Diabetes

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The Canadian Institutes of Health Research (CIHR) is the Government of Canada's agency for health research. Through CIHR, the Government of Canada invested approximately $30.8 million in 2005-06 across Canada in research on diabetes.

The Facts

• In 2000, 1.4 million people in Canada had diabetes. This number is projected to increase to 2.4 million by 2016.
• More than 8% of deaths in Canada are attributable to diabetes-related complications.
• Type 1 diabetes is usually diagnosed in childhood and involves an abnormal autoimmune response that destroys insulin-producing cells in the pancreas, resulting in little or no insulin production.
• Type 2 diabetes typically begins in adulthood, although more and more children are developing the disease. Type 2 diabetes develops as the body's cells become more and more resistant to the effects of insulin.
• People who have a family member with diabetes, are physically inactive or are overweight are at higher risk of developing the disease.
• Both type 1 and type 2 diabetes are due to a combination of genetic and environmental factors.
• About 90% of people with diabetes have type 2; 10% have type 1.
• Complications of diabetes include nerve damage, cardiovascular disease, blindness, kidney disease and impotence.
• The economic cost of diabetes was estimated at $1.6 billion in Canada in 1998. Approximately 75% of this figure stems from indirect costs, including factors such as lost production due to long-term disability and premature mortality.

Research Finding Solutions to Diabetes

• New research by Dr. Peter Light of the University of Alberta suggests why high-fat diets are not just bad for your heart, but can lead to type 2 diabetes. To send signals critical for many different biological functions, the body uses a network of channels into and out of cell membranes. High-fat diets interfere with one particular channel involved in metabolism, affecting insulin secretion, which contributes to type 2 diabetes.

• The groundbreaking Edmonton Protocol allows insulin-producing islet cells to be transplanted into people suffering from type 1 diabetes to replace the lack of these cells. Research by CIHR-funded Dr. John Elliott at the University of Alberta could make the process more efficient and readily available. Dr. Elliot has found a protein that, when encouraged to overproduce, increases the survival rate of cells during transplant. The result could mean that instead of requiring multiple donors to harvest enough cells to treat a single patient, just a few will be necessary.

• CIHR-funded University of Alberta researcher Dr. Alexander Rabinovitch is also helping solve the problem of shortages of donated tissue needed for islet cell transplantation. Using cell culture techniques and the hormones gastrin and epidermal growth factor, he successfully stimulated more insulin-secreting cells to grow in engineered tissue. The result will eventually help reduce demand for donor tissue, which is not plentiful.

• Improving your lifestyle by eating better and getting more exercise may not be enough for many people to get their type 2 diabetes under control, according to CIHR-funded researcher Dr. Stewart Harris at The University of Western Ontario. Even though most primary care physicians prescribed exactly this treatment, research found that many patients with type 2 diabetes are not reaching their targets in glycemic control, which creates other serious health problems. Better alternatives or more aggressive treatment techniques must be used in order to improve the success rate of primary care.

• Self-confidence and strong social networks help teenage girls establish control over type 1 diabetes. Dr. Gary Rodin's lab at the University of Toronto found that social acceptance, romantic appeal and close friendships improved control over metabolism.

In the Pipeline...
Managing Diabetes Care Now and for the Future

Diabetes is now recognized as a reliable risk factor for heart disease and other serious illnesses. The DREAM Trial, on which Dr. Hertzel Gerstein of McMaster University is taking a lead position, is testing the drugs ramipril and rosiglitazone for the prevention of diabetes as well as atherosclerosis. When the research is completed, Dr. Gerstein will be able to say if these two drugs can effectively combat type 2 diabetes and atherosclerosis, thereby making a new method of diabetes treatment available to the public.

The Researchers...
Dr. Jill Hamilton - Searching for Early Signs of Diabetes

Dr. Jill Hamilton is a researcher at the Hospital for Sick Children (SickKids), University of Toronto, and is interested in studying children at risk for diabetes long before the disease occurs.

"I think one of the aspects of my work that is most interesting is that we have an opportunity to intervene very early to treat and even prevent disease from happening," she comments.

So, it may come as a surprise that the area of research of concern to Dr. Hamilton is type 2 diabetes, also known as "late-onset" diabetes because it tends to affect older generations. But according to Dr. Hamilton, type 2 diabetes is an extremely complex disease that can be triggered by environmental and genetic factors. And her hope is that these factors can be caught early, very early in fact.

Dr. Hamilton has begun work on a project involving infants, in the hopes of finding the first glimpse of what causes this disease and, ultimately, finding treatment options. She's working in partnership with co-primary investigator Dr. Anthony Hanley and co-investigators Drs. Ravi Retnakaran and Bernard Zinman of Mount Sinai Hospital, who are looking at the problem of gestational diabetes.

Dr. Hamilton's hypothesis is that babies who are exposed to maternal diabetes while in the womb may themselves be at risk for developing diabetes later in life. "When babies are exposed to high glucose levels and various other inflammatory molecules that impact on insulin action, there may be permanent reprogramming of pathways involved in glucose metabolism," she notes.

With the project, Dr. Hamilton will be taking a number of body measurements of the children at three months of age and at 12 months. She will also be monitoring changes in fat tissue. At 12 months. Dr. Hamilton will take blood samples to test for insulin resistance and beta cell function as well as other indicators that could signal the early presence of type 2 diabetes.

"Working with kids at three months is pretty easy. At 12 months it's a little trickier. They've been used to waking up in the morning and being fed right away." She adds, "The mothers are great about it because they've already been recruited into the maternal study, and they're committed to this research. That's been a very positive experience."

The CIHR Institute

CIHR's Institute of Nutrition, Metabolism and Diabetes, under the leadership of Scientific Director Dr. Diane Finegood, is leading the charge in the fight against diabetes. Through its strategic focus on obesity, the Institute is helping to shed light on one of the key risk factors for type 2 diabetes.

About CIHR

The Canadian Institutes of Health Research (CIHR) is the Government of Canada's agency for health research. CIHR's mission is to create new scientific knowledge and to catalyze its translation into improved health, more effective health services and products, and a strengthened Canadian healthcare system. Composed of 13 Institutes, CIHR provides leadership and support to more than 10,000 health researchers and trainees across Canada.

Canadian Institutes of Health Research
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http://www.cihr-irsc.gc.ca/