Kovler at the Forefront of Diabetes Care

Hello. Welcome to a special At the Forefront Live, where we take you inside the Kovler Diabetes Center and show you the great work being done here for the city of Chicago and beyond. We'll introduce you to doctors and researchers who will answer your questions about diabetes and diabetes care. We'll also meet a patient who stays active and doesn't let diabetes get her down. And we'll take you inside a laboratory where scientists are working on treatments and possible cures. That's coming up right now on At the Forefront Live.

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Joining me to start today's program is Dr. Lou Philipson. Dr. Philipson is the director of the Kovler Diabetes Center and is the James C. Tyree Professor of Diabetes Research and Care in the departments of Medicine and Pediatrics at the University of Chicago. Welcome Dr. Philipson.

Hi. Thanks for having us.

Well let's start our conversation with an overview of diabetes and the challenges that the disease presents to our world today.

Well it's an amazing problem. It's staggering proportions. It has been described, diabetes has, as a tsunami for countries all over the world. In the United States alone, it's been estimated by the CDC and others that we have something over 34 million people living with diabetes and another 88 million living with pre-diabetes at high risk to get diabetes sometime in the next few years. The problem is that having diabetes is not only by itself an issue, but it is the leading cause of blindness, of kidney failure leading to dialysis, of amputations, heart disease, and strokes. So the financial costs are staggering. The personal costs to caretakers and families are amazing.

And of course, it disproportionately affects minorities and people in rural areas. And it dramatically increases all our problems with health care delivery disparities. And of course, many of you have realized that it's a huge problem now for people who might get COVID-19.

Absolutely, and that's part of the reason why the Kovler Diabetes Center and what happens is so important there. Can you talk to us a little bit about Kovler?

Well sure. It's been a great pleasure for me to be the founding director of our Diabetes Center. We've had a Diabetes Center here for decades, going all the way back to when I started here as a medical student a long time ago in the '80s. But over the last 15 or so years, through the generosity of the Kovler family and many others, we've had a named diabetes center where we have a couple of areas of distinctiveness. One is that it is a comprehensive center for both diabetes care and research. The other really amazing thing is that we have side by side adult and pediatric oriented diabetologists working together. So there is a seamless transition for that most difficult part, when children become adults and oftentimes they're lost to continuity of care.

We also want to have direct access to physicians and the team. So our center allows diabetes doctors, educators, pharmacists, psychologists, foot doctors, gastrointestinal specialists, cardiologists, kidney specialists, rheumatologists. We're all there for our patients in essentially one building, and in some cases, the same floor. So that sort of integrated care really makes our diabetes center unique.

We're going to learn more about that as we progress on the show, but there's just so many good things happening there. Can you tell us just briefly a little bit about the genetics of diabetes and connect that with the research that's happening here at the university?

One of the big impacts the University of Chicago has had on diabetes is in fact the genetics of diabetes. And even our dean, Ken Polonsky, and my colleague, distinguished professor Dr. Graeme Bell, started out this program when I was early on in my career in the 1990s, understanding how single gene defects can cause diabetes. It was thought to be a rare condition. Now, we know it's not that rare. It's about 2% or 3% of everyone with diabetes before the age of, let's say 40. And it's an important consideration in any child who has diabetes almost from birth, I would say up to six months or a year old. So we've become the largest center for those kinds of diabetes in the United States. Together they're called monogenic diabetes. They're sometimes also called in children neonatal diabetes and adults MODY or maturity-onset diabetes in youth.

So with that NIH funding, we also now have a new grant on atypical diabetes called RADIANT, which is a consortium of centers across the United States-- we're one of the two organizing centers-- to investigate new causes of diabetes funded by a $5 million a year grant from the NIH that we're very excited about. We also have a big impact research program in type 1 diabetes, focusing on prevention and novel treatments of type 1 diabetes in a high technology sort of concept.

And thank you, Dr. Philipson. Now we're going to hear from Tracey Brown, the president of the American Diabetes Association.

