The complex nature of diabetes demands different perspectives and innovative insights. Researchers and scientists pave the way for breakthroughs that not only enhance our understanding of diabetes, but also yield transformative strategies for its prevention, management, and an eventual cure. We are honored to highlight the great work of some research teams who are receiving American Diabetes Association (ADA) support.
Rachel G. Miller, PhD, University of Pittsburgh
Published in Diabetes Care®, February 2025
Women with type 1 diabetes have a greater excess risk for heart disease than their male counterparts, despite having generally lower blood pressure throughout their lives. Dr. Miller aims to understand this discrepancy by combing for clues in the Pittsburgh Epidemiology of Diabetes Complications Study. This study has tracked the health outcomes of people with childhood-onset type 1 diabetes since the 1980s, which provides extensive and rich observational data for Dr. Miller and her colleagues to leverage.
She and her team are studying how patterns of risk factors beyond blood glucose (blood sugar) differ for men and women with type 1 diabetes across their lifespan, and how these differences affect heart disease and other diabetes complications. Their work revealed that women with type 1 diabetes experience a significant drop in diastolic blood pressure as early as their 20s, decades sooner than the decline that naturally comes with reaching menopause. Also, the effect of blood pressure on cardiovascular disease shows up differently between the sexes: Men with type 1 diabetes and higher blood pressure were more prone to major events like heart attack and stroke, while women with higher blood pressure were more likely to experience coronary artery disease.
The research suggests that the arteries of women with type 1 diabetes may stiffen at far younger ages than expected, offsetting any cardiovascular protection imparted by lower blood pressure. More research is needed to better understand the physiological effects of diabetes on the cardiovascular system, whether pregnancy and menopause affect a woman’s risk of cardiovascular complications from diabetes, and the effectiveness of blood pressure medications.
Dr. Miller’s findings indicate that blood pressure targets and other cardiovascular risk factors may need to be tailored by sex and life stage. “The ultimate goal would be to move past the current one-size-fits-all approach and hopefully better predict and prevent complications in everyone with diabetes,” she said.
Dr. Miller has studied diabetes for more than 20 years and credits her first ADA grant with “springboarding” her independent research. This work took on new meaning in 2021, when her own 10-year-old daughter was diagnosed with type 1 diabetes. “I went from having this intellectual textbook understanding of what living with diabetes is like to actually helping someone manage it every day,” she shared. “It’s made me a better researcher.”
Mingyu Zhang, PhD, MHS, Beth Israel Deaconess Medical Center
Published in the Journal of the American Heart Association, June 2025
The seeds of diabetes and other cardiometabolic diseases can be sown early in life, even in the womb. With support from an ADA grant, Dr. Zhang and his colleagues are investigating how environmental exposure to toxic metals and chemicals affects the future health of pregnant women and their children.
Their work will help fill a gap in our understanding of the health effects of forever chemicals, which are used in everything from food packaging to synthetic clothing to personal care products, and make their way into the environment, including drinking water.
Among their preliminary findings: Prenatal exposures to specific per- and polyfluoroalkyl substances (PFAS)—popularly known as “forever chemicals”—were linked to higher blood pressure in children ages 3 to 18. Childhood hypertension may persist in adulthood, potentially putting youth on the path to type 2 diabetes, obesity, heart disease, and other interrelated diseases.
“We know that the fetal period is a very critical window for development,” explained Dr. Zhang’s co-investigator Zeyu Li, a PhD student at Johns Hopkins Bloomberg School of Public Health. “The research suggests that with these chemicals, not only is their existence forever, but their health effects are also forever.”
The research also shines a light on the health disparities among racial and ethnic minorities in the United States, who have a higher risk of hypertension and diabetes. The strongest associations between PFAS and high blood pressure were observed in teens, boys, and Black children.
While more research is needed to understand the underlying mechanisms at play, limiting exposure to PFAS and other substances could be part of the diabetes prevention puzzle. Drs. Zhang and Li hope their research will inform recommendations for pregnant women to choose PFAS-free consumer products, as well as government policies to protect all Americans from PFAS.
Sarah A. Stanley, MBBCh, PhD, Icahn School of Medicine at Mount Sinai
Published in Nature, September 2025
Previous research suggests that people with above-average activity in the amygdala—the emotional center of the brain—have a much higher risk of developing diabetes. In her earlier career as a clinician, Dr. Stanley also observed that stressful situations, from a routine doctor’s visit to a medical emergency, caused patients’ blood glucose (blood sugar) to spike, even if their diabetes was otherwise well managed. Because of the connection between the amygdala and diabetes, this raised the question as to whether there is a connection between emotional stress and blood glucose spikes.
With the ADA’s Pathway grant, Dr. Stanley and her team set out to unravel the many ways the central nervous system regulates how the body breaks down, stores, and uses blood glucose. Using mice, she traced a new connection between the amygdala and other organs that signal the liver to rapidly release extra blood glucose in response to stressful stimuli.
“Clinicians give a lot of advice about lifestyle factors such as healthy eating and exercise. We should pay as much attention to managing chronic stress,” said Dr. Stanley
What's more, Dr. Stanley’s team discovered that when stress happens again and again, this pathway starts to wear out and stops working properly. As a result, the liver begins sending out too much glucose even when it isn't needed. When this chronic stress is combined with a high-fat diet, the body’s metabolism becomes overloaded, leading to ongoing high blood glucose and gradual weight gain.
This research underscores the importance of addressing acute and chronic stress, both to stave off complications for people living with diabetes and to prevent type 2 diabetes. She hopes these and subsequent findings could lead to new targeted therapies to improve blood glucose management for people at high risk.
