Type 2 Diabetes and Obesity Research
Over the past 3 decades, sedentary lifestyles coupled with excessive caloric intake have been major determinants to the explosive increase in the prevalence of obesity and type 2 diabetes mellitus (T2DM). According to the American Diabetes Association (ADA), there are approximately 26 million Americans now living with diabetes1. In adults, type 2 diabetes accounts for 85 to 95 percent of all diagnosed cases2.
The UF Health Diabetes Center of Excellence Type 2 Diabetes Research Program involves an interdisciplinary network of providers from UF Adult and Pediatric Endocrinology Divisions who are committed to unlocking the causes of T2DM, identifying risk factors for further complications, and exploring novel ways to treat, educate, and ultimately prevent the disease among youth and adult populations.
Particularly among adults, diagnosis of type 1 vs. type 2 diabetes can be challenging. Around 5–15% of adults diagnosed with type 2 diabetes might actually have type 1 disease with islet autoantibodies present; if this is the case, perhaps as many as 50% of actual type 1 diabetes cases are misdiagnosed as type 2.3 In addition, rare genetic forms of diabetes, alternative to type 1 and 2, have also been identified4,5. UF researchers are paving the way to enhanced routine patient screening methods to ensure an accurate diagnoses and offer an array of available treatment options.
The University of Florida is proud to be recognized as one of 4 demonstration sites for the American Association for Diabetes Educators‘ pilot study of the effectiveness and sustainability of a flexible, 5- tier type 2 diabetes education and support team that serves minority populations and utilizes professional and lay health workers. This project addresses the challenge of creating the necessary workforce to meet HHS/CDC goals for diabetes self- management education and support. Learn more.
Extending outward from the traditional role of diabetic complications, UF faculty from the Division of Adult Endocrinology are increasing their attention to early diagnosis and treatment of a novel genre of lipotoxicity-related complications related to obesity in the setting of T2DM. Recently, non-alcoholic fatty liver disease (NAFLD) & subsequent nonalcoholic steatohepatitis (NASH) have become increasingly common complications of obese patients with T2DM.
Although uncertain, the presence of NAFLD may play a pathogenic role, or at least be a hallmark of future T2DM6, and it is likely that this condition carries an inherent health risk to many patients with this disease:
- UF researchers have discovered that the prevalence of prediabetes and newly diagnosed T2DM is 3x times higher in obese patients with NAFLD compared to patients without fatty liver.
- T2DM is associated with worse liver disease, including a two to four-fold increase in advanced liver disease, cirrhosis and hepatocellular carcinoma.
- UF researchers found that sugars fructose and sucrose play a key role in the development of fatty liver and nonalcoholic steatohepatitis (NASH)7.
The nature of this relationship remains to be established and continues to be understood through collaborative interdisciplinary research efforts at the University of Florida.
- Routine screening of NAFLD- Magenetic Resonance Imaging & Spectroscopy (MRS) techniques are employed to screen patients with NAFLD for T2DM and NASH, in addition to liver biopsies for individuals who are at highest risk of disease progression
- Exploring Patient Metabolic Profile- UF research continues to unlock the complex role of ethnic makeup in patients diagnosed with NAFLD, such as high rates of sedentarism, obesity, and Hispanic ancestry
- Identifying plasma biomarkers for diagnosis- Basic research labs focus on understanding the role of mitochondrial metabolism in the pathophysiology of obesity, insulin resistance, and fatty liver and defining how ‘nutrient overload’ causes alterations in glucose and mitochondrial metabolism in the liver
- Employing novel imaging techniques (ie transient elastography)Evalute dysfuntcional metabolic pathways in the liver which could be a target for future therapeutic interventions
- Asses the benefits and risks of certain medications in the management of T2DM8
- Combining surgery, diet, and exercise techniques
Researchers from UF’s Division of Pediatric Endocrinology focus on understanding the rapid emergence of childhood obesity and are learning more about current treatment options for pediatric populations. UF experts like Dr. Janet Silverstein have provided decades’ worth of evidence-based recommendations regarding T2DM in youth. Current research interest among UF Pediatric researchers include a greater understanding of:
- Current and existing medication management options for reducing calorie intake (ie incretins)9
- Further understanding of novel therapies which target physiologic modalities other than enhancing or replacing insulin secretion or improving insulin sensitivity
- Benefits and risks of adult diabetes medications used in pediatric populations (ie metformin)10
- Evaluating success rates of oral supplement and subcutaneous injection medication methods
- Novel gene therapy for obesity based on viral expression of adiponectin. AAV vector design. Link.
1. American Diabetes Association. Diabetes Statistics.
2. National Diabetes Education Program. The Facts About Diabetes.
3. Tuomi T. Type 1 and type 2 diabetes: what do they have in common? Diabetes 2005; 54 (s uppl 2): 40–45.
4. Steck AK, Winter WE. Review on monogenic diabetes. Curr Opin Endocrinol Diabetes Obes. 2011 Aug;18(4):252-8.
5. Concannon P, Rich SS, Nepom GT. Genetics of type 1A diabetes. N Engl J Med 2009; 360: 1646–54.
6. Lomonaco R, Cusi K. Non-alcoholic fatty liver disease (NAFLD) in diabetes: distraction or impending disaster? Evidence-Based Management of Diabetes; 2012 (Chapter 21).
7. Sautin, Y, Ishimoto, T, et. al. High-Fat and High-Sucrose (Western) Diet Induces Steatohepatitis That Is Dependent on Frucotkinase. Hepatology 2013: 1632-1643.
8. Lomonaco R, Cusi K., et. al. The Future of Thiazolidinedione Therapy in the Management of Type 2 Diabetes Mellitus. Current Diabetes Reports 2013; Volume 13, Issue 3, pp 329-341
9. Wood JR, Silverstein J. Incretins and amylin in pediatric diabetes: new tools for management of diabetes in youth. Curr Opin Pediatr. 2013 Aug;25(4):502-8.
10. Copeland K, Silverstein J, Moore K. Management of newly diagnosed type 2 diabetes mellitus (T2DM) in children and adolescents. Pediatrics 2013; 131:364–382.