My name is Tracy Brown, the Chief Executive Officer of the American Diabetes Association, and this month is Diabetes Awareness Month. You know, there are over 122 million people living with diabetes and pre-diabetes in America. And there are over 10% of Chicagoans who are also living with diabetes. So this month, our goal is to continue to drive as much awareness as possible about diabetes. And we want to be able to accelerate the meeting of our mission, which is to prevent and cure diabetes and improve the lives of all those living and affected by diabetes.

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And welcome back. We're very excited to have Juanita Nave join us to talk about her journey with diabetes. And Juanita is a teacher, singer, and actor. So as you can see, diabetes has not kept her down. Juanita, welcome to the program.

Thank you. Thank you for having me. I'm glad to be here.

Well we're so happy. Tell us a little bit about your time dealing with diabetes. I realize this has been something you've been dealing with for quite some time, but you've been very successful.

Well, I would say my journey with diabetes started at birth really, because my mother was a type 1 diabetic. So I saw it growing up, but it did not directly affect me until I was 19 in college. And that's when I was diagnosed with type 1 diabetes. And ever since then, it has been an up and down journey, but really I learned a lot by seeing what my mother went through, knowing what to do and what not to do. So I've just really been determined all my life to live as healthy as I can and enjoy life.

So in the little intro, I said you're a teacher-- which that alone is a huge job-- but you're also an actress, you sing. How do you keep so active?

Well, I love teaching, but I would say that my first love is performing. I actually went to undergrad at Alabama A&M on a music scholarship. So I have really sang all my life, and then I was introduced to acting in high school. But I came along at the time where everyone was kind of pushed into careers where you know that you would make a living. So my father said, ah the singing and acting, that's great. But I need you to really do something where you are sure to make a living. So I actually got an undergrad degree in mechanical engineering technology. So that turned into teaching math.

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So what kind of advice would you give to others who are battling with diabetes? Because again, clearly this hasn't kept you down. You're very active, you do a lot of things. What kind of advice would you give?

I would tell them that this-- no one wants a disease. But this is one that you can almost control 100%. I am very in tune to the three things that keep me healthy, keep me feeling good. That's the medication, exercise-- you've gotta move your body-- and you've gotta eat right. So those three things will ensure that you have a full and prosperous life.

And it sounds like you're very proactive in your approach. Did you get some of that from your mother?


I would definitely say I did. Like I said, some things to do and some things not to do.

I understand. Can you talk to us just for a moment about your experience here at UChicago Medicine?


Oh wow. I've been at University of Chicago since I had my son. I have a 22-year-old son, and that's when I was able to meet Dr. Philipson. And I love the fact that University of Chicago is a teaching hospital. So they are truly on the cutting edge. I've been exposed to so many different ways to maintain and control my diabetes. The technology-- I was on an insulin pump over 10 years ago, and now I'm on the continuous glucose monitor, which I really love and helps me keep my blood sugars in control. And I don't have to stick myself, so that's a great thing.

Well you've been an absolute delight. We do need to take a quick break, and when we return, we'll talk to two of our experts about diabetes in children. They'll answer your questions. Stay with us.

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And welcome back. Joining us now is Dr. Rochelle Naylor and Amy Hess-Fischl. They'll talk to us about diabetes in children, including management of the disease, education, and some of the new technology that's available.


Now first of all, can you each tell us a little bit about your role here at UChicago Medicine? And Dr. Naylor, let's start with you.

All right, yes. Well first off, thank you for having me. It's my pleasure to be here.


So I am a pediatric endocrinologist, and so that means that I take care of children who have any issues with hormones. So that's puberty and thyroid and other things, but a very large percentage of my patients actually have either type 1 or type 2 diabetes, and sometimes some more rare forms like monogenic diabetes.

Amy?

I'm a dietitian and a certified diabetes care and education specialist, or used to be called diabetes educator. I see all patients with diabetes, and specifically type 1's, pediatrics and adults, as well as teenagers. And so my role is really to help them to understand the nuances and the individuality of what their needs are and how to manage their day-to-day life, because they're doing it 24/7.

And Dr. Naylor, we're going to start right off with a viewer question, because we've received a couple and I want to try to get to as many of those as we can do in the show. And this first one is, can type 2 diabetes be reversed?

