Research Profile

The principal goal of my project is develop new tests to improve the design of future clinical trials for type 1 diabetes. Specifically, to provide a rapid and robust method to predict how soon an individual is likely to lose their remaining insulin producing cells after diagnosis. Current trial designs are handicapped by the highly variable rates of disease progression post-diagnosis; while positive outcomes can be confidently defined for a population, it is much harder to determine if any specific individual has benefitted from an experimental therapy, and if so, to what degree. If successful my project will address this critical knowledge gap, potentially allowing participants to serve as their own controls. It would also permit much more flexible study designs with shorter durations, thereby hastening a successful outcome for the search for a true cure for type 1 diabetes.

If successful my project should accelerate discovery of effective therapies to arrest or slow the destruction of insulin producing cells in people with a recent diagnosis of type 1 diabetes. Thus my answer to this question depends upon how long the person asking it has had diabetes, since this will determine how likely it is that they could directly benefit from my research. Thus, if the person has had type 1 diabetes for less than 3 years, and it is progressing slowly, then I would be able to tell them that there was a chance that my project could facilitate new treatments that would improve their quality of life and health outcomes. However, if they had had type 1 diabetes for longer than this, then unfortunately I would have to inform them that they would be unlikely to directly benefit from my project, as they would likely require a different form of treatment to those my project would impact. However, in either case I would also remind them that type 1 diabetes often runs in families, and so while my research may not benefit them directly, that there was a good possibility that it could benefit a family member who does not yet have clinical type 1 diabetes, but is at risk of developing it in the future, by accelerating the discovery of more effective therapies and identifying the treatment(s) which would be most appropriate to them.

For the past 20y I have been a faculty member of the world renowned Barbara Davis Center for Childhood Diabetes, conducting basic and translational research aimed at improving the quality of care and health outcomes for people with, or at risk of developing, type 1 diabetes. Although neither I, nor any member of my immediate family, suffer from diabetes, I am nonetheless fully committed to involvement in diabetes research, and the guiding mission of my recent career has been to make meaningful contributions to the search for true cures for these devastating conditions. This current award will enable me to take full advantage of recent technological advances to convert my research into a form that is suitable for use in a clinical rather than entirely academic setting, where it can potentially be of direct benefit to people with a recent diagnosis of type 1 diabetes.

My expectation is that future diabetes research will be focused more on the individual than on the group as a whole. It is clear that diabetes is much more heterogeneous than was previously appreciated, which suggests that a range of treatment options, rather than a single "magic bullet", will ultimately be required to provide fully inclusive and effective clinical care for any person with diabetes. Considerable advances have been made, but for this to become a reality I envisage that research will need to focus on at least three distinct areas. First, to take advantage of advances in "artificial intelligence" and "big data" to more accurately describe which regulatory mechanism(s) have become unbalanced in any particular individual that has led them to develop clinical or pre-clinical diabetes, and develop targeted drugs or lifestyle interventions to correct them. Second, to identify improved methods to regenerate or rejuvenate the individual's own insulin producing cells, or replace them using, to the extent possible, surrogates derived from the person's own cells. Third, to develop personalized algorithms and more bio-compatible and affordable technologies to provide equitable access to an effective "artificial pancreas" for those who it is impossible to protect, repair, or replace their natural source of insulin.