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Physicians Update

 
Fall 2009

New Frontiers Explored in Managing Diabetes

11/09/2009

Managing DiabetesThe incidence of diabetes continues to rise, but scientific advances in the field of endocrinology have improved management of the disease and outcomes for patients.

“We still don’t know what causes type 1 diabetes, but we know that type 2 diabetes is associated with the sedentary lifestyles and calorie-rich diets that have made Americans far more obese today than we have ever been,” says Andrew Drexler, M.D., director of the Gonda (Goldschmied) Diabetes Center at UCLA. At the same time, Dr. Drexler notes that diabetes control has improved dramatically over the past 20 years and enabled many patients to have normal life expectancies with fewer complications.

Diabetes increases the risk for cardiovascular disease, hypertension, kidney failure, blindness, nontraumatic lower-limb amputations and complications during pregnancy. UCLA has established a strong national reputation for incorporating multidisciplinary strategies, which include collaboration with certified diabetes nurse educators and registered dieticians, to care for patients with diabetes and associated morbidities. For example, UCLA’s intensive diabetes-management program for pregnant women with both pre-existing and gestational diabetes — which includes biweekly visits, frequent glucose monitoring, continuous-infusion insulin pumps, stringent glycemic glucose control and comprehensive diabetes education — is well-known for excellent clinical outcomes that include full-term pregnancies with normal-birth-weight infants who do not require intensive care following delivery, Dr. Drexler says. UCLA has also established programs designed to decrease the incidences of blindness, kidney and heart diseases.

Another unique program at UCLA may help some patients with a related disease — chronic pancreatitis — relieve chronic pain while reducing future diabetes risk.

“For patients with chronic pancreatitis, the risk for developing diabetes is quite high because inflammation in the pancreas creates scar tissue that may interfere with insulin production,” says Gerald Lipshutz, M.D., surgical director of the Pancreas Transplant Program at UCLA. He explains that many patients with the condition undergo surgery to remove all or part of the pancreas as a way to reduce or eliminate chronic pain. If the entire pancreas is removed from previously nondiabetic patients, they will develop diabetes because the ability to produce insulin will be lost, he says. If only part of the pancreas is removed and the patient’s islets (insulin-producing cells found in the pancreas) can be spared and replaced after surgery, diabetes may be avoided.

UCLA Islet Transplantation TeamThat is the goal of the Auto Islet Transplantation Program at UCLA. “We’re basically taking something that would otherwise be discarded and trying to use it to prevent chronic disease 10 to 20 years down the line,” Dr. Lipshutz says. In appropriate patients at UCLA, part of the diseased pancreas is removed and the islet cells are then transported to a specialized facility at the University of California, San Francisco, for isolation, and within the same day, Dr. Lipshutz replaces the patient’s islets through a catheter inserted into his or her liver. While many programs in Los Angeles and across the U.S. can surgically remove the pancreas, UCLA is one of only a few centers in the U.S. able to perform auto islet transplantation.

In addition to refining strategies to manage and prevent diabetes, UCLA clinicians and scientists are also attempting to understand what causes it. Currently, a major area of diabetes-related research at UCLA focuses on islet cells: how they are formed and destroyed, how they might be repaired, how they make and release insulin, and how this process might be increased to restore insulin levels. The Larry L. Hillblom Islet Research Center at UCLA was built specifically for the purpose of bringing together the expertise necessary to conduct basic science and translational research in this field. Future research, Dr. Drexler says, will also focus on stem cells, which may play a pivotal role in finding a cure for type 1 diabetes, and finding a way to curb the obesity epidemic, which experts believe will provide the key to treating type 2 diabetes.





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