During my first week on campus at Purdue University I met countless new faces, I was taken to house parties, I had a paper due on the second day of class, I decided to rush a fraternity, and I found a new calling, rugby. This crazy new lifestyle called for improvisation and adaptation. High school was simple and it was easy to manage as a diabetic. My meals were scheduled for me. All I had to do was count the carbohydrates and dial up my insulin pump. Once I arrived at college I was on my own. I could eat whenever I wanted and however much I wanted. I didn’t have a curfew. I didn’t have parents telling me what to do. And if I deemed it necessary, class was optional. The potential traps were endless and sometimes hard to avoid. But by keeping myself educated on the tricks of the trade and aspiring to live a healthy and active lifestyle I have become successful as both a Type I diabetic and an easy-going college student.

The juggling act is really about following a finely tuned schedule that allows me to do all the things I need and want to do, while maintaining tight control over my blood sugars and insulin levels. There will always be struggles, and even failure. But it is the successes that have encouraged and inspired me to want to help others. If I could, I would prevent every other diabetic from suffering the hard lessons. I want to use my skills and passion to help educate those who are struggling with this disease, and help build a network of dedicated advocates who will work closely with the Juvenile Diabetes Research Foundation in finding a cure.

Lisa is being recognized for her advocacy work on behalf of children with diabetes. She provides direct assistance and support to families with legal issues surrounding diabetes care at school.

Lisa is a longstanding moderator for JDRF’s Online Diabetes Support Team, a group of dedicated JDRF volunteers who help people with type 1 diabetes and their families by answering their questions about living with the disease. While the Online Diabetes Support Team cannot give medical advice, they do provide personalized support and expertise on a variety of topics. The ODST has answered nearly 20,000 requests for support and information to date.

Lisa has also been instrumental in the success of JDRF’s School Advisory Toolkit, a publication that provides practical information and advice to help families and schools work together to create a safe, caring, and positive learning environment for children with type 1 diabetes. Three years ago, Lisa wrote an executive summary for JDRF that led directly to the development of the School Advisory Toolkit and the School Advisory Team.

“I am deeply humbled and honored by the Commission’s recognition of my advocacy work on behalf of children with diabetes,” Lisa says. “As one might well imagine, this work has deep personal meaning…and it is truly one of the most rewarding forms of volunteerism I’ve had the honor to perform. This award serves as affirmation that protecting the rights of all children with diabetes is worthy of the public’s attention: appropriate diabetes care at school is a basic human and civil right that touches the life of every child living with diabetes.”

Be sure to visit DiabetesInCASchools.

We are delighted to announce the introduction of a new bill, AB 1802, into the California Legislature by Assembly Member Isadore Hall III (D-Compton) in support of children with diabetes attending California schools.  Hall’s bill would establish a procedure by which a parent or guardian can designate a trained volunteer school employee to administer insulin to a child with diabetes in a public school, based on the medical instructions provided by the child’s physician.  Read the press release.

Please take action! Join us in saying “thank you” to Assembly Member Hall for his steadfast commitment to seek legal clarity and deliver a solution that is safe, appropriate and provides a wide net of support to children living with diabetes.  Send a letter to Assembly Member Hall expressing your gratitude and support and tell your story (even if you’ve already done it before) so it can be shared with other lawmakers.

Stay informed about AB 1802 as it moves forward, learn more about why this bill makes sense, and

sign up to receive email alerts at www.DiabetesInCASchools.com

Give children with diabetes a voice.  Tell your stories. Help protect and preserve the human and civil rights of children with diabetes to receive appropriate care at school.

In Partnership,

Lisa Shenson & Jim Stone, Grassroots Co-Chairs

www.DiabetesInCASchools.com

Results from the studies are published in the February 5, 2010, issue of The Lancet, available online at www.thelancet.com.  An article also appeared in the New York Times on the same day as The Lancet article was published and you may read it athttp://www.jdrf.org/intranet/index.cfm?fuseaction=home.download&folder_file_id=9F98E850-1279-CFD5-A7D4D18564F65218

The trials tested the safety and effectiveness of a first-generation artificial pancreas system used overnight in a hospital setting with participants between 5 and 18 years of age with type 1 diabetes.  The system combined commercially available blood glucose sensors and insulin pumps, controlled by a sophisticated computer program that determined insulin dosage based on blood glucose levels while the participants slept.

