Diabetes Core Update – May 2015

Podcast Date: April 24, 2015
Hosts: Dr. Neil Skolnik & Dr. John Russell
Theme: “Future World in Diabetes” – Exploring new research on diabetes pathogenesis, early detection, comorbidities, and futuristic therapeutic approaches.

Episode Overview

This episode presents a “Future World in Diabetes,” focusing on innovative studies from ADA journals. Dr. Skolnik and Dr. Russell discuss groundbreaking advances in understanding the etiology, early markers, and treatment strategies for both type 1 and type 2 diabetes. Topics include links between fitness and glycemic control, enteroviral associations with type 1 diabetes, early neuropathy in prediabetes, celiac serology in children, and the potential of reprogrammed gut bacteria as treatment.

Key Discussion Points & Insights

1. Cardiorespiratory Fitness and Glycemic Control

Article from Diabetes Care
[01:56]

• Study Summary:
  A cohort study (n > 300, heterogenous in age, BMI, glucose control) assessed how VO₂max (cardiorespiratory fitness) correlates to glycemic indices such as A1C and fasting glucose, across the entire spectrum from normal to diabetic.
• Findings:
  • Low VO₂max correlated closely with poor glycemic control (higher A1C, fasting/2hr glucose levels).
  • Both early and late phase glucose-stimulated insulin secretion were worse in those with low VO₂max.
• Clinical Correlations:
  Dr. Skolnik connects these findings to established trials, emphasizing the pivotal role of physical fitness:

  “Poor fitness equates with poor control... one of the core principles that we need to impart to patients is that exercise leads to better sugar control and better health.” — Dr. Neil Skolnik [02:47]

• Memorable Reference:
  • Cites the DPPT (2002) and Look Ahead trials, which demonstrated lifestyle (exercise + diet) dramatically reduces diabetes progression.

2. Enteroviral Infection and Type 1 Diabetes Etiology

Article from Diabetes
[04:07]

• Study Summary:
  Researchers examined fresh pancreatic tissue in newly diagnosed adults with type 1 diabetes (3-9 weeks after onset) for enteroviral proteins/RNA.
• Findings:
  • Enteroviral proteins found in islets in all T1D patients but only in 2 of 9 controls.
  • Viral RNA present in most T1D cases, not in controls.
• Interpretation & Future Directions:
  Dr. Russell discusses the possibility of a viral (enteroviral) cause for T1D long suspected since the 1960s, opening up potential for antivirals or vaccines:

  “Could it be possible in a few years that we would be vaccinating all our children with a vaccine against enterovirus… to get rid of type 1 diabetes?” — Dr. John Russell [06:03]

• Clinical Implications:
  • While no antiviral exists yet, this could transform prevention strategies if confirmed.

3. Peripheral Neuropathy in Prediabetes and Early Diabetes

Article from Diabetes Care (PROMIS cohort)
[07:11]

• Study Summary:
  Peripheral neuropathy prevalence and nerve dysfunction assessed in 467 adults at high risk for T2D (PROMIS cohort).
• Findings:
  • Neuropathy present in 29% of normoglycemic, 49% of prediabetic, and 50% of new-onset diabetic subjects.
  • Progression toward diabetes over three years increased neuropathy risk.
• Clinical Insight:
  Dr. Skolnik remarks on how this matches clinical experience, but he notes the surprisingly high prevalence detected (potentially due to sensitive testing tools):

  “It can be also an early manifestation of diabetes and in fact present prior to someone’s diagnosis of diabetes...” — Dr. Neil Skolnik [08:51]

• Takeaway:
  • Consider diabetes or prediabetes as a potential cause in any peripheral neuropathy, even pre-diagnosis.

4. Celiac Serology Fluctuations in Children with Type 1 Diabetes

Article from Diabetes Care
[10:04]

• Study Summary:
  Longitudinal study of 446 children with T1D, tracking celiac disease serology and its course.
• Findings:
  • 14% became celiac-serology positive.
  • 58% had persistently elevated titers; 41% fluctuated; 28% normalized spontaneously.
• Clinical Perspective:
  Dr. Russell discusses the reassuring implication—that not all children need a lifelong gluten-free diet:

  “Perhaps there’s some hope that we could be able to use wheat products… in some of these children who are going to be struggling to stay away from all the refined sugars and carbohydrates of the world.” — Dr. John Russell [11:34]

• Application:
  • Recommends retesting and not immediately committing to restrictive diets unless persistent/high titers or symptoms exist.

5. Reprogrammed Bacteria — The Future of Type 2 Diabetes Treatment?

Article from Diabetes
[12:10]

• Study Summary:
  Researchers engineered Lactobacilli to secrete GLP-1, shown to transform gut epithelial cells into insulin-producing cells in diabetic rats.
• Findings:
  • Treated rats had higher insulin, better glucose tolerance, and ~25–33% of normal islet capacity restored by gut cell conversion.
• Future Impact:
  Dr. Skolnik calls these kinds of innovations “awe inspiring,” merging translational medicine with futuristic therapies:

  “The amount of potential advancements in the field as evidenced by these two articles this month, are just simply awe inspiring. And it is a fantastic time to be treating patients with diabetes…” — Dr. Neil Skolnik [13:36]

• Big Picture:
  • Optimism around both understanding T1D’s roots and bioengineered treatments for T2D, emphasizing it’s “the treatments of the future.” [14:32 - Dr. John Russell]

Memorable Quotes

• On Exercise and Glycemic Control:

  “One of the core principles that we need to impart to patients is that exercise leads to better sugar control and better health.” — Neil Skolnik [02:47]

• On Enteroviral Etiology for T1D:

  “Could it be possible in a few years that we would be vaccinating all our children… to get rid of type 1 diabetes?” — John Russell [06:03]

• On Early Neuropathy:

  “It can be also an early manifestation of diabetes and in fact present prior to someone’s diagnosis of diabetes.” — Neil Skolnik [08:51]

• On Celiac Serology in T1D:

  “Perhaps there’s some hope that we could be able to use wheat products… in some of these children…” — John Russell [11:34]

• On Future-Oriented Research:

  “The amount of potential advancements in the field... is just simply awe inspiring.” — Neil Skolnik [13:36]

Timestamps for Key Segments

• [01:56] – Cardiorespiratory Fitness & Glucose Control
• [04:07] – Enteroviral Infections in T1D
• [07:11] – Peripheral Neuropathy in High-Risk Patients
• [10:04] – Celiac Serology Normalization in Children with T1D
• [12:10] – Reprogrammed Bacteria for T2D Treatment
• [13:36] – Reflections on “awe inspiring” research & the future

Summary Table

| Segment | Topic | Timestamp | |:--------------------------------------- |:---------------------------------------------------|:---------:| | Cardiorespiratory Fitness & A1C | Fitness links to better glucose control | 01:56 | | Enteroviral Roots in T1D | Evidence for enteroviruses as trigger | 04:07 | | Early Neuropathy Detection | Neuropathy prevalent before diabetes diagnosis | 07:11 | | Celiac Serology Fluctuates in T1D Kids | Not all seropositive children need lifelong GF diet | 10:04 | | GLP-1 Engineer Bacteria Therapy | Future prospect: gut bacteria treat T2D | 12:10 |

Conclusion

This forward-looking episode synthesizes major research trends, emphasizing early detection, preventive strategies, and novel therapeutics, inspiring clinicians with optimism about transformative care options on the horizon for both type 1 and type 2 diabetes.

For further reading: diabetesjournals.org