So type 2 diabetes, I'll have to step back and say that it is an imperfect term. It's sort of everything that is not type 1 and not monogenic. And so it really is many diseases all living under that same umbrella. But most people who have type 2 diabetes, they have it in association with being at a higher weight than would be ideal for their height, and their body doesn't respond as well to their insulin. So they typically make insulin, and they, in fact, often make more insulin than a person who doesn't have type 2 diabetes. But their body nevertheless cannot overcome their insulin resistance. Because they still have insulin, a proportion of people with some weight loss, some increased exercise-- because that helps our bodies respond well to our insulin-- and with some changes to the diet-- where they're eating more fiber-rich carbs and trying to avoid sugar-sweetened beverages and simple carbs-- some people can have their type 2 diabetes go into remission. I call it remission because it can come back, particularly if they stop any of those lifestyle changes that they've made. And sometimes just because, even with the lifestyle changes, their body eventually can't keep up and keep their blood sugar normal. But it can go into remission.

For people who really are still labeled type 2 but actually have much more difficulty producing enough insulin, they're much less likely to have their diabetes reverse.

So how prevalent is the issue of kids with diabetes? And I'll throw that out to either one of you.

Yeah, so if we define kids as being anybody under 20, there are about 210,000 children who have type 1 or type 2 diabetes. Type 1 diabetes is more common than type 2 when it comes to children. But both type 1 and type 2 are increasing, and type 2 is actually increasing at a faster rate, and particularly among minorities.


So Amy, I'm throwing this one at you. Why are we seeing numbers like this? Or these increases like this? What's going on in society do you think?


Well, a lot of things, first of all. But we know that our lives have changed dramatically over the last several decades. We're not as active as we used to be. And we're talking type 2. So type 1 and type 2 are very different. But why we're seeing this increase in the type 2s, it has more to do with people aren't doing the things that they were doing before. They're eating out a lot, they're increasing all of the calories that they really don't need. And so that's what we're seeing, that increase in type 2.


Now type 1, I'm going to lob it back out to Dr. Naylor, but certainly, that is really our best guess of we don't know. We don't really have a lot of good answers when it comes to why we're seeing this increase in type 1, but I'm going to leave it up to you Dr. N.


So there's a couple of theories. So type 1 is an autoimmune process. So for reasons that are not completely clear, the body gets confused and starts attacking the insulin-producing cells. One of the theories is the hygiene hypothesis, that basically we are so clean now, that our bodies don't see as much germs and bacteria early on. And so it doesn't really get trained to properly identify self versus non-self. That's at least one theory. So maybe let your child eat the cookie off the floor after all. Or, don't get worried that the dog is licking them all over. But yeah, that's one theory, but we don't really know.


It's interesting. So I know there's some new technology that's available to help those with diabetes, and I would assume also children with diabetes. Can either one of you talk to us a little bit about what we're seeing there?

Sure, I can start and again you can throw in whatever you'd like Dr. N, as well. Again, we are seeing such an increase in the number of people that are using technology, and so we're seeing more insulin pumps and continuous glucose monitors. But what we're seeing is the integration of those two. So we're seeing these hybrid closed loop technologies, where the pump and the continuous glucose monitor are working together. So it's adjusting insulin doses based on the glucose readings, which is such a game changer. Again, I think back 23 years ago when I first started, and again really it's amazing that parents don't have to poke their children's fingers. They can see the glucose readings in their bedroom without having to go to their child's room. And so again, the big thing is this evolving technology with these hybrid closed loops are going to be kind of the big buzz now.

Certainly, for all of you that are listening, again, I strongly encourage that if you don't already get a subscription to this, is the American Diabetes Association's Diabetes Forecast. Now it's free for everyone online, this consumer guide. Every year they come out with tables and lists of all the new products. So definitely check that out, because that's a really good way to keep your finger on the pulse of some pipeline products that are coming, but also the current products that are on the market.

Dr. Naylor?