Maintaining recommended blood sugar levels overnight is a major issue for people with type 1 diabetes – and particularly for the families of children with diabetes – because of the possibility of blood glucose dropping dangerously  low during sleep and going unnoticed, which can lead to seizures, coma, and in some cases be fatal.

Notably, the Cambridge study showed that the children and teenagers spent twice as much time during the night within targeted blood glucose levels when their diabetes was regulated with the artificial pancreas system than when they followed conventional “manual” therapy.  And low blood sugars were minimized.

“These studies show that automated systems not only can help people manage diabetes by maintaining good control, they will also improve quality of life for the people with type 1 diabetes and their families by lowering the risk for hypoglycemia,” said Roman Hovorka, Ph.D., from the Institute of Metabolic Science at the University of Cambridge, the principal investigator of the study and lead author of the paper. “These results suggest that closed-loop devices may be able to significantly lower the patient’s risk of developing complications later in life by reducing or even overcoming the burden of hypoglycemia.”

“Without a doubt, the biggest worry for parents of kids with type 1 diabetes is that their child will have a low blood sugar emergency during the night, when they’re hard to identify,” said Aaron Kowalski, Ph.D., Assistant Vice President of Metabolic Control at JDRF and Director of the JDRF Artificial Pancreas Project.  “This study is proof of principle that diabetes in kids can be safely managed overnight with an artificial pancreas. We need to redouble our efforts to move the artificial pancreas from a concept in the clinic to a reality in the home of kids and adults with type 1.”

The first phase of the Cambridge study compared the effectiveness of a simple artificial pancreas system used overnight with standard blood testing and insulin delivery using a pump.  It showed that the time participants spent in target blood glucose levels (between 70 mg/dL and 140 mg/dL) improved from 39% to 52%.  The second phase of the study evaluated the effects of a using the same artificial pancreas system overnight with the additional variable of the participants eating a particularly large meal, which can impact overnight blood glucose levels.  The results were comparable to the first phase of the research.  The third phase of the study evaluated the effects of moderately intense exercise, which can also impact blood sugar levels.  Using the automated system in this setting showed the greatest improvement in blood sugar control, with the amount of time spent in the target range increasing from 48% to 78%.

“The pooled data from the closed loop studies showed that blood glucose levels were 61% in target, and even increased to 75% in target after midnight when closed-loop became fully effective,” said Dr. Hovorka. “Based on these results, this study is a significant step towards an artificial pancreas.”

The Cambridge studies were randomized, controlled trials involving 17 children and adolescents conducted at the Wellcome Trust Clinical Research Facility at Addenbrooke’s Hospital in Cambridge, United Kingdom over the course of 54 nights.  Twelve subjects were used for the first study; 6 subjects were used for the second, and 9 for the third.  Some 33 nights were on a closed-loop artificial pancreas system, while 21 nights were controlled (on standard therapy).  During the closed-loop studies, continuous glucose measurements were fed into a computer program every 15 minutes, which calculated the insulin infusion rate; the insulin pump was adjusted manually by a research nurse.  During control nights, the subject’s standard insulin pump settings were applied.

Type 1 diabetes is an autoimmune disease in which the immune system attacks and kills off the cells in the pancreas that produce insulin, a hormone that enables people to convert food into energy.  It affects 3 million American children, adolescents, and adults.

To manage their disease, people with type 1 diabetes need to measure their blood sugar multiple times throughout the day (typically by pricking a finger for a drop of blood), and pump insulin or inject themselves multiple times daily to keep blood sugar levels within a healthy range.  That daily routine continues for life, because insulin administration does not cure diabetes.

Research has shown that good blood sugar control is a key factor in reducing the risk of the devastating long-term complications of the disease, such as blindness and kidney disease – but that the fear of low blood sugar emergencies often prevents many people from achieving tight control, and remains a constant concern for those who manage their diabetes well.   The landmark Diabetes Control and Complications Trial (DCCT) showed that with intensive insulin therapy, excellent blood glucose control was obtained, but at the expense of a considerable increase in hypoglycemia.

