Helping the Nation Understand Diabetes
Lynne Wagenknecht, DrPH, is not alone in seeing a crisis looming on the public health horizon.
“We’re about to face a huge confluence in this country of people who are aging, have diabetes and have obesity,” says Wagenknecht, a professor of epidemiology in chronic disease with an extensive research portfolio in cardiovascular disease, diabetes and obesity. “This confluence really is going to cost this country a lot of money.”
As the associate director of the Division of Public Health Sciences (PHS) and the School of Medicine’s new associate dean of interdisciplinary research, Wagenknecht is one of many at Wake Forest Baptist Medical Center working to address that confluence.
“Because we have expertise in aging at this institution as well as in diabetes and obesity, we have an opportunity to look at all three of those and work in a specific niche,” she says.
There is an interconnected web of researchers and faculty at Wake Forest Baptist who are dedicated to responding to this national need.
Efforts range from scientists working to understand the basic building blocks of diabetes and its contributing factors, to large population-based studies on how to protect people from heart disease and other complications of diabetes on a national scale. These efforts capitalize on regenerative medicine approaches and encompass health disparities that affect minority populations.
“Diabetes is one of our greatest threats to public health,” says Ronny Bell, PhD, MS, professor of epidemiology and prevention and director of Wake Forest Baptist’s Maya Angelou Center for Health Equity. The center strives to understand and address health disparities through population-based research, community partnerships and education.
“One of every seven dollars spent on health care in the U.S. is related to diabetes,” he says. “It makes for a perfect storm of bad health conditions.”
The Rise of Diabetes
The disease directly affects approximately 26 million Americans. Of these, approximately 7 million people are undiagnosed. An additional 79 million people are believed to have prediabetes, or precursor symptoms that may foreshadow diabetes in their future.The risk of death among people with diabetes is about twice that of healthy people of similar age.
In 2012, the cost of the disease was estimated at $245 billion, including $176 billion in direct medical costs and $69 billion in indirect costs, such as reduced productivity and premature death. Diabetes is a leading cause of heart disease, stroke, high blood pressure, blindness, kidney disease, nervous system diseases and amputations. Diabetes also contributes to memory loss, depression and sexual dysfunction. It essentially affects every major organ system in the body.
The primary concern—and the focus of much research—is type 2 diabetes, formerly known as adult-onset or non-insulin-dependent diabetes. Accounting for about 90 percent or more of all diagnosed cases, type 2 diabetes is associated with older age, obesity, physical inactivity and a family history of diabetes, among other factors. Race/ethnicity also plays a role; African-Americans, Latino Americans and American Indians are among groups at particularly high risk for type 2 diabetes and its complications.
Responding through Research
“Things have changed extraordinarily during my time here,” says Bowden, director of Wake Forest Baptist’s Diabetes Research Center, who joined the Medical Center 24 years ago. His work helped create the field of diabetes genetics.
“I was the only person here working in human genetics, and there was very little diabetes research here,” he recalls. “Since that time, diabetes research has exploded in the numbers of people involved in diabetes research directly and indirectly.
“When I arrived here, Public Health Sciences was part of a small floor in one of our research buildings. Now, it’s literally its own research building. There has been extraordinary success and growth in trials to understand what can be prevented about diabetes and its complications.”
Wagenknecht says the prevalence of cardiovascular disease, which was the primary focus of her research when she arrived 22 years ago, has declined over time. As diabetes and obesity increased, research in those areas expanded in response, and Wake Forest Baptist was ready.
“What this institution was poised to do was to study diabetes and its complications, including heart disease,” Wagenknecht says. “That’s one of our major strengths—we’re looking at diabetes and its outcomes, the illnesses associated with long-standing type 2 diabetes, specifically heart disease.
“The culture of collaboration at this institution has driven disparate groups of faculty to work together on common problems. We work together well, and people are recruited here who are good collaborators and recognize that the strongest research comes from collaborative work, not in isolation.”
The nature of diabetes also lends itself to collaboration, she says.
“Diabetes affects so many aspects of a person’s health and affects so many systems in the body—the heart, the brain, the kidneys,” Wagenknecht says. “Retinopathy is an important complication that can lead to blindness. Many different parts of the body are affected, and many of those research groups work in different departments and centers.”
Bowden’s work with Barry Freedman, MD, FACP, chief of nephrology and the John H. Felts III Distinguished Professor of Internal Medicine, is one example. The two have collaborated for more than 20 years to better understand the links between diabetes and kidney disease. Bowden has also worked with radiologists and cardiologists to use imaging to better understand diabetes and heart disease.
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