The History of Diabetes at the University of Chicago Medical Center

The convergence of World Diabetes Day and American Diabetes Month in November is an opportunity to raise awareness about the disease, as well as clinical, research and advocacy efforts. For more than a century, the University of Chicago Medical Center has been at the forefront of treatment and research for all forms of diabetes. Today, the Medical Center sees more than 30,000 outpatient diabetes visits each year and uses more than $15 million in grants to study the disease.

Q: What is diabetes?

A. Diabetes is a term describing several diseases that are characterized by high blood sugar due to deficiency of the hormone insulin, which helps transport sugar from the bloodstream into cells of the body. Type 1 diabetes, previously known as juvenile diabetes, is typically diagnosed early in life and is an autoimmune disorder that results in the destruction of the insulin-producing beta cells in the pancreas. Type 2 diabetes, which typically appears later in life, is usually related to being overweight or obese. The fat cells make the body less sensitive to the effects of insulin and the beta cells become unable to keep up with the extra demand for insulin. Gestational diabetes appears in expectant mothers, and will either go away after the pregnancy or reveal a higher risk for diabetes. Monogenic diabetes is a group of disorders caused by mutations in one of several genes leading to neonatal diabetes or maturity onset diabetes of the young (MODY). Other forms of diabetes can occur along with other diseases like cystic fibrosis, or after treatment with certain medications such as steroids or after transplant surgery.

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Q: How many people in the United States have diabetes?

A. According to the Centers for Disease Control and Prevention, 25.8 million Americans have been diagnosed with diabetes and an additional 7 million cases remain undiagnosed. Experts estimate that nearly 80 million Americans have pre-diabetes, in which blood sugar levels are elevated but not high enough for a diagnosis of Type 2 diabetes. A 2009 study by University of Chicago researcher Elbert Huang estimated that 44 million Americans will have Type 2 diabetes in the year 2034, creating annual costs of $336 billion.

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Q: What landmark research discoveries for diabetes were made at the University of Chicago?

A. University of Chicago researchers have studied diabetes for more than a hundred years. In the early 20th century, anatomist Robert Russell Bensley was the first to describe the growth and development of endocrine cells within the pancreas. In 1967, biochemist Donald Steiner discovered proinsulin, the precursor of insulin, a key discovery of how the body makes insulin that improved the synthesis of the hormone for medical use. More recently, geneticists at the University of Chicago Medical Center have discovered genes associated with MODY, neonatal diabetes, and susceptibility to type 2 diabetes in the Mexican-American population.

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Q: What is Lilly’s Law (the Neonatal Diabetes Mellitus Registry pilot program)?

A. "Lilly’s Law" was inspired by Lilly Jaffe, a patient at University of Chicago Kovler Diabetes Center. In 2006, physicians from Kovler determined that 6-year-old Lilly’s diabetes was caused by a rare genetic mutation. The mutation disrupted the function of a protein that facilitates the proper release of insulin from pancreatic cells, a deficiency that can be corrected with a common oral medication. Because of this condition, Lilly’s doctors were able to switch her from insulin injections to daily pills. Media reports of Lilly’s case attracted the attention of families around the country, leading to the transition from injections to pills among dozens of children with similar forms of monogenic diabetes.

To facilitate the identification of patients who would be candidates for treatment with oral medication instead of insulin injections, the Kovler Diabetes Center established a registry for anyone diagnosed with diabetes before the age of 12 months. In 2009, a similar statewide registry was created through a bill sponsored by Rep. Tom Cross and members of the Illinois Diabetes Legislative Caucus. Physicians are required to report cases of neonatal diabetes to the Illinois Department of Public Health, where the information will help researchers study previously undiscovered mutations and develop new treatments.

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Q: What research is taking place at the University of Chicago Medical Center?

A. More than 150 scientists across the Medical Center are studying the biology of diabetes and new ways to treat and prevent the disease. Researchers in the Kovler Diabetes Center conduct cutting-edge and creative research, such as: examining the molecular mechanisms of how environmental chemicals, food additives and bacteria contribute to obesity and diabetes; exploring how the brain controls insulin secretion and metabolism; and testing probiotic approaches to prevent Type 1 diabetes.

University of Chicago laboratories continue to look for genetic mutations that cause diabetes or predispose people to acquiring the disease later in life. Scientists are studying the biology of pancreatic islet beta-cells that produce insulin in order to develop new methods of correcting deficient production of the hormone, such as islet cell transplants and stem cell research. The effect of obesity, poor sleep and other risk factors for diabetes is under study by researchers from various departments, including the University of Chicago Sleep, Metabolism, and Health Center.

Medical Center physicians are also studying and creating new community programs to reduce obesity and diabetes on Chicago’s South Side, where the diabetes rate is three times that of other areas in the city and state. Through collaborations with the community, researcher Deborah Burnet designed the Power-Up and Reach-Out programs to teach proper diet and exercise to overweight schoolchildren at risk for developing Type 2 diabetes. Monica Peek and Marshall Chin are exploring how to use community health workers and text-messaging technology to improve diabetes self-management in urban populations.

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Q: How has the University of Chicago Medical Center worked on diabetes-related legislation?

A. The University of Chicago Diabetes Research and Training Center is a member agency of the Illinois Diabetes Policy Coalition, a consortium that advocates on behalf of people with diabetes. The coalition supports policy initiatives for evidence-based research to address diabetes-related issues and health disparities, and promotes prevention and education efforts. Representatives from the Kovler Diabetes Center also have worked with the Illinois Diabetes Legislative Caucus, participating in October’s first-ever Illinois Diabetes Summit and working with representatives to design legislation that improves the lives of people with diabetes.

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