About JDRF’s Artificial Pancreas Project
This study is the latest development within JDRF’s Artificial Pancreas Project, and stems from the progress made since 2006 in the JDRF-funded Artificial Pancreas Consortium, a group of university-based mathematicians, engineers, and diabetes experts that has developed the computer programs needed for an artificial pancreas, and established their scientific feasibility.   These academic studies within the Artificial Pancreas Project are an excellent complement, and essential to JDRF’s work with industry participants to develop first -generation systems.

JDRF announced the first major non-exclusive industry initiatives of the Artificial Pancreas Project last month, when it entered into a non-exclusive partnership with Animas, a Johnson & Johnson company, to develop a first-generation artificial pancreas system.  JDRF also announced a non-exclusive partnership with BD (Becton, Dickinson and Company) aimed at developing novel insulin delivery products – a key component of developing safe and effective artificial pancreas systems.

The eventual, ultimate goal of the JDRF Artificial Pancreas Project is speeding the development of automated diabetes management systems.   The goal of an artificial pancreas has also been embraced by the U.S. Food and Drug Administration, which along with JDRF and National Institutes of Health, brought together scientists, regulators, industry, and patients for scientific workshops n the subject in 2005 and 2008; the FDA has designated an artificial pancreas as one of its “critical path” initiatives.

An artificial pancreas would measure blood sugar through a continuous glucose monitor (CGM), which continuously reads the glucose levels through a hair-thin tube inserted just below the skin, typically on the stomach.  The CGM would beam those readings to an insulin pump.  In an advanced system, the pump would house a sophisticated computer program that would automatically calculate the necessary amount of insulin, based on the CGM’s glucose readings, and deliver the right amount of insulin.

The development of an artificial pancreas system is an essential step towards an ultimate cure for type 1 diabetes – a “bridge to a cure.”

More information about the JDRF  Artificial Pancreas Project can be found online at jdrf.org/artificialpancreasproject.  The site includes information for people with type 1 diabetes about research leading to the development of an artificial pancreas, as well as interactive tools, project timelines, chats with researchers, and access to information about clinical trials.

The organization’s mission supports activities related to education for and about children with diabetes. This includes funding scholarships for diabetes education conferences and higher education. Diabetes Scholars Foundations also provide scholarships for a variety of diabetes-related conferences throughout the year.  To learn more, please visit www.diabetesscholars.org.

The Diabetes Scholars Foundation Scholarship Program is available to incoming freshmen seeking an education at an accredited four year school.  This scholarship recognizes students who are actively involved in the diabetes community, who have high academic performance, who participate in community and/or extra-curricular activities and who have demonstrated that they are successfully managing the challenges of living with diabetes. Diabetes Scholars Foundation scholarships are not based on financial need.  Application Package, including Letters of Recommendations, must be received in full by April 15, 2010.

Last year the organization received 600 applications and awarded $200,000 in scholarships.  It is a small non profit with a big idea.  Diabetes Scholars Foundation is supported by many of the same companies that support diabetes research and JDRF:  Animas, Bayer, Accu-Check, OmniPod and Abbott to name a few.  This small nonprofit also hopes for support from individuals like us.

The Juvenile Diabetes Research Foundation and diaTribe have a long, fruitful history. Dr. Aaron Kowalski, Assistant Vice President, Metabolic Control/Head of Artificial Pancreas Project at JDRF has been an advisory board member of diaTribe since 2006 and diaTribe editor in chief, Kelly Close, is a member of the JDRF, San Francisco/Marin Branch Board. She has had type 1 diabetes since she was a teenager. diaTribe is for everyone eager to learn about the latest advances in diabetes management focusing on research and product news. Visit www.diatribe.us/jdrfinterview to sign up for your complimentary lifetime subscription.

diaTribe dialogue

by eric chang, jenny lesser, katherine wu, and kelly close

We were very fortunate to speak with Alan Lewis, PhD, the new President and CEO of the Juvenile Diabetes Research Foundation (JDRF). Dr. Lewis brings to the position a wealth of experience in drug development and discovery – in our conversation, he discussed the future of diabetes research, his hopes for the JDRF, and how diabetes therapy will change on the road to a cure. The JDRF, of course, has great influence on the direction of diabetes research – we appreciated Dr. Lewis’ candor and are eager to see where he will take the organization.

finding the cure

diaTribe: Dr. Lewis, we really appreciate your taking the time to speak with us today. We’d like to start with the billion-dollar question: is a cure something we can reasonably expect to see in the next decade? As patients, of course, we have been hearing that it’s “just around the corner” for the last few decades.

