Good news at the cutting edge of Type 1 diabetes research: Michigan Medicine and JDRF have jointly announced that they will establish a new Center of Excellence for advanced scientific research into Type 1 diabetes. The two organizations will contribute a combined nearly $14 million for the center, which will be housed at the University of Michigan.
The Center of Excellence, like other JDRF efforts, will focus both on improving the health of people with Type 1 diabetes and in advancing towards a cure. To do so, the Center will bring together a multidisciplinary team of great breadth on some of the most important problems in the diabetes world. Particular focuses will include the impact of the metabolic environment on T1D, and the potential of personalized medicine to drive new therapies.
Both organizations have long been associated with the vanguard of diabetes science. JDRF is among the world’s most prominent funders of Type 1 diabetes research. And Michigan Medicine has conducted leading diabetes research for decades, at least since its involvement with the landmark Diabetes Control and Complications Trial.
We spoke with Elizabeth Weiser Caswell, who, along with her father Ron Weiser, has also donated generously to help launch the project. Mrs. Caswell, an Ann Arbor resident, has been a passionate advocate for diabetes research for decades. She has served on JDRF’s research committee for years, most recently as the vice chair. Her connection to the disease is personal: both her husband and two of her children have Type 1 diabetes.
“I’ve found a passion and a life’s work in volunteering for JDRF and helping pursue better treatments and cures. I don’t want my children to ever have the experience that my husband and I had of having a child diagnosed with T1D.”
Mrs. Caswell’s own interest in advanced diabetes research was spurred when she toured the Melton Lab at Harvard University, where Professor Douglas Melton and his team have developed ways to create functional beta cells from human stem cells. These cells offer both an unparalleled opportunity to study the disease and could themselves be central to the development of a cure. She jumped at the chance to help establish an organization of similar quality near her home turf.
“The University of Michigan team,” Mrs. Caswell explains, “has some interesting questions to pose. When we talk about T1D, predominantly we talk about glucose, right? But not a lot of people are talking about the whole picture of the metabolism. We know we have glucose dysregulation, but what’s happening to the rest of the metabolic environment?”
Much of the Center of Excellence’s work will focus on the potential of precision medicine in Type 1 diabetes management. Personalized approaches are already central to diabetes management—after all, we all have our own unique basal dosages and carbohydrate ratios—but the Center of Excellence scientists plan to expand the scope of what personalized medicine means.
Central to this work is the concept of the “metabotype,” the idea that individual people have different metabolic profiles that make their conditions behave somewhat differently, and therefore would benefit from more customized treatments and interventions. This is a fairly new concept, but a popular one with researchers in recent years, especially in the nutrition field.
The metabotype research that the Center of Excellence hopes to conduct could lead to a number of avenues for innovation. Mrs. Caswell enumerated some them for me:
“What if we knew more about a person’s metabolic profile in total? What can the metabolic environment contribute to the survival and health of transplanted beta cells, or of beta cells in those newly diagnosed? Can metabotypes help make smarter artificial pancreas algorithms? Could people with certain metabotypes be protected from various kinds of neuropathy, or more likely to progress quickly?”
Beta cell failure, Mrs. Caswell emphasized for me, just scratches the surface of Type 1 diabetes. A more holistic understanding of the broader metabolic environment could yield treatments that will meaningfully slow disease progression, increase quality of life, and perhaps even make a full cure more viable.
The center’s research into disease burden and diabetic complications promises to be just as advanced. Specialists drawn from a wide breadth of the industry—“nephrologists, neurologists, ophthalmologists and retinopathy specialists, probably the biggest team on the project”—will dive deep into the causes of the complications that conspire to make life with diabetes so difficult. One technique involves experimenting with organoids, mock organs grown from stem cells in a dish.
A final project is study of the psychosocial impact of T1D.
“Day to day, that’s the part that most of us struggle with the most. You can keep working on your HbA1c, time-in-range, carb counting. It gets better, it gets worse, you get burnout. But it’s the living your life with it and the 24/7 part that’s most difficult.”
The Michigan team plans to harness interesting data sources to approach the issue. Massive insurance databases, for example, may help better define the scope of diabetes depression in the country. Doctors will also leverage Michigan Medicine’s large patient cohort in an effort to understand the relationship between physical status and mental health burdens. “What if your metabotype could be amended to reduce your psychological burden?,” Mrs. Caswell wondered.
“One of the things I’ve always loved about JDRF is that the organization is always working to bring people together from across the field and always working to leverage those relationships. This is a great example of that.
“So many different kinds of talent can be brought together, which doesn’t happen often. It takes something like this to bring together people from different fields.”