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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. National Institute of Diabetes and Digestive and Kidney Diseases. Diabetes, Endocrinology, and Metabolic Diseases;

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Research highlights from the national institute of diabetes and digestive and kidney diseases l.jpg

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

Griffin P. Rodgers, M.D., M.A.C.P.

Acting Director


National institute of diabetes and digestive and kidney diseases l.jpg
National Institute of Diabetes and Digestive and Kidney Diseases

  • Diabetes, Endocrinology, and Metabolic Diseases;

  • Digestive Diseases and Nutrition; and

  • Kidney, Urologic, and Hematologic Diseases.

The NIDDK conducts and supports basic and applied research and provides leadership for a national program in:


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NIDDK’s Research and DiseasesDissemination Spectrum

“Bench to Bedside and Beyond”


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Organizational Structure of NIDDK’s Three Extramural Scientific Divisions

NIDDK

DDN

DEM

KUH

Division of

Digestive Diseases

and

Nutrition

Division of Kidney,

Urologic, and

Hematologic

Diseases

Division of Diabetes,

Endocrinology,

and

Metabolic Diseases


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A Paradigm of NIDDK’s Integrated Research Programs Scientific Divisions

Kidney

Disease

Type 2

Diabetes

Obesity


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Overweight and Obesity Scientific Divisions

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 Scientific Divisions

Stroke

Idiopathic intracranial

hypertension

Pulmonary disease

abnormal function

obstructive sleep apnea

hypoventilation syndrome

Cataracts

Coronary heart disease

Pancreatitis

Diabetes

Nonalcoholic fatty liver disease

steatosis

steatohepatitis

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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1991 Scientific Divisions

Obesity Trends Among U.S. Adults

2004

No Data <10% 10-14% 15-19% 20-24% ≥25%


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Trends in U.S. Child and Scientific DivisionsAdolescent 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 Scientific Divisions

Current environment

Adipocity phenotype

(e.g., body mass index)

Past environment

Genetic susceptibility


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A Paradigm of NIDDK’s Integrated Research Programs Scientific Divisions

Kidney

Disease

Type 2

Diabetes

Obesity


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Two Major Forms of Diabetes Scientific Divisions

Type 1

  • Usually diagnosed in childhood, adolescence, or young adulthood

  • Body’s 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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1994 Scientific Divisions

2004

Estimates of Diagnosed Diabetes Among Adults in the U.S.

No Data <4% 4-4.9% 5-5.9% ≥6%


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Diabetes: Burden of Disease Scientific Divisions

  • 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. Scientific Divisions

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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15 Scientific Divisions

12

9

Cases per 100 person-years

6

3

0

All participants

Caucasian

African

Hispanic

American

Asian

American

Indian

Metformin

Placebo/Standard care

Lifestyle

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 Scientific Divisions

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 NIDDK’s Integrated Research Programs Scientific Divisions

Kidney

Disease

Type 2

Diabetes

Obesity


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End-stage Renal Disease in the U.S. Scientific DivisionsNumber of Patients per Million Population

1993

2003


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End-stage Renal Disease in the U.S. Scientific DivisionsAll 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. Scientific DivisionsAdjusted Incident Rates & Annual Percent Change


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Progress in Combating the Scientific DivisionsU.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 Scientific DivisionsRenal 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 Scientific Divisions

  • Microvascular damage – retinopathy

  • Macrovascular damage – CVD

  • Preventing complications by preventing diabetes - DPP


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Conventional Scientific Divisions

p = 0.001

Intensive

Eye Disease: Intensive Diabetes Treatment Reduces Risk

100

Cumulative Incidence of > 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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Conventional Scientific Divisions

Intensive

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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Strategic Plan for NIH Obesity Research Scientific Divisions

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 Scientific DivisionsProgress Report on The Diabetes Research Working Group’s 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: Scientific DivisionsRenal 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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Weight-control Scientific DivisionsInformation 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 Scientific DivisionsEducation 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 Scientific Divisions

  • 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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N Scientific DivisionsKDEP

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.