Clinical and Health Affairs
The Minnesota Partnership to Conquer Diabetes
By Elizabeth R. Seaquist, M.D., and Victor Montori, M.D.
■ The University of Minnesota and Mayo Clinic have launched a 10-year effort called the Decade of Discovery: A Minnesota Partnership to Conquer Diabetes. The partnership harnesses the extensive research expertise at the two institutions in an effort to make discoveries that will transform prevention, management, and treatment of diabetes—a disease that affects one in three people in the state. The ultimate goal is to find a cure. This article describes the vision for this undertaking as well as research that might one day lead to a cure.
According to the Minnesota Department of Health, one in three adults in the state has diabetes or prediabetes (impaired glucose tolerance that has a high likelihood of turning into diabetes in the future). Diabetes is the sixth leading cause of death in Minnesota, accounting for 17,485 years of potential life lost. It also has a tremendous impact on the quality of life of those who have the disease, as nearly one in two Minnesotans with diabetes report being limited in terms of their activity. Overall, diabetes costs the state $2.68 billion annually; about $1 billion of that is the result of lost productivity.
To reduce the burden of diabetes in our state, implementation of proven strategies for managing the disease as well as discovery of new methods to prevent, treat, and cure it are needed. During the past year, the University of Minnesota and Mayo Clinic have made a commitment to do just that. Through an effort called the Decade of Discovery: A Minnesota Partnership to Conquer Diabetes, the two institutions have set a goal of preventing, optimally treating, and ultimately curing type 1 and type 2 diabetes by 2020. Led by Aaron Friedman, M.D., senior vice president of health sciences and dean of the Medical School at the University of Minnesota, and Robert Rizza, M.D., executive dean for research at Mayo Clinic, the partnership is an attempt to harness expertise at the two institutions and elsewhere in the state in order to achieve this ambitious goal.
How the Partnership Came to Be
This collaborative is an offshoot of the Minnesota Partnership for Biotechnology and Medical Genomics, a partnership between Mayo and the university that was formed in 2003 with support from the state of Minnesota. The purpose was to position Minnesota as a world leader in biotechnology and biomedical research. The partnership has become a globally recognized model of innovation in the biomedical field. Since its inception, Minnesota has invested more than $90 million in the partnership. Those funds have been used to recruit new researchers and fund 45 research grants and 14 infrastructure improvement projects. As a result of that investment, more than $100 million have returned to the state in the form of grants from the National Institutes of Health, philanthropic contributions, and private industry investment. Projects supported by partnership grants have focused on understanding, treating, and preventing cancer, diabetes, heart disease, multiple sclerosis, epilepsy, and other conditions.
In 2007, Gov. Tim Pawlenty challenged the two institutions to raise the bar on what they could do through the partnership by tackling a disease of importance to Minnesotans. After assessing their past work, their research strengths, and the work being done by other potential partners in the state, leaders from both the university and Mayo identified diabetes as the disease for which they collectively had the best chance of producing a major medical breakthrough in the next decade. The institutions were leaders in islet transplantation, regenerative medicine and stem cell biology, the pathogenesis of insulin resistance and obesity, diabetes prevention, diabetes care quality improvement, and the effect of diabetes on the brain, kidney, and cardiovascular system. In addition, together they had received more than $55 million in research funding from the National Institutes of Health to study diabetes, and the university had received a $40 million gift from the Schulze Family Foundation to cure type 1 diabetes.
Preventing and Curing the Disease
In October 2010, the university and Mayo launched the Decade of Discovery. The initiative will involve more than 150 researchers at the two institutions as well as other researchers and health care providers from around the state. Their work will focus on two core areas: 1) prevention and care delivery and 2) treatment and cure. Although both the university and Mayo have resources in place to support ongoing diabetes research in the form of philanthropic gifts, industry contracts, and grants from the National Institutes of Health and other governmental agencies and private foundations, expanding their efforts will require additional resources. Plans are underway to seek new funding from the state as well as from private donors and industry partners.
Prevention and care delivery. The prevention and care delivery portion of the initiative will focus on public health and health services delivery research led by Robert Jeffery, Ph.D., professor of epidemiology and community health and director of the Obesity Prevention Center at the University of Minnesota, and Nilay Shah, Ph.D., an assistant professor in the department of health sciences research at Mayo Clinic. As an expert in obesity and diabetes prevention, Jeffery has started taking a census of existing prevention programs in the state to identify potential partners and their areas of interest. Shah, an expert in population health, is compiling data on health status, disease control, health care usage, investments, and programs by county to create a map that can be used to help others make informed decisions when planning and executing interventions related to diabetes. In addition, this information will provide the necessary baseline data on the effectiveness of projects designed by Decade of Discovery researchers and their partners related to preventing and treating diabetes. Over time, the intent is to involve all stakeholders in preventing diabetes and providing optimal care to people who have the disease in Minnesota.
Treatment and cure. As for treating and/or curing diabetes, one emphasis will be exploring new approaches to replacing insulin-producing beta cells that can build upon the already successful islet transplantation program at the university. This work will be led by David Bernlohr, Ph.D., chair of the department of biochemistry, molecular biology, and biophysics at the University of Minnesota, and Stephen Russell, M.D., Ph.D., professor of molecular medicine at Mayo Clinic. They are now working with cell biologists, developmental and stem cell biologists, immunologists, clinical researchers, and experts in islet transplantation from both institutions to identify areas where there is synergy and potential for growth. As resources become available, new projects will grow out of these collaborative efforts, and new researchers will be attracted to the state.
Another aim of the treatment/cure effort is to build new relationships between the researchers investigating the pathogenesis of diabetes and obesity and their complications and the scientists with expertise in drug development. For example, Bernlohr is internationally known for his work on the relationship between obesity and insulin resistance, two major risk factors for the development of type 2 diabetes. He has identified new molecules that perturb cellular pathways involved in insulin resistance. With the support of the Decade of Discovery partnership, he can work with medicinal chemists in the College of Pharmacy’s Institute for Therapeutics Discovery and Development to develop a new therapeutic approach.
Achieving the Goal
During this first year, our aim is to develop the relationships necessary to complete the prevention and care delivery census and diabetes map project, and to develop the infrastructure necessary to support new research in islet cell biology and novel drug development. The time it takes to achieve our ultimate goal of defeating diabetes will depend on the resources we receive and the creativity and hard work of researchers.
We estimate that an investment of $250 million to $350 million over 10 years will be necessary to build more robust research capabilities, advance the IT infrastructure, implement populationwide changes, and fully integrate recognized best practices into clinical practice. These funds will be sought from the state, the federal government, industry, and private donors. Minnesota researchers are already world leaders in diabetes research. With the additional investment, focus, and collaboration brought by the Decade of Discovery, we believe we can conquer diabetes in the coming decade. MM