Spotlight on Clinical Research

Diabetes

November is American Diabetes Month, an ideal time to focus on developing new treatment approaches to this disease. Yale is at the forefront of diabetes research, especially regarding ways to prevent and treat Type 1 diabetes. 

Type 1 diabetes can occur at any age, but is usually first diagnosed in children and young adults. It accounts for about 5% of diabetes cases. This type of diabetes requires using insulin to control blood sugar levels. Studies have shown that carefully preventing high blood sugar levels can prevent such long term complications as eye disease, kidney disease and heart disease. In order to reduce the risk of these complications, doctors recommend intensive insulin therapy to get blood sugar under control. A side effect of this approach is that sometimes hypoglycemia occurs, where the blood sugar dips too low.

A majority of patients who take insulin experience some type of hypoglycemic episodes. Symptoms can be mild and may include confusion and dizziness; in more severe cases, a patient may experience convulsions and become unconscious. Nocturnal hypoglycemia can occur while sleeping when patients may be unaware that their blood sugar is dangerously low. Besides the physical symptoms, many patients with Type 1 diabetes worry about hypoglycemia, sometimes to the point where it affects their quality of life.

In order to reduce these harmful effects, doctors first need to understand what happens in the brain during bouts of hypoglycemia. When the brain doesn’t have enough fuel, such as during an episode of hypoglycemia, there is a change in neurotransmitters, which are the chemical messengers that help communicate information within the brain.

Yale endocrinologist Dr. Raimund Herzog and his colleagues are conducting clinical trials in which they use special technology to measure neurotransmitters in the brain under low blood sugar conditions. In these non-invasive studies, Dr. Herzog uses nuclear magnetic resonance spectroscopy (also known as NMR spectroscopy) to study the brain chemistry of patients during periods of hypoglycemia. Yale scientists are leading experts in NMR spectroscopy and Yale is one of just a handful of centers in the country that conducts studies using this powerful research tool.

“Because Type 1 patients frequently have hypoglycemia, they get used to it and we think the brain tries to protect itself by switching to increase usage of alternate fuels, so it’s not dependent on glucose,” said Dr. Herzog. Understanding more about how alternate fuels are used in the brain will help doctors identify drugs or dietary supplements that may allow the brain to work normally even when glucose levels are low.

When glucose levels become low in a healthy person, hormones help prevent harmful effects from occurring. In Type 1 diabetes patients, however, frequent episodes of hypoglycemia may diminish the brain’s capacity to detect this condition and may prevent the hormonal response from working properly. New technologies, such as continuous glucose sensors that are currently being developed at Yale and elsewhere, can help alert patients to bouts of hypoglycemia, but they can’t entirely eliminate them.  That’s why doctors need to find other ways of managing this condition.

“It’s really not possible for us to develop therapies targeting such specialized problems without having participants in clinical trials,” said Dr. Herzog. This type of research may benefit  all patients with diabetes that struggle with frequent low blood sugar episodes. Being able to intensively manage Type 1 diabetes without the fear of hypoglycemia would allow patients to achieve better control of their blood sugar, which in turn would prevent long term complications.

To find out more about this clinical trial and other trials to treat and prevent diabetes, call 203-737-4777 or e-mail diabetes.research@yale.edu.