ARCHIVED - Research About - Diabetes

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The Canadian Institutes of Health Research (CIHR) is the Government of Canada's agency for health research. CIHR's mission is to create new scientific knowledge and to catalyze its translation into improved health, more effective health services and products, and a strengthened Canadian health-care system. Composed of 13 Institutes, CIHR provides leadership and support to nearly 12,000 health researchers and trainees across Canada. Through CIHR, the Government of Canada invested approximately $32.7 million in 2007-08 in diabetes-related research across Canada.

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The Facts

• In 1922, a 13-year-old girl named Elizabeth Evans Hughes, the daughter of the U.S. Secretary of State, underwent treatment for diabetes in Toronto under the care of insulin discoverer Dr. Frederick Banting. Miss Hughes weighed just 45 pounds and could barely walk. She went on to live a full life, dying in 1981 at age 73.

• More than 2 million Canadians have diabetes. At least 177 million people worldwide have the disease, a number that is expected to more than double by 2030.

• Type 2 diabetes used to be called "adult-onset diabetes", as it usually occurred in people over the age of 40. The term is no longer used because the condition is becoming increasingly common in young people, including teenagers, because of the obesity epidemic.

• Approximately 3.5% of non-Aboriginal women, and up to 18% of Aboriginal women develop gestational diabetes during pregnancy. The condition carries several risks for both mother and infant, such as the possibility of the child being abnormally large at birth.

(Sources: Canadian Diabetes Association, the World Health Organization)

Finding Solutions

Diabetes - time to listen to your gut

Researchers at the Toronto General Hospital Research Institute have discovered a new pathway between the gut, the brain and the liver which, when activated, lowers blood sugar. In experiments with rats, the researchers discovered that fat can activate nerves in the intestine to signal the brain and, subsequently, the liver to lower blood sugar levels. Eating a high-fat diet for just three days, however, can disable the signal. This discovery means the gut could be a new drug target in the fight against diabetes. The CIHR-funded study, published in Nature, was led by Dr. Tony K.T. Lam.

Combining exercises doubles benefits

Performing aerobic exercise or resistance training can improve the body's ability to control blood sugar, but combining the two can double those benefits, according to a CIHR-funded study. Researcher Dr. Ron Sigal of the University of Calgary found that people with type 2 diabetes can maximize their glucose control and reduce the risk of long-term health complications through a combination of aerobic exercise, like running, swimming or cycling, and resistance training, such as weight lifting.

Mothers-to-be should seek MD counselling

Women with diabetes who want to start a family should get medical counselling, according to a new clinical practice guideline on teratogenicity (disturbances that affect the development of a foetus) associated with the high blood sugar disease. CIHR-supported researcher Dr. Victoria Allen of Dalhousie University co-authored the document. The guideline, approved by the Society of Obstetricians and Gynaecologists of Canada, notes that a substantial number of women with diabetes do not seek out pre-conception care programs.

The Researchers

Dr. Jeffrey Johnson - Unravelling the Metformin Mystery

It's a 40-year-old case of pharmacological guilt-by-association that's costing Canadian lives and millions of health care dollars. But Dr. Jeffrey Johnson's research is helping clear what might be a good drug's name.

Metformin is a medication that's inexpensive and highly effective in helping regulate type 2 diabetes. Yet in Canada, the drug carries a warning that keeps it from being used in many diabetes patients with heart disease, a common type 2 diabetes complication.

"The problem is that metformin has a close chemical cousin, phenformin. About 40-years ago phenformin was found to have deadly side effects. Given these deaths, metformin was found guilty-by-association even though it had never actually been directly shown to be unsafe," says Dr. Johnson, a CIHR-supported researcher in the Department of Public Health Sciences at the University of Alberta.

Now Dr. Johnson and his colleagues are leading the effort to prove once and for all whether metformin deserves its spot on the pharmacist's shelf as treatment tool of choice for all type 2 diabetes patients. It's a critical question given the current type 2 diabetes epidemic - approximately two million Canadians, or about one-in-six adults, have this form of lifestyle related diabetes.

In 2005, Dr. Johnson and his then PhD student Dr. Dean Eurich (now a researcher at the University of Alberta) published a landmark study, finding that metformin was associated with a significantly lower incidence of death in type 2 diabetes patients when compared with other anti-diabetes drugs.

This evidence helped prompt the U.S. Food and Drug Administration to remove its heart failure contraindication for metformin, affecting millions of American with diabetes. However, in Canada, metformin still carries the contraindication.

"We need to generate the evidence to definitively provide the basis for changing the Canadian clinical practice guidelines for metformin," says Dr. Johnson, who with his colleagues is planning large-scale Canadian metformin research trials to do just this.

For more information, go to www.impact.cihr-irsc.gc.ca.