“Clearly, the cure represents different things to different people, and there’s probably no such thing as a single cure for all patients with type 1 diabetes.”
-Alan Lewis, PhD

Dr. Alan Lewis: As you well know, JDRF’s mission is to cure diabetes, so one of the first questions I asked when I joined the organization was where this stood – i.e., what is the cure and when can we expect to see it. Clearly, the cure represents different things to different people, and there’s probably no such thing as a single cure for all patients with type 1 diabetes. I also realize there’s a danger in increasing the hope for something sooner that it will actually occur. Some people say that they realize that if they could maintain their blood sugar within normal range, they wouldn’t have to worry about hypoglycemic events and complications. That for them is a cure. Thus, I think in actuality a closed-loop artificial pancreas (a device designed to automatically respond to changes in glucose levels in the body, mimicking the natural response of the pancreas) will be considered a cure for these people who tell us they are more concerned with maintaining their blood glucose levels within a tighter range than they are worried about wearing devices.

But we really believe that you need to restore and preserve the beta cells (insulin producing cells in the pancreas) and protect them from future immune attack. That is ultimately the cure. So the question is, how do you do that? There are multiple ways to pursue that goal, such as encapsulation (protecting transplanted beta cells from immune attack using an artificial barrier), which JDRF partner Novocell is working on, for example. We’ve also recently announced a major collaboration with the Genomics Genomics Institute of the Novartis Research Foundation (GNF) in beta cell regeneration, to recover lost beta cells. We have a number of programs in pharmaceuticals – they more work to slow the progression of diabetes, so if we talk about anti-CD3 antibodies, for example, they come more under the category of treatments (for more on anti-CD3, see Learning Curve from diaTribe #15). In terms of a time frame, it’s going to probably exceed 10 years, certainly longer than we would like. But from my vantage point, it’s not that far away, when you consider that it often takes 12-plus years to develop a new molecule for clinical indication. My feeling is we will see a lot of benefits beyond the decade.

diaTribe: Great, thank you – we hope so, and we so appreciate all that JDRF is doing.

who is dr. lewis?

diaTribe: To step back a moment, could you give us a little more personal insight into your background and what led you to this position? What interested you particularly in diabetes?

Dr. Lewis: I moved into diabetes research when I became involved with stem cell research while at Celgene in San Diego. You probably remember that California at that time was a hot-bed for stem cell research, so I connected with many of the researchers in the field. Around the same time, in 2003, the proposition that led to the California Institute for Regenerative Medicine (CIRM) was introduced, with stem cell advocate Bob Klein driving a statewide initiative to create a fund for regenerative medicine and stem cell research. Bob is a former board member of JDRF, and the Foundation was closely involved with those issues.

My full-time involvement with diabetes research began at the end of 2005. I was approached by Novocell, a stem cell engineering company in San Diego that was focused on creating a cell therapy for diabetes. I took on the CEO position there in February of 2006, and we worked on islet cell technology.

As you know, islet cell transplantation has been possible for some time as an experimental therapy for type 1 patients, particularly people with brittle diabetes. But transplanted cells, which come from cadavers, don’t last long, and the patient has to take high doses of immunosuppressive drugs to prevent the rejection reactions that destroy transplanted cells. Novocell took a different approach to replacement. They took those donated islet cells and encapsulated them in a polymer that protected them from attacks by the immune system. In that way, people undergoing transplants wouldn’t have to take immunosuppressive drugs for the rest of their lives. Novocell was also developing a proprietary protocol to coax human embryonic stem cells into insulin-producing cells. This was my first entry into cutting edge stem cell research, and I realized immediately that this was the future of medicine.

diaTribe: Well, a natural follow up is, what lessons have you learned/experiences do you have that you feel helped prepare you for the position?