I would just add, so first off, you can see Amy's enthusiasm, and it is a big deal. I've been-- including my fellowship training-- over a decade. And it is amazing how much care has changed in that time. But pumps and particularly the CGM is really a game changer, not only in ability to achieve really excellent glycemic control, but to make it easier. I mean before we had CGM, people maybe checked their blood sugar six to eight times a day, which is actually a lot for finger pokes. It's the whole process. But with some of these technologies, you're getting a reading like every five minutes, plus predictions to help you make decisions. Like, is my blood sugar high but going down? Is my blood sugar low but coming up? Versus no it's low, and going down. I know I need to have a carb snack, versus it's high and it's going up. I know I need to give them insulin.

It really is a game-changer. That technology is amazing. I really encourage every patient to really at least try it out. I have some patients who are kind of reluctant to try it out, and I say you know, just try it. If you decide you don't like it after you tried it, OK. But unless you've tried it, you can't decide that you don't want to be on a pump or you don't want to be on CGM. And they really do make things so much better in terms of control.

Sure. We have a couple more questions from viewers that we're going to try to get to real quickly, because we're going to run over time here before too much longer.


So first one is dealing with medication. My doctor called and said there's a recall on metformin, to stop taking it. If I'm controlling my diabetes, can I consider not taking any oral medications? This person has been on that medication for 10 years. Probably want to talk directly to your physician about this one, I'm guessing.

Yes, exactly so. But I will point out to that person that recall was on the extended release tabs. I believe we're kind of back up and being OK with them, but certainly you could even go to the regular formation until it's OK to take the extended release. But you definitely don't want to come off of any medication without talking to your doctor.

Sure. And one final question from a viewer. Any new treatments for type 1? I've been reading about trials where vaccines are used to restore pancreatic functions.

I've been getting a lot of texts from patients and previous patients. Again, take some of this information with a grain of salt. Again, we know that, when we look at the newspaper and things that are on social media, it might be very small studies, things that haven't been studied in long term in a lot of people. So again, a lot of these things again may not be ready for prime time. So again, keep that in mind. Dr. N, what do you think?


I would say the same thing. That there are brilliant people working day and night to try to find a cure for type 1 diabetes. And hopefully we all live to see that day, but we're not there yet. So these things are exciting, promising, but they are not ready for prime time. But definitely continue to follow the science and the research.


There is some exciting science, and you guys couldn't have written the segue-way any better I think for me, because we're going to actually take a trip to one of our labs here in just a moment.

But first, I want to read one more comment from a viewer and then wrap up this segment. Proud former type 1 diabetic here. Thank you to U of Chicago. I have done both islet and pancreas transplant with you. Cannot say enough wonderful things about the doctors, nurses, staff there. Thank you, thank you, thank you. So I love seeing comments like that. That's so, so great.

And you guys were awesome. So thank you to both of you for your excellent information.

We do need to take a quick break. When we come back, we will tour one of the labs here at UChicago Medicine. We're on the forefront of diabetes research.


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And welcome back on this segment of our Kovler at the Forefront Live. We're going to take a trip to a special laboratory where important work is being done in the fight against diabetes. Dr. Ryan Anderson joins us to discuss this zebrafish lab. First of all, welcome to the program.

Thanks for having me.

And I think my first question probably is the most obvious. And that is, what do zebrafish have to do with diabetes?

That's a really great question. And it's one that people usually ask first when I tell them that we're working with zebrafish to study a disease that's so common. And the main reason is that, although on the surface the zebrafish looks a lot different than a human being or a mouse, if you take a look inside at all of the different internal organs, they're actually remarkably similar to those of a human or a mouse. Not only the layout of the organ systems, but also the different cells that make up those organs and all the different genes that make those organs and cells work. But in addition to reproducing what you can see in a human or a mouse, the zebrafish has a lot of great experimental advantages that make them easy to work with in the lab.


So show us what you're doing over there. You have a couple of zebrafish right there. What goes on in the lab?


