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DRI's Commitment to a Cure

by Diabetes Research Institute on Thursday, February 24, 2011 at 10:01am on T1 Diabetes Cure - Global Headquarters and Diabetes Research Institute Facebook pages.

Hello everyone! All of us at the Diabetes Research Institute and Foundation are very pleased to be a part of this community and applaud Julie for creating this global forum. We look forward to providing news about the DRI’s cure-focused research progress and the DRI Foundation’s fundraising efforts each week and welcome your questions and comments. We’d also like to take this opportunity to invite you to come to Miami to tour the DRI, meet our scientists and see, firsthand, the exciting research underway.

For those of you who are not familiar with the Diabetes Research Institute and Foundation, it was created with one sole purpose – to find a cure for those living with type 1 diabetes. You can learn more at In this first post, we’d like you to meet Gary Kleiman, whose parents were among the founders of the organization in 1971. Gary, who works at the DRI, has lived with type 1 diabetes for more than 50 years and has also lived the significant progress that’s been made over this time. We recently received a question via email about research progress and we wanted to share it with you together with Gary’s response, as he speaks to the frustration that you all share and the progress made thus far:

QUESTION - “I don't mean to sound cynical but what has been accomplished for Type 1 that is so groundbreaking?  There have been no changes to insulin delivery systems since insulin was discovered, save for the pump but that too is invasive.  I keep reading about breakthroughs and yet they all seem to be in academia and not at the bedside.  I am very upset that organizations like the JDRF, DRI and ADA can release statements indicating 'breakthrough' and 'close to a cure' when the truth is nobody can define 'close' and there aren't any changes in treatment.  At its core, its still highly and frequently invasive.  If anything, treatment methods have become worse.  Now its multiple injections per day, sometimes as many as 5, or wearing two catheters with a pump if you also include the CGMS.

So, please tell me what is so great about all the 'breakthroughs' OUTSIDE of academia and furthering careers, and when will, if any, make it to the bedside?

We hear so much about ESC's and yet there isn't one clinical trial underway for treating Type 1 and while the Bush Administration put a ban on gov't funds, there was not 1 private industry funded program pursued so I question the validity of ESC's and all the claims, otherwise a clinical trial could have begun 8-10 years ago..
Thank you.”

GARY KLEIMAN’S RESPONSE - Thanks for your e-mail, which was forwarded to me.  As one who has lived with diabetes forever and a day, I certainly appreciate your frustration with the hype and unrealized promises.  Personally, it drives me crazy too.  I’ll try to address your issues one by one from my perspective.

Having been one of those who actually boiled glass syringes, used steel needles, unpurified insulin and rebelled against urine testing, I feel that there has been progress. Granted, it’s a lot of work with unpredictable challenges and variables to achieve even a near-normal A1c. But, I have witnessed and benefitted from research and vastly improved technology.

While far from ideal, I do like the pump. It gives me much more flexibility with meals, amounts of carb intake, daily schedules and, most of all, the ability to sleep longer on weekends.  I don’t think multiple injections can achieve the same level of control without the increased risks of severe hypoglycemic episodes.  Even with a potential closed loop pump, subcutaneous glucose monitoring and insulin delivery is not the answer and certainly not the cure. I believe in cellular replacement strategies to restore normal blood sugar levels.

In 2002, I participated in a clinical islet transplant study and was actually off insulin for two years. That was quite simply amazing. However, the drugs used to prevent rejection caused unwanted side effects and had to be reduced.  Subsequently, many of the islets were lost and I slowly re-introduced small doses of insulin. But today, 8+ years later, I still have c-peptide - meaning the transplanted islets are still producing some insulin and my blood sugar is easy to control. Also, I can sense hypoglycemia.  I think this is substantial progress, although not where we want to be yet.

As for the large umbrella organizations and academia, I couldn’t agree more. There has to be a better way to conduct research and to create incentives for corporations and “institutions” to cure diseases. To clarify - the ADA, JDRF and even NIH are funding organizations/agencies. The DRI is a center that actually conducts the research. Our scientists compete for and have been awarded grants from these and other agencies.  This competition for grants is an on-going and required practice at academic research centers, however, the DRI is in a unique position thanks to an affiliation agreement between the University of Miami and the Diabetes Research Institute Foundation which enables us to pursue cure-focused research as our mission.  We also receive critical support from a variety of private foundations and individuals which make it possible to stay committed to our ultimate goal. Unlike the typical academic structure of departmental disciplines, the DRI is its own multidisciplinary department and can pursue research areas that can benefit us, including stem cells, tissue engineering, drug discovery and immunology.  It’s vital for these areas to work together in order to move cure-focused research forward.

Regarding stem cells, the field is only about 12 years old, basically in its infancy. Stem cell trials in patients with spinal cord injuries are beginning and we’re hopeful that similar trials will begin in patients with diabetes. However, issues regarding safety and the complexity to transform a stem cell into an islet still present challenges.  In the lab, stem cells typically move in the direction of neurons or cardiac tissue, whereas an islet, made up of thousands of cells, is almost like a mini organ and, therefore, requires a more complex strategy to transform them into insulin-producing cells. However, we and other groups have successfully turned a small percentage of stem cells into those that can produce insulin in response to glucose.

I can go on with what I perceive as progress, however, I recognize that much of that progress does not yet translate to our day-to-day battles - but I know that will change. I've been part of the DRI from the start and fortunate to be able to witness the dedication and talent of our scientists and collaborators around the world. Together, they continue to make important strides that will  improve the quality of our lives and ultimately cure diabetes. Although I am not the type to predict or promise when, our researchers understand the sense of urgency and will not stop until a cure is found.

Feel free to contact me if you’d like additional information.

Gary Kleiman
Sr. Director, Medical Development
Diabetes Research Institute
University of Miami Miller School of Medicine 


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