Dr. Lewis: There are some clear parallels between leading JDRF and running a start-up company – you need to find great ideas that have a clear path to becoming treatments and cures, and quickly but systematically move those ideas through development. And you have to be smart about placing bets on what will work and what won’t – and on what people with the disease will use and what they won’t.

“In many ways, the volunteers at JDRF are like your investors at a start-up. They have a huge personal interest in seeing you succeed, and they have an extreme sense of urgency about bringing home that success.”
-Alan Lewis, PhD

In many ways, the volunteers at JDRF are like your investors at a start-up. They have a huge personal interest in seeing you succeed, and they have an extreme sense of urgency about bringing home that success. But at the same time, they understand the complexity of what you are trying to do and are willing to support that as long as your path to success is clear. They also all have passion and are absolutely supportive. They always say the same thing to me: anytime you need anything, let me know – I’ll do anything I can to help. I can assure you that sentiment is incredibly motivating for somebody who’s in charge of an organization, and I never had that in my life before.

From my earlier research background, I know the advantages of managing a large portfolio of research, but also the difficulties of managing a big scientific staff. We need to be big enough and smart enough to be the go-to organization in diabetes research – but at the same time, not so spread out that we can’t actively manage our science, and mass our resources behind the most promising ideas. We need to take some smart bets.

diaTribe: It’s an amazing team that you have both in the US and globally and what you are doing on so many fronts is truly inspiring. So from patients, thank you for doing that.

Dr. Lewis: And you know, that’s so meaningful for me to hear: Thank you. Nobody ever tells you that in a biotech company! This is a very different world.

the jdrf’s research priorities

diaTribe: The JDRF has made some real strategic shifts to focus more on improving things for patients in the “here and now.” Can you discuss the changes that have been made and what the implications are for the organization?

Dr. Lewis: As I said earlier, the simplicity of the idea of a single “cure” is very appealing and therefore the mission has been very straightforward. But realistically, patients have to maintain their health, and they need to live longer while that research is ongoing. Work aimed at more current breakthrough therapies is critical – it will help more people to benefit from an ultimate cure. So we have made an absolute commitment that we intend to do both, getting better treatments in the short term while focusing on the ultimate goal of a cure through beta cell preservation and restoration.

One top priority right now is developing a first-generation closed-loop system for glucose management, with faster-acting insulin. Another priority is the beta cell. The JDRF is incredibly supportive of replacement therapies, supporting research on cell therapy, embryonic stem cells, adult stem cells, just to name a few. Cell transplants for diabetes, however, are an incredibly difficult thing to do and to commercialize. So what we decided to do is focus energy on beta cell regeneration, regenerating insulin producing cells rather than transplanting cells. We’ve been investigating and investing in regeneration for years now, and have made progress to the point where we can start translating our research into clinical therapies. The collaboration that we talked about with GNF is obviously huge for us in addressing those translation challenges; a multimillion-dollar collaboration with the idea of generating multiple new drugs. We’re looking for other, similar partnerships to advance research in this field.

“Working with academics in the field, we really believe that, like we did with the Artificial Pancreas Project, we will be seen as the leader in beta cell regeneration.”
-Alan Lewis, PhD

That, we believe, is the way forward. And obviously, we feel we’re well positioned to drive the future of medicines. Working with GNF and other academics in the field, we really believe that, like we did with the Artificial Pancreas Project, we will be seen as the leader in beta cell regeneration. Regeneration will also be very effective, we believe, for people with type 2 diabetes.

In addition, for a cure for type 1, we need to modulate the immune system response that causes diabetes. We believe perhaps the most important and effective area of focus for us in this area is to create antigen-specific therapies that suppress the immune system.

We’re already involved with a number of immunotherapies that are nonspecific or from the anti-CD3 class, which we talked about earlier. But some of these kinds of programs tend to have a risk of adverse side effects. So our approach now is trying to regulate the autoimmunity of the disease safely and with durability with antigen-specific therapies. We really believe it’s critical for us to have this kind of therapeutic, both to modulate the immune rejection of transplanted cells, and more importantly, to regenerate beta cells. It’s a one-two – regeneration plus a targeted antigen-specific therapy. Now, what is that today? I can’t tell you because it’s relatively new. There are a number of approaches that we are investing in and investigating, and we believe the combination will be the really exciting way that people will see a cure down the road.

diaTribe: Dr. Lewis, we’d love to hear more about your views on the Artificial Pancreas Project (APP). What is the biggest barrier right now? Is it the speed of insulin action? The accuracy of the glucose-sensing devices?

