News & Research

Diabetes complications are one of the many research areas funded by the American Diabetes Association. In a joint effort, the American Diabetes Association and the American Podiatric Medical Association (APMA) are sponsoring a fellowship to provide an opportunity for a podiatrist to get postdoctoral training in a diabetes research lab.

According to the ADA, about 60% to 70% of people with diabetes have mild to severe forms of nervous system damage. The results of such damage include impaired sensation or pain in the feet or hands. Almost 30% of people with diabetes aged 40 years or older have impaired sensation in the feet (i.e., at least one area that lacks feeling). With such a high incidence of nerve damage and sensory issues, a strong case is made for directing research efforts to these complications.

Meet Dr. Lawrence Lavery, DPM, MPH of the Scott and White Hospital in Temple, Texas. He is the recipient of the ADA-APMA Mentor-based Postdoctoral Fellowship award which began in July 2007. Dr. Nathan Hunt, DPM, the postdoctoral fellow training with Dr. Lavery, will learn to conduct clinical research and enhance the understanding of diabetic foot research and complications. To engage in his training, Dr. Hunt's first task is to work on Dr. Lavery's ADA Clinical Research Award entitled, "Epidemiology of Lower Extremity Complications in Dialysis Patients with Diabetes."

Evaluating the occurrence and frequency of lower extremity complications in persons with diabetes and on dialysis is the first of three objectives in this ADA project. Complications could include blocked arteries in the arms and legs (peripheral vascular disease), sensory nerve damage (sensory neuropathy), chronic damage to the foot and ankle joint bones (Charcot fractures), wounds, amputations, infections and even death. The research team expects that there will be a higher occurrence and frequency of lower extremity complications in persons who receive dialysis treatment. They will perform an analysis of 337 patients for two years to answer this question.

Identifying the risk factors and causal pathways for lower extremity complications in those receiving dialysis is the main focus of the secondary objective. Comparing and evaluating patient s with and without lower extremity complications will provide answers as to whether there is a unique set of risks to those who receive dialysis. Here, they will follow and analyze data from patients during a two year period as well.

Finally, the last objective is to evaluate the health-related quality of life for dialysis patients with or without lower extremity complications. Not only do researchers hypothesize that the quality of life will be worse in those with foot complications but they also believe that there will be lower values in patients who undergo dialysis as compared to those who do not undergo dialysis. This expectation is based on previously observed patients that participated in clinical research studies.

The future of diabetes research will be enriched with the ADA-APMA fellowship and the outcomes of the ADA study. With Dr. Hunt's mentored training, the diabetes complications research field will benefit from a specialized investigator. Trained investigators increase research, discoveries and prevention of diabetes complications. Dr. Lavery states, "Advances in medicine are often driven by new clinical investigators, so training researchers is essential to improve the lives of people with diabetes." Analysis and data reporting performed by Dr. Hunt will provide new information about foot complications in end stage renal disease. Identifying the occurrence, frequency, risk factors and causal pathways of lower extremity complications could lead to improved strategies in prevention and intervention.