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Health Talk 

One in 10 people in Louisiana have been diagnosed with some form of diabetes. The disease contributes to more than 3,000 deaths in the state every year. It doesn't have to be that way. November is Diabetes Awareness Month, and on Nov. 8, the American Diabetes Association is organizing a Step Out Walk to Fight Diabetes in Audubon Park. The event will raise awareness and funding for things such as research into better treatments and a cure for diabetes, which, according to Dr. Vivian Fonseca, is not as far off as it once sounded. Fonseca is a diabetes researcher, chief of endocrinology and alumni chair in diabetes at the Tulane University Health Sciences Center. Here he talks about diabetes and advances in the field.

Q: What's the difference between type 1 diabetes and type 2 diabetes?

A: In type 1 diabetes, you have a problem of making insulin so your life is kind of dependent on insulin. In type 2, your body makes insulin, but it is somewhat resistant to insulin so you end up with a relative deficiency of insulin. There are some medicines that work for type 2, but sometimes you need insulin too.

Q: Sometimes type 1 diabetes is referred to as juvenile diabetes. Does it only happen to kids?

A: It can occur at any age, but it is more common in younger people, just as type 2 was more common in older people before the increase in childhood obesity. That increase in obesity is related to the large number of children with diabetes, type 2.

Q: If obesity and diet are related to the onset of type 2 diabetes, what causes type 1 diabetes?

A: We don't really know. There is very often a family tendency, but not as much as type 2. There are some theories it happens after a virus, but we really don't know.

Q: As a researcher, what are some of the newest advances you see in the field of diabetes?

A: We have been involved with several clinical trials for treatment of diabetes and prevention of diabetes. We have been involved in pumps (to deliver the medication) and trials of inhaled insulin. With inhaled insulin, you don't have to inject it. It's a kind of breathalyzer that delivers insulin. It is absorbed through the lungs. The benefit is it's inhaled rather than injected.

With the first model, there were some concerns about possible long-term affects on the lung and it required long-term monitoring. The earlier system also required a somewhat larger delivery device. We have subsequently developed new ones. We are doing the testing right now. It's smaller, so the particle size may be different.

In the future we hope to try things like stem cell therapy.

Q: How would stem cell therapy be applied to diabetes treatment?

A: We are giving stem cells to animals with diabetes and we are finding it does help insulin-producing cells. They tend to improve and start making insulin again. We don't fully understand how it works, and that's what we're exploring.

Before we can use stem cell therapy with patients, we need to have enough animal data to convince the FDA to allow us to do the human studies. Once we have that, we will randomly select adults to give them stem cells or nothing. Then we will monitor it. Hopefully we will have data to support it.

Q: What kind of stem cells are used for this?

A: Adult stem cells from bone marrow.

Q: You mentioned convincing the FDA to let you move to human trials. In general, what does it take to get a new therapy approved after you've started testing it in people?

A: We ask patients to volunteer to participate. Before that, we create study designs. These are reviewed by ethics committees and approved. Then we randomly give people the new inhaler or something that has already been approved. With the insulin inhaler studies, you'd either give people injections or the inhaler. Then you collect all the data.

Usually the studies last four or five years before the drug gets approved.

Q: What else are you working on?

A: For type 2 diabetes, we are doing studies with new or old treatments. One is a study on an aspirin-like substance. It was used in Germany in the 1880s to treat diabetes. It's never been properly tested and we are doing the proper testing. With something like this, you may think it works, but proving something works is very different. It was known but never tested using modern clinical methods.

Q: As a physician, what else do you think people should know about diabetes?

A: It's a very serious disease. It affects a lot of people. It's the leading cause of blindness and kidney failure in the United States. It's responsible for a lot of amputations. There are a lot of issues and all these complications can be prevented by keeping good control of blood sugar.

For more information on the American Diabetes Association's Step Out Walk, visit www.diabetes.org.

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