Dr. Lewis: Broadly speaking, it’s a combination of issues that can’t be overcome. From a mathematical perspective to run these systems, there are algorithms that we are helping to create. The sensors probably need to be further improved, even though we have seen so much improvement already. And you’ve mentioned fast-acting insulin – clearly, if we could further improve the speed, then we’d be in a much better position to closely mimic the physiological response.

We’ve been talking with companies and people to accelerate CGM, pump and algorithm development, all to the end of getting a first-generation artificial pancreas. Our goal is to make sure that many companies and academic groups can develop this program. I think we’re optimistic that we will be able to form collaborations around the world, in the not-too-distant future. I think that support will go a long way to ensuring that short-term timelines will be met and that we won’t be waiting longer than five years for success.

diaTribe: Dr. Lewis, how have you felt about all of the work that the JDRF has done on the reimbursement side? We know the organization has been lobbying to increase reimbursement for devices and provider time to reduce costs for patients and improve care. Some of this is actually newer work for JDRF, is it not?

Dr. Lewis: Yes, it is. You know, we have an incredibly valuable Government Relations staff that has been instrumental on the research side. They are a key component of the Artificial Pancreas Project and the continuous glucose monitoring (CGM) studies we have undertaken. Our connections with insurers and with the FDA also helps.

One of our objectives with the CGM research we have done (for more on the JDRF CGM studies, see our Conference Pearls from diaTribe #16) was to convince insurers to increase their coverage. Since the first results from those trials were published more than a year ago, most of the top insurers now reimburse for CGM devices. When it comes to the regulatory environment of the FDA, that helps with the Artificial Pancreas Project. When we create the first generation artificial pancreas, I think we can do a lot of the groundwork with the FDA, like we’ve done for CGM – I’m optimistic this will be able to help speed the FDA’s approval process for the artificial pancreas.

We keep the FDA very aware of what we’re trying to do, and I think we have a very good relationship. I think our role is seen very positively by these authorities and by Congress. We are lobbying in the best sense for patients and trying to teach people when we can. We know what the issues are and I think we have seen incredible progress – and in the same breath, I will say there is so much more to do, and we aren’t looking up for a microsecond.

company commentary

diaTribe: Tell us a little more about your thoughts on the companies JDRF is currently funding – we’d love to hear your opinions, especially since you’ve so recently led a company yourself.

Dr. Lewis: Well, so many different companies are onto very exciting tracks. It’s a terrific complement to our academic research. I think Tolerx and Macrogenics are doing a fantastic job. They’re very smart; they have great clinical trials with anti-CD3 therapies. Novocell – I think what they’re doing is phenomenal, and many of our volunteers like the approach.  Bayhill Theraputics is a very interesting one as well. They started off in multiple sclerosis and then made real strides in diabetes and recently  Genetech/Roche made a great deal with them. And the list goes on with companies like Smart Cells and Osiris and others.

“Wouldn’t it be wonderful if you could have a general anti-inflammatory cell that is not going to be rejected, that you could put into patients – not just type 1s but other patients, too?”
-Alan Lewis, PhD

I love what Osiris Pharmaceuticals is trying to do with mesenchymal stem cells. Wouldn’t it be wonderful if you could have a general anti-inflammatory cell that is not going to be rejected, that you could put into patients – not just type 1s but other patients, too? I’m keeping my fingers crossed that this approach will work.

Novocell is another example of a company that is moving aggressively towards the clinics that has been supported by JDRF. All in all, we funded more than 25 different small biotech companies over the past few years. Ultimately, you need lots of shots on goal to be successful. And so the more shots we have, the better chance we’ll score with some. So far, we have had four companies move on to commercialization agreements with pharma or diabetes companies. That’s pretty good.

diaTribe: Have you seen interest in the field from larger companies?

