RESEARCH
Doctors' chemistry produces diabetes solutions
November 6, 2008
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Bill Taylor
SPECIAL TO THE STAR
It may seem an odd question to ask two scientists who are in a tag team, wrestling with an epidemic of Type 2 diabetes that they say will strike the world as a tsunami would:
Do you like each other?
But Daniel Drucker and Bernard Zinman, colleagues and friends at Mount Sinai Hospital, give it due weight and a considered answer. And, yes, they do.
The doctors' relationship, the chemistry between them and their proximity – their offices are about 25 metres apart – make their work, at the cutting edge of diabetes research, more immediate and effective. It only takes a minute to pop over for a quick consultation.
"You could argue that, with the Internet, Dan could be in Iceland," says Zinman. "But to see each other on a daily basis, to go on rounds together can be kinda fun. It makes us better doctors and scientists."
Both call themselves clinician-scientists. Drucker focuses on the molecular level of diabetes research and looks to Zinman, a leading clinician in Mount Sinai's diabetes centre, for clinical input. In turn, Zinman's patient care is shaped by his colleague's findings.
"At the end of the day, the basic science can only succeed if you're asking the right questions," Drucker says. Key to this is having immediate and continuing access to patient information.
"We have different skills but the questions are the same," Zinman adds.
One recent breakthrough: a new formulation of the drug exenatide, which gives better blood-sugar control and can be administered once a week rather than twice a day. But they're quick to share the credit, saying researchers around the world have been working on this.
"It takes hundreds of individuals to make a new drug," Drucker says.
Conventionally, medical research moves from "bench to bedside," Zinman says. But the new open-plan layout of the Samuel Lunenfeld Research Institute means therapies can be developed "bedside to bench. Four days a week, we have patients not 20 feet away from here coming to get therapy and take part in research studies."
What Zinman and Drucker are doing is not unique, they say, but their way of working may be.
"I'd say we're together out of the country once a month at meetings of international experts," Drucker says. "There may be a person from the University of Washington or Harvard or Cambridge. But it's pretty rare to find two people from one institution who have complementary skills."
"Real advances are being made in the prevention of Type 2 diabetes in people at high risk," Zinman says. "Lifestyle changes, weight loss, exercise...certain medications.
"We'd never say it's a good time to have diabetes," Drucker adds. "But if you compare the opportunities and therapies today and what's on the horizon with where we were a decade ago, we're making huge strides."
The coin has another side. The doctors are studying an epidemic of diabetes among native Canadians who are, Zinman says, "at five times the national average of risk. We're trying to understand why."
And there is the global threat of Type 2 diabetes, especially in Asia. China, Zinman says, will soon have 50 million people with the disease. India, will be even worse, he predicts, calling it "the world leader."
"And Canada is a country of immigrants. South Asians have a very high risk when they're living a western lifestyle. And they have very bad cardiovascular complications.
"The United Nations for the first time has passed a resolution that diabetes is a global health problem. It's the first time a non-communicable disease has been recognized as having a huge impact on hundreds of millions of people. And, consequently, the world economy."
Type 2 diabetes used to strike adults almost exclusively. Now, Drucker says, among the Asian population, "we see children with Type 2. Or young people, maybe 30, getting heart attacks."
"AIDS/HIV was the epidemic of the last century," Zinman says. "Diabetes is the 21st-century epidemic, of unbelievable proportions. A tsunami is coming."
In the meantime, he and Drucker, colleagues and friends, continue their tag-team fight to stem the tide.
"It's an exciting time," Drucker says with almost clinical understatement.
Toronto Star