Research Highlights from the National Institute of Diabetes and Digestive and Kidney Diseases

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Research Highlights from the National Institute
of Diabetes and Digestive and Kidney Diseases

• Griffin P. Rodgers, M.D., M.A.C.P.
• Acting Director

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National Institute of Diabetes and Digestive and
Kidney Diseases
The NIDDK conducts and supports basic and applied
research and provides leadership for a national
program in

• Diabetes, Endocrinology, and Metabolic Diseases
• Digestive Diseases and Nutrition and
• Kidney, Urologic, and Hematologic Diseases.

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NIDDKs Research and Dissemination Spectrum
Bench to Bedside and Beyond
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Organizational Structure of NIDDKs Three
Extramural Scientific Divisions
NIDDK
KUH
DDN
DEM
Division of Kidney, Urologic, and Hematologic Dise
ases
Division of Digestive Diseases and Nutrition
Division of Diabetes, Endocrinology, and
Metabolic Diseases
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A Paradigm of NIDDKs Integrated Research Programs
Kidney Disease
Type 2 Diabetes
Obesity
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Overweight and Obesity
For Adults

• BMI below 18.5 Underweight
• BMI between 18.5 and 24.9 Healthy weight
• BMI between 25 and 29.9 Overweight
• BMI 30 and above Obese

For Children and Adolescents

• BMI below 5th percentile Underweight
• BMI between 5th and less than 85th Healthy
  weight
• BMI between 85th and less than 95th At Risk of
  Overweight
• BMI 95th percentile and above Overweight

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Health Complications of Obesity
Stroke
Idiopathic intracranial hypertension
Pulmonary disease abnormal function obstructive
sleep apnea hypoventilation syndrome
Cataracts
Coronary heart disease
Pancreatitis
Diabetes
Nonalcoholic fatty liver disease steatosis steatoh
epatitis cirrhosis
Dyslipidemia
Hypertension
Gynecologic abnormalities abnormal
menses infertility polycystic ovarian syndrome
Gall bladder disease
Cancer breast, uterus, cervix, prostate,
kidney colon, esophagus, pancreas, liver
Osteoarthritis
Phlebitis venous stasis
Skin
Gout
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Obesity Trends Among U.S. Adults
2004
No Data lt10 10-14
15-19 20-24 25

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Trends in U.S. Child and Adolescent Overweight
20
20
15
15
6-11 years old
Percent
Percent
10
10
12-19 years old
5
5
0
0
1971-1974
1976-1980
1988-1994
1963-1967
1999-2000
2001-2002
2003-2004
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Obesity Gene/Environment Interactions
Current environment
Adipocity phenotype (e.g., body mass index)
Past environment
Genetic susceptibility
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A Paradigm of NIDDKs Integrated Research Programs
Kidney Disease
Type 2 Diabetes
Obesity
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Two Major Forms of Diabetes
Type 1

• Usually diagnosed in childhood, adolescence, or
  young adulthood
• Bodys immune defense system mistakenly destroys
  insulin-producing cells in the pancreas
  (autoimmunity)
• Results in lack of insulin to control blood sugar
  levels insulin therapy lifesaving but not a cure

Type 2

• Historically diagnosed in adults now in children
  and adolescents
• Body has reduced sensitivity to insulin
• Therapy increases insulin release/sensitivity
  some insulin administration may be required
• Obesity is a serious risk factor
• Can be prevented or delayed by diet and exercise
  as shown in NIH clinical trials

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Estimates of Diagnosed Diabetes Among Adults in
the U.S.
No Data lt4 4-4.9
5-5.9 6
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Diabetes Burden of Disease

• 20.8 million Americans (7 percent of the U.S.
  population) have diabetes
• 90-95 percent of cases are type 2 diabetes
• Minorities are disproportionately affected by
  type 2 diabetes
• 1 in 3 Americans born in 2000 is predicted to
  develop diabetes during his or her lifetime (for
  Hispanic females 1 in 2)

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Diagnosed Diabetes in the U.S. Diagnosed
(1960-2004) and Projected Diagnosed (2005-2050)
Cases
50
40
30
Diagnosed cases
People (millions)
Projected diagnosed cases
20
10
0
1960
1970
1980
1990
2000
2010
2020
2030
2040
2050
Year
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Results from the Diabetes Prevention Program
Substantial Reduction in Diabetesin All
Race-Ethnic Groups
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Complications Common to Both Type 1 and Type 2
Diabetes
Acute complications
Stroke

• Dangerously high or low blood glucose
• ? coma, death

Blindness
Heart Disease
Chronic complications
Kidney Disease

• Affect all major organs
• Develop over time/ exposure to high blood glucose
• Tight control of blood glucose can prevent or
  delay

Atherosclerosis
Foot Ulcers and Amputations
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A Paradigm of NIDDKs Integrated Research Programs
Kidney Disease
Type 2 Diabetes
Obesity
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End-stage Renal Disease in the U.S. Number of
Patients per Million Population
1993
2003
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End-stage Renal Disease in the U.S.All Values
are for Calendar Year 2004

