagnosed Diabetes in the U.S. Diagnosed (1960-2004) Diagnosed (1960-2004) and and
Projected Diagnosed (2005-2050)Projected Diagnosed (2005-2050) Cases Cases
Diagnosed casesDiagnosed casesProjected Projected
diagnosed casesdiagnosed cases
Results from the Diabetes Prevention Program Results from the Diabetes Prevention Program Substantial Reduction in DiabetesSubstantial Reduction in Diabetes
in All Race-Ethnic Groupsin All Race-Ethnic Groups
LifestyleLifestyle MetforminMetformin Placebo/Standard carePlacebo/Standard care
Case
s pe r
10 0
per
s on-
yea r
sCa
ses p
e r 1
00 p
erso
n -ye
a rs
00
33
66
99
1212
1515
All participantsAll participants CaucasianCaucasian AfricanAfricanAmericanAmerican
HispanicHispanic AmericanAmericanIndianIndian
AsianAsian
Complications Common to Both Complications Common to Both Type 1 and Type 2 DiabetesType 1 and Type 2 Diabetes
Blindness
Kidney Kidney DiseaseDisease
Stroke
Heart Disease
AtherosclerosisAtherosclerosis
Foot Ulcers and Amputations
Acute complicationsAcute complications
Chronic complicationsChronic complications
Dangerously high or low Dangerously high or low blood glucoseblood glucose
→ → ccoma, death oma, death
Affect all major organsAffect all major organsDevelop over time/ Develop over time/ exposure to high blood exposure to high blood glucoseglucoseTight control of blood Tight control of blood glucose can prevent or glucose can prevent or delaydelay
ObesityObesity Type 2Type 2DiabetesDiabetes
KidneyKidneyDiseaseDisease
A Paradigm of NIDDK’s A Paradigm of NIDDK’s Integrated Research ProgramsIntegrated Research Programs
End-stage Renal Disease in the U.S. End-stage Renal Disease in the U.S. Number of Patients per Million PopulationNumber of Patients per Million Population
19931993 20032003
End-stage Renal Disease in the U.S.End-stage Renal Disease in the U.S.All Values are for Calendar Year 2004All Values are for Calendar Year 2004
Prevalence: Prevalence: 472,099472,099 patients were patients were undergoing treatmentundergoing treatmentMortality: Mortality: 84,25284,252 deaths in patients deaths in patients undergoing treatment for ESRDundergoing treatment for ESRDPrimary cause:Primary cause:
Diabetes: Diabetes: 45,87145,871High blood pressure: High blood pressure: 28,13228,132
Primary treatment:Primary treatment:Dialysis: Dialysis: 335,963335,963 patients received dialysis patients received dialysisKidney Transplant: Kidney Transplant: 16,90516,905 performed performed
Minorities Minorities are disproportionately affectedare disproportionately affected
End-stage Renal Disease in the U.S. End-stage Renal Disease in the U.S. Adjusted Incident Rates & Annual Percent ChangeAdjusted Incident Rates & Annual Percent Change
Progress in Combating the Progress in Combating the U.S. ESRD EpidemicU.S. ESRD Epidemic
After 20 years of annual increases from 5 to 10 After 20 years of annual increases from 5 to 10 percent, rates for new cases of kidney failure percent, rates for new cases of kidney failure have stabilizedhave stabilizedBetter disease prevention methods appear to Better disease prevention methods appear to be responsiblebe responsible
Use of angiotensin-converting enzyme inhibitors Use of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers and angiotensin receptor blockers Better glycemic controlBetter glycemic controlBetter blood pressure control Better blood pressure control
NIH research has established the value of these NIH research has established the value of these interventionsinterventions
But, progress has not yet been realized across all But, progress has not yet been realized across all U.S. populationsU.S. populations
Incident Diabetic End-stage Incident Diabetic End-stage Renal Disease in the U.S.Renal Disease in the U.S.
Age 20 to 29 YearsAge 20 to 29 Years
00
55
1010
1515
2020
2525
3030
3535
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
YearYear
Per m
illion
pop
ulat
ion
Per m
illion
pop
ulat
ion CaucasianCaucasian
African AmericanAfrican American
More Insights into Preventing More Insights into Preventing Complications of DiabetesComplications of Diabetes
Microvascular damage – retinopathy
Macrovascular damage – CVD
Preventing complications by preventing diabetes - DPP
Eye Disease: Intensive Diabetes Eye Disease: Intensive Diabetes Treatment Reduces RiskTreatment Reduces Risk
00
2525
5050
7575
100100
Study YearsStudy Years
00 11 22 33 44 55 66 77 88 99
Cum
ulat
ive
Per
cent
Cum
ulat
ive
Per
cent
ConventionalConventional
Cumulative Incidence Cumulative Incidence of of >> 3-Step Change 3-Step Change
p = 0.001p = 0.001
IntensiveIntensive
Cum
ulat
ive
Inci
denc
e of
Non
fata
lC
umul
ativ
e In
cide
nce
of N
onfa
tal
Myo
card
ial I
nfar
ctio
n, S
troke
, or
Myo
card
ial I
nfar
ctio
n, S
troke
, or
Dea
th fr
om C
ardi
ovas
cula
r Dis
ease
Dea
th fr
om C
ardi
ovas
cula
r Dis
ease
0.000.00
0.020.02
0.040.04
0.060.06
Years Since Entry into DCCT/EDIC StudyYears Since Entry into DCCT/EDIC Study
ConventionalConventional
IntensiveIntensive
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 210 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21
Heart Disease: Heart Disease: Intensive Diabetes Intensive Diabetes Treatment Reduces RiskTreatment Reduces Risk
NIH and NIDDK Strategic NIH and NIDDK Strategic Research PlansResearch Plans
Strategic Plan for NIH Obesity ResearchStrategic Plan for NIH Obesity Research
Research Toward Preventing and Research Toward Preventing and Treating Obesity Through Behavioral Treating Obesity Through Behavioral and Environmental Approaches to and Environmental Approaches to Modify Lifestyle, with an Emphasis on Modify Lifestyle, with an Emphasis on Childhood ObesityChildhood Obesity
Research Toward Preventing and Research Toward Preventing and Treating Obesity Through Treating Obesity Through Pharmacologic, Surgical, or Other Pharmacologic, Surgical, or Other Medical ApproachesMedical Approaches
Research Toward Understanding the Research Toward Understanding the Relationship Between Obesity and Its Relationship Between Obesity and Its Associated Health ConditionsAssociated Health Conditions
Cross-cutting Topics – Technology, Cross-cutting Topics – Technology, Multidisciplinary/Interdisciplinary Multidisciplinary/Interdisciplinary Research Teams, Translational Research Teams, Translational Research, Training, Research, Training, Education/OutreachEducation/Outreach
Developed by the NIH Obesity Research Task Force with Developed by the NIH Obesity Research Task Force with critical input from external scientists and the publiccritical input from external scientists and the public
Although listed separately, the first two themes are interdependent. We seek to create an interdisciplinary approach in which lifestyle interventions are informed by an understanding of the basic biological and genetic factors and vice versa.