Dr. Lewis: One I haven’t mentioned is Johnson & Johnson. Clearly, they are exceptionally well placed. They’ve made a commitment to diabetes research and product delivery, and their stem cell program with BetaLogics has been moving nicely in that direction. They’ve got some very smart people in their organization.

diaTribe: What do you think will motivate larger companies to invest in more cure-based research?

Dr. Lewis: I think the notion that there isn’t just a single cure, and that there are ways to approach patients on the way to the ultimate cure. Again, large companies are risk averse, and the ones involved in diabetes therapies would have large markets to lose if there were one single cure. However, the multiple shots on goal approach, with combination therapies, devices and solutions for patients with diabetes, makes it more attractive to large companies.

the future of diabetes – and messages for all

diaTribe: A last thing for patients specifically: How do you think diabetes will look five years from now and ten years from now?

Dr. Lewis: Well, there’s going to be incremental changes and improvements over the years, and it will vary according to what stage of your disease you are in. The next five years, we’ll be trying to slow progression of this disease by improving A1c with less hypoglycemia, so you have more time within your target glucose range. Hopefully, this will also reduce long-term complications. We will likely have drugs on the market that preserve some beta cell function in the newly diagnosed. And there will likely be improvements in treating diabetic eye disease and hypoglycemia unawareness.

If you talk about the next five to ten years, then you’re getting into keeping people within your target range longer, with minimal interventions. We’ll be preserving beta cell mass earlier in the disease, and maybe even increasing beta cell mass in some patients with established disease. And obviously, there will be some better treatments for certain complications. Beyond that, we’re going to try to prevent and reverse this disease. The goals are clear.

diaTribe: Do you have advice for companies that make products for people with diabetes, those that fund product development, or for patients themselves?

Dr. Lewis: Diabetes is large market, and I don’t only mean the type 2 market. The corporate and investor communities will realize that type 1 therapies are on their way. Insulin has been around since 1921, and we need alternative products. Importantly, this is a receptive patient group often diagnosed at a young age so their support system is well established. Also, given the nature of type 1 diabetes, compliance is likely to be better than in much of the type 2 marketplace – that should be appealing to the corporate community. I think there will be a far greater focus on type 1 patients due to the growth in numbers, the accelerated innovation landscape, and the characteristics of that patient group.

“For people with diabetes, these are exciting times. We have a portfolio of research aimed at benefiting people at all stages of diabetes.”
-Alan Lewis, PhD

For people with diabetes, these are exciting times. We have a portfolio of research aimed at benefiting people at all stages of diabetes – those who have been living with the disease, sometime for decades. Those with complications. The newly diagnosed and those at risk. We are focusing our research so that we can deliver both near term and longer-term treatments and cures. Our aim is to cure, treat, and prevent diabetes – with emphasis on cure.

diaTribe: That is fantastic. We hope you will be at JDRF as long as it takes to achieve all of these goals. Thank you so much, Dr. Lewis, for sharing your valuable time with us.

Mark Sanchez

Voters can go to http://www.nfl.com/pepsirefresh and vote for Sanchez, or text ‘MARK’ to PEPSI (73774). Voting ends at 12:01 a.m. on Feb. 5, 2010.

If Sanchez outpolls other Pepsi Refresh Project sponsors, the funding will help JDRF establish a nationwide program to educate people about the symptoms of type 1 diabetes – the most severe form of the disease – and get medical care before suffering the life-threatening short-term complications of high blood sugar. Symptoms for type 1 or juvenile diabetes can be mistaken for common illnesses, such as the flu, and if left untreated, even over a very short timeframe, can be deadly.

“I want to help establish a much needed, nationwide educational program with JDRF to ensure that the warning signs of type 1 diabetes will become household knowledge for medical personnel, parents, teachers, and friends,” said Sanchez. “Then, a quick and accurate diagnosis can be made and proper treatment given before it results in a life threatening situation.”

