Herman, William , MD, MPH
Role of inflammation on hyperglycemia and impact of hyperglycemia on bone marrow transplantation outcomes.
General Research Subject: Insulin Resistance Pre Diabetes
Focus: Integrated Physiology
Type of Grant: Merck
Project Start Date: January 1, 2011
Project End Date: December 31, 2013
High blood glucose levels in patients with severe illnesses, such as heart attacks or strokes, are associated with poor hospital outcomes. While prior studies suggest that high blood glucose levels are associated with increased risk of infections, the relationship between blood glucose levels and bone marrow transplantation (BMT) outcomes is not clear. To further investigate the role of hyperglycemia in BMT outcomes, the fellow will study patients who received BMT at the University of Michigan Hospital from 2002 to 2008. Four stages of BMT will be studied: 1. Before the transplant; 2. Days 0-14 after the transplant, when patients' immune systems are weak and they are at high risk for infection; 3. Days 15-28 after the transplant, when the transplant begins to work; and 4. Days 29-100 after the transplant, when transplant success or cancer recurrence is evident. The fellow will use the electronic medical record to collect data on blood glucose levels, infections, length of hospital stay, levels of inflammatory markers, medications, re-hospitalization, cancer recurrence and mortality.
She will use statistical analyses to test the association between high blood glucose levels and the above outcomes. The fellow will also conduct a feasibility study on the implementation of intensive insulin therapy in 5 patients hospitalized for BMT. This project will increase the understanding of the associations between blood glucose levels and BMT outcomes, assist in the development of new protocols for intensive glucose control during BMT, and potentially decrease complications from BMT and improve the likelihood of a successful transplant.
What area of diabetes research does your project cover? What role will this particular project play in preventing, treating and/or curing diabetes?
When a variety of foods are available, taste is a major determinant of food intake. Food choices and intake clearly contribute to obesity and the risk of type 2 diabetes. Over the past few decades, overweight and obesity have become epidemic in the United States and have contributed to the dramatic increase in the prevalence of type 2 diabetes. Indeed, it is estimated that one in three Americans will develop type 2 diabetes over his or her lifetime. Lifestyle interventions involving hypocaloric diets and increased physical activity that achieve a 5 to 7% reduction in initial body weight have been proven to delay or prevent the development of type 2 diabetes. Unfortunately, the maintenance of such interventions is problematic. We propose to investigate taste perceptions and preferences in young children and adults and their associations with stress, food selection, obesity and type 2 diabetes. The results of this research will inform the development of targeted interventions for weight control and diabetes prevention.
If a person with diabetes were to ask you how your project will help them in the future, how would you respond?
A better understanding of the associations among taste perceptions and preferences, stress, food selection and obesity will help us to tailor dietary interventions for individuals at risk for type 2 diabetes to both prevent weight gain and treat overweight and obesity. A better understanding of the relationship between sweet taste perceptions and preferences may also help to risk stratify individuals into groups at lesser and greater risk for the development of obesity and type 2 diabetes, and assist in developing tailored dietary interventions to prevent weight gain.
Why is it important for you, personally, to become involved in diabetes research? What role will this award play in your research efforts?
For the past 10 years, I have served as a Diabetes Prevention Program/ Diabetes Prevention Program Outcomes Study investigator. The effectiveness of the intensive lifestyle intervention in delaying or preventing the development of type 2 diabetes is dramatic. Yet, we see individuals who are unable to adhere to the lifestyle intervention over time. A 'one size fits all' approach to lifestyle intervention may in part explain this variation in effectiveness. Better understanding the relationship between taste perception and preferences and dietary adherence, obesity and type 2 diabetes may assist us in designing tailored interventions for diabetes prevention.
In what direction do you see the future of diabetes research going?
There is increasing recognition that there is substantial heterogeneity among individuals with respect to both behaviors and genetics, and that one treatment is unlikely to be effective for all individuals. Understanding this inter-individual heterogeneity and better tailoring interventions to account for it offers an enormous opportunity to both improve the effectiveness and efficiency of diabetes care. In the future, I believe that diabetes research will attempt to better understand the heterogeneity among individuals and tailor both behavioral and medical interventions to improve their effectiveness and efficiency and to reduce costs.
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