Great. Well, so one of the things that we commonly do is collect embryos from the zebrafish and study those embryos both during development and once they reach a certain size where they are more similar to an adult animal. So there's a male and a female zebrafish here, and we set them together overnight. And they'll lay eggs, which we can collect. So they're in there together with this specialized tank. And the eggs that they lay will just fall to the bottom where we can harvest them just using this simple tea strainer, like a miniature spaghetti strainer. And we can just pour the water through the strainer, and we can collect all of those eggs really quick and easy and transfer them to Petri dishes where they'll continue to grow and develop completely normally for up to a week. And we can study these now in their Petri dish underneath the microscope. So we can see what the cells are doing in live animals.


That's great. Let's go ahead and walk back to the microscope behind you, because I think that's what's happening back there right now, right?

Great. Yes, so we've got some embryos that we also collected just a few minutes ago. And we've set them here on the microscope, and Melissa's looking at these embryos that are just a couple of hours old. And the first thing you can notice is that there's this really large egg shell around the outside of the embryo. And then there's a cluster of cells here that sit on the top. Now these are all exactly the same as their neighbors, and these are basically equivalent to embryonic stem cells. So each of these cells can become any type of cell or tissue in the adult zebrafish.

So a really great thing about zebrafish is that their embryos progress through development really quickly. So this is what an embryo looks like at 24 hours, and we also collected some embryos yesterday. So Melissa, if you want to switch the plates.


And are we seeing the pancreas in these little guys?


So in that first set, they're too young. So those are like embryonic stem cells, but they develop so quickly that within about 14 hours, we start to see pancreatic cells forming. And by 24 hours, these embryos look like little fish. And so here we can see, here's the eye of the fish, and this is the body. And it's twisting and turning already, trying to learn how to swim. And the pancreas is going to form in these guys right around this area. So it's already formed in this animal. It's got about 50 of these beta cells that make insulin. Now one thing that's really great about the fish is that we can make genetically engineered zebrafish that have fluorescent, glowing beta cells, so we can study how these cells are developing and how we can manipulate them in the live animals.

So we switch this over to the fluorescent view. You want to just turn on green fluorescents?

And while she's doing that, tell us how that translates eventually to humans.

Great. So because they're so similar to humans, we can manipulate the genes in the zebrafish to explore how different genes are working together to promote the growth and the formation of the pancreas. We can look at genes that might be important for the function of the pancreas, and those that might get changed under diabetes conditions. We can also use the zebrafish to test different types of drugs, drugs that have already been explored for other uses or completely novel drugs that might have a role in protecting the pancreas during the initial stages of diabetes, or those that might even reverse the course of diabetes.

And it's really easy to do that in zebrafish because we can just add the drugs into the water in most cases.

Great. And we've got about 30 seconds left, so tell us real quickly what we're seeing here as we--

OK, can we see an islet here?

Oh, in the 24 hour?

Yeah, in the 24 hour. So here, this glowing green spot here, this is the pancreas of a 24 hour zebrafish, and it's a cluster of about 50 cells that is hooked up to the circulation. And it's sampling the blood to measure what is the need for insulin, and then it's delivering that insulin into the blood. And this system, this metabolism, is already set up in these fish by 24 hours.

So we'll use fish about this age and slightly older to do most of our studies.

That's fantastic. Dr. Anderson, this is really, really interesting, and good luck on your research. That's all the time we have for this segment.

We are going to take a quick break, and when we return, we'll talk about diabetes and its devastating impact on the south side of Chicago.

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And welcome back. Dr. Celeste Thomas joins us for this portion of the program. Dr. Thomas is an endocrinologist who will speak to us about diabetes care and the health disparities that we see on the south side. Welcome to the program.

Thank you.

So diabetes has a huge impact on the south side of Chicago. Can you talk to us about how serious the problem is and what UChicago Medicine is doing to help?

Yeah, so the problem is a serious one. The Illinois Department of Public Health can provide some information for us that shows that there are some zip codes in the Chicago area that have up to 27% of the adult population carrying a diagnosis of diabetes. And what we know about type 2 diabetes especially is that there is pre-diabetes, and there are those who are not yet diagnosed. So if we can imagine that we have that 27% with carrying a diagnosis, that the numbers are actually even higher, the burden in the communities.