In addition to Sanchez, quarterback Drew Brees and linebacker Demarcus Ware are also participating in the Pepsi Refresh Project challenge

“We’re honored to have Mark Sanchez in the vanguard of our efforts to help save lives and eventually find a cure. Mark is an outstanding example of leadership on and off the field, bringing attention to a problem that can have an enormous impact on the 15,000 children diagnosed with type 1 diabetes annually – that’s 40 children a day,” said Alan J. Lewis, Ph.D., the President and CEO of JDRF. ”

All forms of diabetes are clearly on the rise, but the sad fact is that type 1 diabetes is far and away the most prevalent form of the disease affecting children, and so we are also grateful to the Pepsi Refresh Project Challenge for investing in a program that will positively impact so many lives.”

The Audi competition, is not a typical race to the finish.  Instead, the winning car will have completed the trip with the most fuel efficiency.  Typically the drive for most of us from DC to Miami takes about sixteen hours.

The winner will be announced at an event hosted by Audi on Friday, February 5, 2010, at the W Hotel in South Beach, Florida.  At that time Audi will award the winning prize of $20,000.  Michael Silver has decided to donate his prize to two type 1 diabetes nonprofit organizations that, in his words “play noble roles in coping with and attempting to cure the condition that affects my 10-year-old son and as many as 3,000,000 Americans” that live with type 1 diabetes.  The two organizations are the Diabetes Youth Foundation of Concord, CA and the Juvenile Diabetes Research Foundation Bay Area.

You can follow Michael’s progress on Twitter and read his Yahoo! Sports column.  Mike plans to use his driving time to generate awareness of type 1 diabetes and encouraging others to make donations by providing opportunities for people to help.

Michael says he would love to hear from you while he competes “on fuel efficiency, roadside attractions between D.C. and Miami and potential CD selections. And, we can also talk football.”

More on this competition as it progresses.  For now, donations may be made to JDRF by visiting curetype1.org/ridewithsilver.  Good luck!  Drive slowly.  Remember to fill your tank only when it needs filling, if at all!

Thank you for selecting JDRF as your beneficiary.

The group meets from 6:00 – 8:00 and everyone is welcome.  This is an opportunity for adults to meet others that also have type 1 diabetes, to share best practices, exchange tips, address challenges, discuss technology, to learn from others and to share with others. I believe a discussion is planned to determine how future group meeting will be structured.

The JDRF office address is 49 Stevenson Street, San Francisco, CA  94105 and our office is in suite 1200.  Our office is located between Market and Mission Streets and 1st and 2nd Streets.  The general office number is 415 977 0360.

Wine and cheese and snacks will be provided compliments of Roche.

If you would like more information, please get in touch with Carolyn Eisen, JDRF Outreach Manager, at (415) 597-6317 or ceisen@jdrf.org.

Twenty seven people have RSVP ed that they plan to join this week’s group.  I hope you will also join us.

I should also mention parking if you plan to drive.  After six the meters are free and there is generally an abundance of parking on Mission Street between 1st and 2nd Streets.  There are also lots on Stevenson near 3rd Street and several others.  Be sure to find out what time the lot closes for the day.  Many close at 8:00.

It is easy if you plan to take Muni or BART just exit at Montgomery and walk a half block south of Market to Stevenson.

However, these days, we are constantly being reminded by the media and health professionals, about the impending obesity and diabetes, colloquially known as “diabesity,” epidemic. However, this issue, that has been at the center of attention of many health and lifestyle articles, generally excludes Type I diabetes, leaving it in the rather hefty shadow of its counterparts. I’ve even noticed this trend on an academic level. At the beginning of the quarter, after perusing the course syllabus for a biology course I am taking, I was excited for a lecture module titled “Diabetes.” Finally, I’d get a chance to learn the science behind the chronic disease that demanded so much attention and energy from my cousin and best friend. Needless to say, I was extremely disappointed about how much time was afforded to type 2 diabetes and its interaction with the Kreb cycle and insulin-uptake and only a hasty, brief plug was given to Type I diabetes.

In my opinion, type I diabetes deserves just as much awareness as the other types of diabetes and I would like to be more active in Type I diabetes outreach. JDRF has been supporting individuals with type 1 diabetes and their families for the past 40 years creating a sense of unparalleled community and hope. In these past few days, I’ve spent countless hours reading people’s stories and blogs about diabetes and have become so inspired to work alongside others who are dedicated to finding a cure for type 1.