Shedding timely light on a year-round research focus: diabetes
November is National Diabetes Month, a time to raise awareness of the disease which, if not treated properly, can lead to serious health complications.
Diabetes impacts hundreds of millions of people globally, posing a substantial risk of life-threatening complications and premature death. The disease is categorized most commonly as type 1 and type 2 diabetes, less frequently caused by single gene mutation (monogenic diabetes) or a consequence of other health conditions/medications. Diabetes can also emerge during pregnancy, which is called gestational diabetes mellitus (GDM).
Several Institute investigators focus their research on different aspects of diabetes across the lifecourse, from childhood to late adulthood: prevention, optimizing treatment and medication adherence, evaluating diabetes-related health policies, and early detection and developmental origins of the disease. In their own words, here’s why they study diabetes and what they’re currently working on.
Dr. Harnois-Leblanc is a postdoctoral research fellow investigating the role of dietary habits on diabetes risk markers from early childhood to late adolescence in the Project Viva cohort using causal inference methods under the mentorship of Marie-France Hivert and Jessica Young. More broadly, her research focuses on the prevention of obesity, type 2 diabetes, and cardiovascular disease in at-risk children and children from the general population.
Q: What drove you to study diabetes prevention?
A: I started doing research in the field of pediatric diabetes when I initiated my PhD in 2016, and haven't stopped since then (and do not intend to!). I realized how much the incidence of type 2 diabetes in children was on the rise and how it affected disproportionally some communities more than others.
At the time, we had only little knowledge on how diabetes developed in children and adolescents. We know today that it develops quicker and more aggressively than in adults. Yet, we are still missing evidence on applicable, safe, and effective preventive strategies for diabetes prevention in children and youth.
Q: Tell us more about your recent work.
A: I have characterized the natural history of prediabetes, a condition that occurs before type 2 diabetes develops, and type 2 diabetes in a cohort of Canadian Youth, and observed that 20% of children with normal glucose tolerance developed prediabetes that sustained during adolescence. I have found that if we were to act on increasing physical activity levels and reducing sedentary time during childhood and adolescence, this could improve glycemia and insulin sensitivity, and reduce insulin secretory demands, potentially guarding against future diabetes development.
I am currently investigating whether acting on reducing sugar-sweetened beverages and fruit juice intake could protect against later diabetes development, through their potential impact on glycemia and insulin resistance in late adolescence in the Project Viva cohort. I am further extending this work by examining the potential impact of reducing teens’ fast-food, and on exploring associations between the neighborhood food environment, such as the number of fast-food restaurants and convenience stores around the house, and glycemia and insulin resistance in late adolescence.
We know today that [diabetes] develops quicker and more aggressively [in children] than in adults. Yet, we are still missing evidence on applicable, safe, and effective preventive strategies for diabetes prevention in children and youth.
- Soren Harnois-Leblanc, PhD
Through her work as a clinician-researcher focused on understanding the determinants of diabetes, Dr. Hivert is looking to precision medicine as the key to unlocking more precise diagnostic, prevention, and treatment strategies for the disease than exist today. From her first postdoctoral fellowship through leading research and teaching activities today, Dr. Hivert’s efforts have made significant contributions to advancing knowledge of precision medicine as a viable means of improving the lives of those suffering from, or at risk of, diabetes.
Q: Why is it important to raise awareness about gestational diabetes? How do you incorporate raising awareness of it in your clinical practice?
A: Gestational Diabetes is a condition that is common, affecting 14% of pregnancies around the world. Pregnant individuals usually do not have symptoms, which make the screening process critical to detect it. Gestational diabetes increases the risk of high blood pressure in pregnancy, low blood sugar in the newborn soon after birth, and having a baby with higher birth weight, which leads to more frequent need of c-section for delivery, or injuries to the newborn during the delivery process. We know that we can reduce these complications by treating gestational diabetes targeting maternal blood glucose by adaptation to diet, physical activities, and sometimes adding insulin. But some women and babies still suffer from complications despite our current treatment approaches; this is the reason we need to continue our research.