So what are some of the most common issues that you see with patients? Because I know the impact, again, can be debilitating to folks. What are you seeing?

So some of the things that we see are actually coming into the hospital with a diabetes emergency. So having sometimes weeks of symptoms, of what we would consider classic symptoms of hyperglycemia, high blood glucose levels. But patients not recognizing that those symptoms are due to high blood sugar, and so that increased thirst, and increased urination, oftentimes blurry vision and really significant fatigue and even increased hunger. And so oftentimes that's fed with maybe sugar-containing beverages, and then there's a cycle where high blood sugars spiral out of control, resulting in a need for a hospitalization.


And so one of the things that it's really important is just for us to think about who is at risk for diabetes and to talk about diabetes amongst family members, to talk about what those symptoms are. And so those who are at risk will know that they're at risk and recognize symptoms. And even better, meet with their physician, have testing for pre-diabetes, and prevent the disease.


You know, we've always heard knowledge is power, and I am a firm believer in that. So I think obviously what you're doing and what you're describing right there is so important. Educate patients or prospective patients or potential patients to help them be more healthy and maybe not become patients. What are some of the resources that are out there for the public? If somebody is worried about this, where could they go?


Right. So the American Diabetes Association actually has a great screening. Screen your risk for diabetes, and so it will ask you about your age, your ethnicity, and race. Because there are those races and ethnicities with a higher risk. Family history. Other conditions like hypertension. And so people can go right to that website and put in that data.


And of course, talking to your doctor. And so, establishing that relationship, even if you're seeing someone just annually. Talking about getting those screenings for these chronic conditions. And that's what we would hope people would do.


We had a patient interview segment earlier in the show with Juanita Nave, and she's been battling diabetes for years, but she has very full life. So I think that's an important lesson also. What message would you give to people out there? Because this isn't the end for them. They can have a very full life.


No. Absolutely, and that's part of the goal. So I'm sure in these segments, we've talked about the different types of diabetes. And so if you've discussed type 1 diabetes or autoimmune diabetes, and right now when we're looking at the burden that we're discussing that's primarily type 2 diabetes. The first thing is prevention, but if we can if we haven't prevented the disease, we can absolutely prevent complications from diabetes. And so when we think about diabetes being a big contributor, number one contributor-- and that older, not be very old, but in our working age-- number one contributor to blindness and non-traumatic lower limb amputation and to need hemodialysis, those complications can be avoided. And so thinking about living well with diabetes, working with your diabetes team, recognizing that so much of the work does come on to the patient, and trying to incorporate it into the lifestyle of not just the patient, but the family.


Well thank you, Dr. Thomas. You were absolutely wonderful.


As we close out the show, here's a parting message for Dr. Kenneth Polonsky, our Executive Vice President for Medical Affairs and Dean of the Division of Biological Sciences.


Well I hope you've enjoyed the program that we presented this afternoon, and I hope it gives you some insight into the outstanding work that's going on in the Kovler Diabetes Center. I think you probably know that the University of Chicago has actually been a leader in diabetes research and in diabetes patient care and treatment for many, many decades. And many of the most important discoveries that have led to the advances that have resulted in the improvements in modern care for patients with diabetes have actually occurred at the University of Chicago. And the work that we do here includes basic scientific discovery work, work on how we can translate these basic scientific discoveries into improved treatments, and then a lot of work in our community to improve outcomes and treatment for people who have diabetes and who live in our community.


So hopefully you've gotten a good insight into all of that. I'd like to acknowledge Dr. Lou Philipson, who's head of the Kovler Diabetes Center, and the other faculty and staff who are involved. I'd particularly like to acknowledge Jonathan Kovler and his family, who have supported the Kovler Diabetes Center from its inception and continuing in a very generous way.


And I hope you all enjoyed the event and learned a lot about current diabetes treatment and research. Thank you.


Thank you, Dean. That's all the time we have for the program. Please remember to check out our Facebook page for a schedule of future programs. If you would like more information on diabetes and the Kovler Diabetes Center, check out their webpage at kovlerdiabetescenter.org.


Thanks for watching. Have a great week.