Thinking outside the box in diabetes

Diabetes prevalence and mean particulate (PM2.5) concentration, Southeast U.S., 2005.

Two heads are better than one in solving a problem. And sometimes it’s better to skip over the usual suspects. Crowdsourcing, or contracting out problems to large groups, can often provide fresh leads on intractable problems – especially when those problems are pressing.

That’s certainly the case for diabetes. From 1980 to 2007, rates of diabetes (Types 1 and 2 combined) doubled for people 45-64, and nearly tripled for those 44 and under.

With funding provided by the American Recovery and Reinvestment Act, Harvard Catalyst and InnoCentive got together last February to issue a diabetes Challenge, soliciting innovative research proposals from the entire Harvard community – not just faculty, but also students, and administrators and staff of all levels. Last week, they announced funding of 12 pioneering ideas for attacking Type 1 diabetes, selected from a pool of 190 entries.

As innovation experts note in the Boston Globe, the most game-changing ideas can come from people far outside the field.

Take Srini Viswanathan’s idea. Last year, the Harvard Medical School MD/PhD student, then in Children’s Stem Cell Program, helped show that a protein abundant in embryonic stem cells is also important in cancer. But a surgical rotation, part of his medical training, took him in a new direction.

“I’d not considered doing any work on diabetes before, but happened to be on my Surgery Rotation at the time the challenge was announced, and at the time I had contact with many patients who had undergone gastric bypass procedures,” said Viswanathan. “I was intrigued by the observation that many of these patients were no longer diabetic after having the surgery, and read about this phenomenon wherein gastric bypass surgery could alter the pancreas’s insulin-producing capacity.”

Viswanathan will explore why beta cells undergo an explosive period of growth in the wake of gastric bypass surgery, in hopes of finding ways to help Type 1 diabetics recover their lost beta cells.

Other Challenge projects include exploring a “germ theory” for diabetes, a noninvasive blood glucose monitor and “smart” microscopic spheres to carry immune-suppressing drugs directly to the pancreas. For a full list, visit the Harvard Medical School website.

Though not part of this Challenge, epidemiologists John Pearson and John Brownstein of the Children’s Hospital Informatics Program (CHIP) offer another unexpected angle on diabetes: the role of air pollution. Noting that animal studies have found an increase in insulin resistance, a precursor to diabetes, in obese mice exposed to particulates, they did a national study.

They obtained county-by-county data on levels of PM2.5 – the fine particulates you find in haze, smoke and car exhaust from the Environmental Protection Agency – and crunched it against data from the Centers for Disease Control and the Census Bureau on diabetes prevalence and known diabetes risk factors like obesity, geographic latitude and ethnicity.

In all analyses, published in the October issue of Diabetes Care, there was a strong, consistent association between diabetes prevalence and PM2.5 concentrations. For every incremental increase in PM2.5, there was a 1 percent increase in diabetes prevalence (Types 1 and 2 combined). “We didn’t have data on individual exposure, so we can’t prove causality, and we can’t know exactly the mechanism of these peoples’ diabetes,” Brownstein says. “But pollution came across as a significant predictor in all our models.”

I have to admit, when Brownstein first told me about this study I was skeptical — but then the data spoke. It’s studies like this that could steer investigators to take a fresh look at a life-threatening problem – and maybe even change public policy.