Q: You’ve played a pivotal role in the Precision Medicine in Diabetes Initiative (PMDI), including as the advocate for the inclusion of GDM as part of the global PMDI effort. Are there other areas where you’ve advocated for more focus on researching GDM?
A: With PMDI, we hope to continue our global effort to propose the next research agenda towards precision medicine for all type of diabetes. On my side, I hope to lead the next international studies addressing questions regarding precision medicine for gestational diabetes with colleagues from all around the world. We are especially interested in addressing questions regarding gestational diabetes that occurs early in pregnancy, and to collaborate with investigators in countries that are highly affected by gestational diabetes, such as in South Asia.
Q: You were recently a key contributor to a landmark Lancet Series on gestational diabetes. Can you describe the significance of this work?
A: Gestational Diabetes Mellitus (GDM) is the most common medical pregnancy complication worldwide. Early diagnosis and treatment of GDM is greatly needed to improve the health of both woman and child. Recent evidence suggests that GDM can have foundations prior to pregnancy and its effects extend after pregnancy and through the life course for both woman and child. There is a critical opportunity to reduce these risks through lifestyle interventions, identifying strategies for prevention, diagnosis, treatment, and long-term follow-up in both women and offspring.
Some women and babies still suffer from complications despite our current treatment approaches; this is the reason we need to continue our research.
Marie-France Hivert, MD, MMSc
Dr. Wright is a decision scientist, interested in the study of how stakeholders make decisions and how they can make better decisions in the presence of uncertainty, complexity, and competing values. The overarching goal of her research is to improve the demand for and supply of effective and efficient health care for patients with chronic diseases with a focus on obesity and diabetes.
She specializes in leading interdisciplinary studies that link a variety of decision sciences methods and related techniques including stated preference elicitation, economic evaluation, simulation modeling, health services research methods, and qualitative research. She is committed to using her methodological toolkit to design health care interventions and policies that will have high uptake and high potential to improve population health.
Q: One of your goals is to improve the effectiveness and efficiency of health care for children with chronic diseases. What drove you to focus on diabetes as part of this?
A: I have long been an obesity researcher, and obesity and type 2 diabetes are related. But my first diabetes-related project focused on adolescents with type 1 diabetes. Frankly, I started doing diabetes work because an endocrinologists asked me to brainstorm project ideas. Eight years later, here we are!
Q: You developed InvestT1D, an innovative, ethically-sensitive, patient- and stakeholder-centered intervention aiming to improve management of type 1 diabetes by offering adolescents financial incentives for engagement in diabetes self-care behaviors. Can you talk a bit about the evolution of this intervention, and next steps?
A: We were grateful to receive funding from the American Diabetes Association for our first InvesT1D grant. Our ADA grant aimed to design the InvesT1D intervention through qualitative interviews with families, an ethical analysis, a survey to evaluate adolescent trade-offs between money and behavior, and a pilot randomized controlled trial.
The NIDDK-funded InvesT1D study will conduct a more robust trial to evaluate health and healthcare outcomes over a longer period than the pilot. Importantly, we will also conduct an economic evaluation to assess the long-term cost-effectiveness of InvesT1D, and we will evaluate the feasibility of implementing it within health systems. There’s no point in having an effective intervention if you can’t disseminate it.
Q: What other diabetes-related work do you have on the horizon?
A: I’m starting to engage in some research around use of antidiabetic medications, including medications like Ozempic (semaglutide) and Mounjaro (tirzepatide) that have received a lot of media attention. This is a very fast-moving research space. However, the topic of novel medication use and access can be studied from a number of perspectives, and we’re having a ton of fun coming up with research ideas.
Importantly, we will also conduct an economic evaluation to assess the long-term cost-effectiveness of InvesT1D, and we will evaluate the feasibility of implementing it within health systems.
Davene Wright, PhD
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