What are your general research interests?
My research focuses on obesity, diabetes mellitus and the complications that are associated with diabetes. I have a particular interest in diabetic neuropathy (i.e., damage to the nerves). Most of my efforts are in the areas of measuring nerve function and searching for potential treatments for nerve dysfunction.
What are your current projects and how are they funded? Who are your collaborators on these projects?
I have three current projects.
In the first, we are testing the effectiveness of a medication to improve nerve function. This is a double-blind, placebo-controlled randomized trial involving two treatment arms, where our hypothesis is that six weeks of targeted intervention will lead to changes in activity of the autonomic nervous system (e.g., enhanced parasympathetic function) and improved peripheral nerve function. Collaborators on this grant include M. James Lenhard, MD, medical director of the Diabetes and Metabolic Diseases Center, Christiana Care Health System (CCHS), and Profs. David Edwards and William Farquhar from the Department of Kinesiology and Applied Physiology at UD. This project is funded by Delaware INBRE (grant #2 P20 RR016472-11, sponsored by the National Center for Research Resources, National Institutes of Health).
The American Society for Metabolic and Bariatric Surgery (ASMBS) is funding a study in which we are assessing the effect of surgically induced weight loss on nerve fiber function in individuals with severe obesity and examining whether there is an association with determinants of insulin sensitivity (i.e., osteocalcin). Participants are evaluated prior to surgery and six months post-surgery. Preliminary results were recently reported at the annual meeting of the ASMBS. Collaborators on this grant include Dr. Lenhard and three surgeons (Michael B. Peters, MD a UD alum; Isaias Irgau, MD; and Gail M. Wynn, MD) from the Christiana Institute of Advanced Surgery.
The third project is funded by a small grant from the CCHS Department of Medicine. In this study, we are examining the association between gestational diabetes, nerve function, and sleep-disordered breathing. Preliminary results showed that 40% (i.e., 12 of 30 participants) of the women with gestational diabetes in our study had sleep-disordered breathing. We are currently recruiting pregnant women without gestational diabetes to determine the prevalence of sleep-disordered breathing in this group. Albert A. Rizzo, MD (Pulmonary Associates), Yugenia Hong-Nguyen, MD (former resident at CCHS and current fellow at Washington Hospital Center, Washington, DC) and Dr. Lenhard are collaborating on this project.
What are the likely “next steps” in your work?
I will continue to search for new therapies for the treatment of diabetic neuropathy and other complications of diabetes. In addition, we are currently exploring the link between osteocalcin (i.e., biomarker of bone metabolism) and cardiovascular disease. Although cardiovascular disease and problems in osteogenesis (e.g., increased bone fragility) have traditionally been viewed as separate disorders, recent evidence indicates similar pathophysiology underlying both conditions. No studies to date have evaluated serum osteocalcin as a biomarker for both entities in a high-risk patient group such as those with diabetes.
How would you describe your work’s importance to an interested lay audience?
The twin epidemics of obesity and diabetes represent a major public health problem worldwide. Obesity seriously increases an individual’s risk of developing many health problems including type 2 diabetes. Globally more than 366 million individuals suffer from diabetes and its complications, and the prevalence of diabetes is projected to double over the next 25 years. It is estimated that approximately 60% of individuals with diabetes have some form of damage to the nervous system. One type of nerve dysfunction can result in impaired sensation of the lower extremities and may lead to amputation. Diabetes can also cause damage to nerves that innervate the heart and blood vessels, leading to an increased risk of death. It is vital to find new therapies to stop the development and progression of nerve dysfunction in order to reduce both morbidity and mortality. It is important to make the public aware of these epidemics. It is my hope that individuals who participate in these research studies will gain a better understanding of the problems associated with neuropathy and how we are trying to find a solution through our research.