• Prevalence 472,099 patients were undergoing
  treatment
• Mortality 84,252 deaths in patients undergoing
  treatment for ESRD
• Primary cause
• Diabetes 45,871
• High blood pressure 28,132
• Primary treatment
• Dialysis 335,963 patients received dialysis
• Kidney Transplant 16,905 performed
• Minorities are disproportionately affected

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End-stage Renal Disease in the U.S. Adjusted
Incident Rates Annual Percent Change
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Progress in Combating the U.S. ESRD Epidemic

• After 20 years of annual increases from 5 to 10
  percent, rates for new cases of kidney failure
  have stabilized
• Better disease prevention methods appear to be
  responsible
• Use of angiotensin-converting enzyme inhibitors
  and angiotensin receptor blockers
• Better glycemic control
• Better blood pressure control
• NIH research has established the value of these
  interventions
• But, progress has not yet been realized across
  all U.S. populations

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Incident Diabetic End-stage Renal Disease in the
U.S.Age 20 to 29 Years
35
30
Caucasian
African American
25
20
Per million population
15
10
5
0
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
Year
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More Insights into Preventing Complications of
Diabetes

• Microvascular damage retinopathy
• Macrovascular damage CVD
• Preventing complications by preventing diabetes -
  DPP

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Eye Disease Intensive Diabetes Treatment Reduces
Risk
100
Cumulative Incidence of gt 3-Step Change
75
Cumulative Percent
50
25
0
0
1
2
3
4
5
6
7
8
9
Study Years
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Heart Disease Intensive Diabetes Treatment
Reduces Risk
0.06
0.04
Cumulative Incidence of Nonfatal Myocardial
Infarction, Stroke, or Death from Cardiovascular
Disease
0.02
0.00
0 1 2 3 4 5 6
7 8 9 10 11 12 13
14 15 16 17 18 19 20 21
Years Since Entry into DCCT/EDIC Study
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NIH and NIDDK Strategic Research Plans
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Strategic Plan for NIH Obesity Research
Developed by the NIH Obesity Research Task Force
with critical input from external scientists and
the public

• Research Toward Preventing and Treating Obesity
  Through Behavioral and Environmental Approaches
  to Modify Lifestyle, with an Emphasis on
  Childhood Obesity
• Research Toward Preventing and Treating Obesity
  Through Pharmacologic, Surgical, or Other Medical
  Approaches
• Research Toward Understanding the Relationship
  Between Obesity and Its Associated Health
  Conditions
• Cross-cutting Topics Technology,
  Multidisciplinary/Interdisciplinary Research
  Teams, Translational Research, Training,
  Education/Outreach

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.
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Conquering Diabetes A Scientific Progress
Report on The Diabetes Research Working Groups
Strategic Plan
Highlights of Program Efforts, Research Advances
and Opportunities related to

• Genetics
• Autoimmunity and the Beta Cell
• Cell Signaling and Cell Regulation
• Obesity
• Clinical Research and Clinical Trials of Critical
  Importance

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Progress and Priorities Renal Disease Research
Plan

• Important scientific resources needed to reach
  research goals include
• Conducting More Epidemiological Studies
• Creating Centers and Cooperatives
• Creating New Ways to Study Renal Injury
• Focusing More on Genetic Susceptibility
• Developing a Renal Genomics Project
• Increasing Research on Treatments

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Examples of NIH and NIDDK Education and Outreach
Programs
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Weight-control Information Network
The Weight-control Information Network (WIN) is
an information service of the NIDDK. WIN was
established in 1994 to provide the general
public, health professionals, the media, and
Congress with up-to-date, science-based
information on obesity, weight control, physical
activity, and related nutritional issues. WIN
produces, collects, and disseminates materials on
obesity, weight control, and nutrition.
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National Diabetes Education Program
The National Diabetes Education Program (NDEP) is
a federally funded program sponsored by the
National Institutes of Health and the Centers for
Disease Control and Prevention and includes over
200 partners at the federal, state, and local
levels, working together to reduce the morbidity
and mortality associated with diabetes.
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Components of the National Diabetes Education
Program

• Control Your Diabetes. For Life. - To promote the
  importance and benefits of diabetes control
• Be Smart About Your Heart. Control the ABCs of
  Diabetes - Encourages control of blood sugar,
  blood pressure, and cholesterol
• Small Steps. Big Rewards. Prevent type 2 Diabetes
  - Translate and promote the Diabetes Prevention
  Program (DPP) clinical trial findings

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National Kidney DiseaseEducation Program
The National Kidney Disease Education Program
(NKDEP) is an initiative of the National
Institutes of Health, designed to reduce the
morbidity and mortality caused by kidney disease
and its complications.
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Aerial View of NIH campus in Bethesda, MD