New effort to fight diabetes in Sonoma County

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Sonoma County medical providers are taking aggressive steps to deal with the high rate of patients with diabetes admitted to local hospitals, a trend that is said to be driving up hospital costs.

In Sonoma County, patients with diabetes account for almost 26 percent of all local hospital admissions, according to a recent UCLA analysis of 2011 hospital patient discharge data. That’s a total of 7,459 hospital admissions.

The added cost of hospital care is estimated at $16.4 million, according to the study, which was conducted by the UCLA Center for Health Policy Research with support from the California Center for Public Health Advocacy.

“We are very concerned about the epidemic of diabetes and the toll that it takes on individuals and the system that cares for them,” said Karen Holbrook, the county’s deputy public health officer.

Holbrook said diabetic patients who are admitted to local hospitals pose more medical complications than those who are not diabetic and often require more tests and treatments. Severe diabetes often results in serious medical conditions such as liver disease and kidney failure, she said.

According to the UCLA study, 31 percent of the state’s hospitalized patients 35 years or older, the age group that accounts for most hospitalizations, had diabetes. The study estimated that the added cost to hospitals in California was $1.6 billion. Hospital stays for diabetic patients in the state cost an average of $2,200 more than for non-diabetic patients, according to the study.

The study’s authors pointed out that 75 percent of this care is covered by Medicare and Medi-Cal, the state’s Medicaid program. Medi-Cal alone pays $254 million in added costs for diabetic patients.

January 3, 2012 ~ Diabetes Living Today® ~ No Sugar Added® Open Forum

Diabetes Living Today® radio program, provides listeners with education, inspiration and motivation to live healthy and well with diabetes. Whether you have diabetes or know someone who does Diabetes Living Today® radio program offers experience, insight, education and tips to manage life with diabetes. Through interviews, including “World Class” Research Scientist, physicians and people living with diabetes, living well tips and questions from the listening audience, host Kitty Castellini and Endocrinologist Dr. Joseph J. Fallon, Jr. are there every step of the way to offer guidance, advice, and most of all, support.

This week Kitty and Dr. Fallon will host their No Sugar Added®  “Open Forum.”

 

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January 3, 2011 ~ Diabetes Living Today® ~ No Sugar Added® Open Forum

 


World’s First View Of Type 1 Diabetes As It Unfolds

A war is being waged in the pancreases of millions of people throughout the world. The siege leads to the development of type 1 diabetes and has been a battlefield largely hidden from view– until now. Researchers at the La Jolla Institute for Allergy & Immunology have created the first cellular movies showing the destruction underlying type 1 diabetes in real-time in mouse models. This detailed, dynamic view will provide the worldwide scientific community insights into this disease process as never before possible and may profoundly affect future directions in type 1 diabetes research.

“We are presenting the first images at cellular resolution of type 1 diabetes as-it-unfolds,” said Matthias von Herrath, M.D. one of the world’s top type 1 diabetes researchers and director of the Diabetes Research Center at the La Jolla Institute for Allergy & Immunology. “Being able to view these insulin-producing cells while they interact in the pancreas, rather than in a static state under the microscope, will greatly enhance our ability – and that of the broader scientific community — to find interventions for type 1 diabetes.”

A paper on the team’s scientific findings, along with the cellular movies taken by the researchers, were published online in the Journal of Clinical Investigation. The movies are freely available and can be seen here (the movie links are at the end of paper). Ken Coppieters, Ph.D., formerly of the La Jolla Institute and now at Ghent University, Belgium, is first author on the study. Dr. von Herrath is senior author.

“This live imaging of the white blood cells that cause diabetes is quite remarkable,” said George Eisenbarth, M.D., Ph.D., a prominent type 1 diabetes researcher and executive director of the Barbara Davis Center for Childhood Diabetes in Colorado. “These images provide critical information about the disease process, in particular showing us the reasons why the beta cell destruction (underlying type 1 diabetes) occurs very slowly over time. Such information may enable new approaches to stop the destruction process, with the ultimate goal being prevention.”