Dr. Stanley credits the Pathway program—both the funding and the mentorship from other experts in the diabetes field—with making her team’s work possible. “It was transformative because it allowed me to explore a new area,” she said. “Right now is a really important time for science. Showing support for basic and clinical research has a huge impact because you just don’t know where it’s going to lead. It could be the next big thing in diabetes treatment, and we won’t know unless we support it.”
Alexander R. Nectow, MD, PhD, Assistant Professor of Medicine, Columbia University
Published in Cell, February 2025
How do we know when to stop eating? Dr. Nectow has spent his career studying how the brain controls food consumption and energy balance and how these processes impact cardiovascular function and health. In fact, his work has uncovered the existence of brain cells that help answer that exact question.
Dr. Nectow’s research focuses on the dorsal raphe nucleus (DRN), a small region of the brainstem known to influence food intake and body weight. While the general function of the DRN is understood, the specific roles of many of its neurons are unclear.
With the American Diabetes Association’s (ADA’s) prestigious Pathway to Stop Diabetes® Accelerator Award, Dr. Nectow and his team at Columbia University set out to “chase down” these cells and learn how they help regulate blood glucose (blood sugar), hunger, and other aspects of metabolism. “The Pathway award let us dive into interesting territory…and do work that would not have been funded through other traditional [research grants],” Dr. Nectow said.
Using state-of-the-art technology, he and his fellow researchers studied the brains of mice to distinguish the individual roles of the DRN’s “mosaic” of neurons. They discovered a new group of brain cells that carried molecular markers for the hormone cholecystokinin (CCK), pointing to a direct role in appetite. These so-called CCK neurons control when to stop eating in a unique way: by responding to input from the body and the senses and tracking every bite of food.
“We were able to put together a really nice story as to what these CCK neurons did, which was basically take bite-to-bite information and turn that into a decision later on to end the meal,” Dr. Nectow explained.
His work suggests that the DRN may play a greater role in eating and weight management than previously thought. The discovery of these specialized brain cells could lead to new therapeutic targets for obesity that lower people’s risk for type 2 diabetes, heart disease, and other serious conditions. If we can find ways to manipulate how these neurons function, we could help the brain think it’s fuller after smaller meals.
The Pathway award did more than fund the Nectow Lab for several years—it helped Dr. Nectow grow as a clinician-scientist. Today, he’s both a neuroscientist and a practicing cardiologist. Treating people with heart disease informs the direction of his research in the lab, yielding insights he can bring back to the clinic.
“[The ADA’s Pathway award] completely changed the course of my career,” Dr. Nectow said. “It simply wouldn’t have been possible to do all of this without the support of the ADA, generous donors, and others involved in funding and supporting the program.”
Jacqueline Maya, MD, Massachusetts General Hospital
Published in JAMA, November 2025
Women are advised to be in their best possible health before getting pregnant to lower the risk of complications. Obesity medications have been a boon, helping people lose weight and better manage type 2 diabetes before conception.
However, questions remain about how one very effective and popular class of drugs, glucagon-like peptide-1 receptor agonists (GLP-1 RAs), such as liraglutide, semaglutide, and tirzepatide, affects maternal and infant health—especially considering people must discontinue the medications during pregnancy.
With the support of an American Diabetes Association® (ADA) Junior Faculty Development Award, pediatric endocrinologist Dr. Maya is working to fill this important gap in knowledge. “People describe these weight-loss medications as life-changing. They aren’t going away,” she noted. “We need to pay closer attention to these pregnancies to understand how to better treat women who take GLP-1 RAs and want to have a healthy baby.”
To achieve this goal, Dr. Maya and her team examined nearly 150,000 pregnancy records from the Mass General Brigham healthcare system and identified people who had taken GLP-1 RAs in the three years before conceiving and gone on to deliver single, full-term babies. They matched these patients to women who hadn’t used the medications but otherwise shared similar characteristics—such as pre-pregnancy body mass index (BMI), chronic conditions like diabetes and high blood pressure, and socioeconomic traits—and compared their pregnancy outcomes.
They found that women who stopped GLP-1 RAs before or early in pregnancy gained more weight and had higher risks of preterm birth, gestational diabetes (GDM), and high blood pressure than those who hadn’t taken the drugs. However, babies born to both groups showed no significant differences in size for gestational age, birth length, or cesarean delivery rates—a result Dr. Maya calls “reassuring.”
She attributes the higher pregnancy complication rates to a confluence of factors. Weight regain is common after stopping any weight-loss treatment, including GLP-1 RAs. This rebound effect may be compounded by weight gain, hormonal shifts, and other normal physiological changes during pregnancy.
Despite the added risks, taking a GLP-1 RA before pregnancy may still prove better than not losing weight at all. Further research could clarify when and how women should taper obesity medications before planning a pregnancy and identify ways to help them manage pregnancy weight gain to minimize complications.
As Dr. Maya states: “I feel very fortunate that I had funding from the ADA. It allowed me to collaborate with epidemiologists, biostatisticians, and other researchers, which will hopefully allow us to get as close to the truth as we can.”
Research is the cornerstone of advancing the American Diabetes Association’s mission to prevent and cure diabetes and to improve the lives of all people affected by diabetes.
The American Diabetes Association remains committed to providing critical funding to support innovative scientific discovery that translates to better treatment, healthier lives, and eventual cures.
The program seeks to identify a new generation of innovative scientists, and researchers and provide the financial support and professional mentorship they need to advance their diabetes research.
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