Conquering Diabetes: A Scientific Conquering Diabetes: A Scientific Progress Report on Progress Report on The Diabetes Research The Diabetes Research
Working Group’sWorking Group’s Strategic Plan Strategic Plan
GeneticsGeneticsAutoimmunity and the Autoimmunity and the Beta CellBeta CellCell Signaling and Cell Cell Signaling and Cell RegulationRegulationObesityObesityClinical Research and Clinical Research and Clinical Trials of Critical Clinical Trials of Critical ImportanceImportance
Highlights of Program Efforts, Highlights of Program Efforts, Research Advances and Research Advances and Opportunities related to:Opportunities related to:
Progress and Priorities: Progress and Priorities: Renal Disease Research PlanRenal Disease Research Plan
Important scientific Important scientific resources needed to resources needed to reach research goals reach research goals include:include:Conducting More Conducting More Epidemiological StudiesEpidemiological StudiesCreating Centers and Creating Centers and CooperativesCooperativesCreating New Ways to Study Creating New Ways to Study Renal InjuryRenal InjuryFocusing More on Genetic Focusing More on Genetic SusceptibilitySusceptibilityDeveloping a Renal Genomics Developing a Renal Genomics ProjectProjectIncreasing Research on Increasing Research on TreatmentsTreatments
Examples of NIH and NIDDK Examples of NIH and NIDDK Education and Outreach ProgramsEducation and Outreach Programs
The The Weight-control Information NetworkWeight-control Information Network (WIN) is an information service of the NIDDK. (WIN) is an information service of the NIDDK. WIN was established in 1994 to provide the WIN was established in 1994 to provide the general public, health professionals, the general public, health professionals, the media, and Congress with up-to-date, media, and Congress with up-to-date, science-based information on obesity, weight science-based information on obesity, weight control, physical activity, and related control, physical activity, and related nutritional issues. nutritional issues.
WIN produces, collects, and disseminates WIN produces, collects, and disseminates materials on obesity, weight control, and materials on obesity, weight control, and nutrition.nutrition.
Weight-control Weight-control Information NetworkInformation Network
National Diabetes National Diabetes Education ProgramEducation Program
The The National Diabetes Education National Diabetes Education ProgramProgram (NDEP) is a federally (NDEP) is a federally funded program sponsored by the funded program sponsored by the National Institutes of Health and National Institutes of Health and the Centers for Disease Control and the Centers for Disease Control and Prevention and includes over 200 Prevention and includes over 200 partners at the federal, state, and partners at the federal, state, and local levels, working together to local levels, working together to reduce the morbidity and mortality reduce the morbidity and mortality associated with diabetes.associated with diabetes.
Components of the National Components of the National Diabetes Education ProgramDiabetes Education ProgramControl Your Diabetes. For Life.Control Your Diabetes. For Life. - To promote the - To promote the importance and benefits of diabetes controlimportance and benefits of diabetes controlBe Smart About Your Heart. Control the ABCs of Be Smart About Your Heart. Control the ABCs of DiabetesDiabetes - Encourages control of blood sugar, - Encourages control of blood sugar, blood pressure, and cholesterolblood pressure, and cholesterolSmall Steps. Big Rewards. Prevent type 2 Small Steps. Big Rewards. Prevent type 2 DiabetesDiabetes - Translate and promote the Diabetes - Translate and promote the Diabetes Prevention Program (DPP) clinical trial findingsPrevention Program (DPP) clinical trial findings
National Kidney DiseaseNational Kidney DiseaseEducation ProgramEducation Program
NKDEP
The The National Kidney Disease National Kidney Disease Education ProgramEducation Program (NKDEP) is an (NKDEP) is an initiative of the National Institutes of initiative of the National Institutes of Health, designed to reduce the Health, designed to reduce the morbidity and mortality caused by morbidity and mortality caused by kidney disease and its complications.kidney disease and its complications.
Aerial View of NIH campus in Aerial View of NIH campus in Bethesda, MDBethesda, MD