The studies are illuminating cell processes that previously had to be extrapolated from photos, computer modeling or lab experiments. Bart Roep, M.D., Ph.D., a diabetes expert and professor at Leiden University Medical Center in the Netherlands, called the work a technological breakthrough. “I thought this was unfeasible (in vivo imaging of type 1 diabetes). But thankfully, they proved me wrong,” he said. “These videos show the cellular interactions in incredible detail, things are moving. The information they have found thus far is amazing and this is just the beginning of the knowledge that can be gained through this technology.”

Dr. Coppieters said the movies have provided a number of surprising insights. “We have drawn several scientific conclusions from these studies in mice that we believe will influence future therapeutic directions,” he said. “We are continuing our studies and hope that other researchers will also find these movies valuable in enhancing their research efforts.”

In the movies, objects resembling ants can be seen furiously scampering about looking for their prey. The “ants” are actually immune system T cells, the body’s cellular soldiers. The “prey” is insulin-producing beta cells, which the T cells mistakenly attack and destroy, eventually leading to type 1 diabetes.

The groundbreaking studies were enabled through the use of a two-photon microscope and a new procedure developed by Dr. von Herrath that allowed the microscope’s use in the pancreas. The pancreas is a small, soft and difficult to access organ that has long presented special challenges for researchers. Up to this point, the scientific community has used the two-photon to study lymph nodes, the liver and other organs in vivo, but never the pancreas.

“The two-photon microscope enables researchers to “see” into living tissues at a much greater depth than conventional imaging methods,” said Dr. von Herrath. “It uses intense pulses of light that enable us to monitor interactions of cells without destroying them.”

The Brehm Coalition, a unique type 1 diabetes research collaboration, provided major funding for the two-photon microscope. The Juvenile Diabetes Research Foundation (JDRF) was a significant contributor to the research studies. “Dr. von Herrath was one of a very limited, select group of scientists chosen to receive funding through the JDRF Scholar Award program,” said Richard Insel, M.D., the JDRF’s chief scientific officer, noting the award targets high-risk, high-reward endeavors. “We are thrilled that Dr. von Herrath’s research has provided new insights into the pathogenesis of type 1 diabetes that could lead to novel therapeutic approaches. This is just the kind of pioneering research that the Scholar Award was designed to encourage.”

Dr. Coppieters said the as-it-happens movies reveal the specific behaviors of various cells. “We’re able to see how the beta cells eventually die and how the immune T cells access the pancreas from the blood stream,” he said. Among the many insights gained, the researchers were able to identify the specific blood vessels where the T cells (normally none of these reside in the pancreas) enter the pancreas, how the T cells launch an attack and the time sequence of events.

The movies also illuminated particularly interesting information regarding the beta cell destruction process. “The T cells move randomly throughout the pancreas until they encounter the beta cells, where they slow down and release toxic substances that eventually kill the beta cells. What was most surprising is that this ‘kiss of death’ takes quite a while, elaborate calculations indicated a timeline in the order of hours (to kill a few beta cells),” said Dr. Coppieters.

The scientists also found remarkable the large numbers of T cells needed in the mice – tens of millions — to produce massive beta cell destruction. “These factors may help to explain the long pre-clinical stage in type 1 diabetes,” said Dr. von Herrath, since T cell numbers in the human pancreas are thought to be significantly lower than in mice.

“This means that the autoimmune attack is already ongoing for years before the number of beta cells drops below a critical threshold, resulting in clinical diagnosis,” he said, noting that 90 percent of beta cells are destroyed in humans before the disease is usually recognized. “From a therapeutic perspective, these studies suggest that we may need to find a way to prevent the T cells from accessing the pancreas in the first place, since once they do, they have the ability to destroy several beta cells at a time.”