in Hampton Roads in Hampton Roads - Eastern Virginia Medical ...

“We have an edge,”he explains. “That’s whythe center is so important. All ofour physicians are backed up by starendocrinologists who can back up the entireoperation.”When Dr. Pepe became dean four years ago,a group of research advisors from outside theschool helped him pinpoint diabetes as a key areawhere the school had world-class expertise and thecommunity had significant needs. He established acenter dedicated to research involving diabetes andobesity. The needs are enormous and increasing aspeople become more sedentary.Every year, diabetes leads to 96,000 amputationsand kills 213,000 in the U.S., nearly six times thenumber who die annually from the seasonal flu.A chronic condition, diabetes occurs when thepancreas either can’t produce enough insulin orthe body doesn’t effectively use what it has. It isthe industrialized world’s leading cause of adultblindness and kidney failure. Every 10 seconds,someone dies from diabetes complications andtwo new patients are diagnosed, according to theInternational Diabetes Federation.In Hampton Roads, at least 130,000 peoplesuffer from the disease, and half don’t know it untilcomplications, such as nerve damage, have occurred.It’s unclear what triggers the bodies of Type 1diabetics to destroy their own insulin-producingcells, but obesity is linked to Type 2 diabetes. Type2 diabetes is striking people at such a young age thatit can no longer be referred to as adult-onset.“Now we’re looking at children, adolescents,who may be adult-onset diabetics,” Dean Pepe says.“Normally, we thought of adult onset at [age] 55.”To head the new emphasis, Dr. Pepe recruitedJerry L. Nadler, MD, who had run the Divisionof Endocrinology and Diabetes at the University ofVirginia.In his nine years there, Dr. Nadler helpedgarner U.S. News & World Report ranking for theU. Va. center. Sentara Norfolk General Hospital,in partnership with EVMS, recently made themagazine’s top 50 ranking.EVMS offers Dr. Nadler the opportunity to workon juvenile diabetes, with the adjacent Children’sHospital of The King’s Daughters, as well as tocollaborate with the Veterans AdministrationMedical Center in Hampton on diabetes in theelderly.LinkingDiabetesand other DiseasesDr. Nadler, who is also chairman of theinternal medicine department, is researching howsome genes may lead to the death of nervesand heart damage in diabetics.That could explain why diabetic patientsoften lose their ability to walk, tend to falland have intense pain. Another relatedcomplication is retinopathy, or nerve damageto eyes.“Some of the same gene family we believeis causing nerve disease might be causing eyedisease as well,” he says.Another focus of the center’s researchis heart disease. The Strelitz Center isplanning to establish a special clinic atSentara Heart Hospital in Norfolk to focuson heart disease prevention and improvedtreatments for diabetics.They have a higher risk of heart diseasebut are often unaware of their diabetes, Dr. Nadlerexplains, adding for many, “the first time they findout is when they have a heart attack.”EVMS researchers are investigating thelinks between diabetes and heart diseasein collaboration with the University ofVirginia and investigators in San Diegoas part of a grant funded by the NationalInstitutes of Health.Dr. Nadler’s personal interest is inunderstanding the link between the typeof obesity that leads to heart problemsand diabetes. He has a team lookinginto it that includes a scientist, SwarupChakrabarti, PhD and a post doctoralfellow, Banu Cole, MD.Diabetics are two to four times as likelyto die of a heart attack than the generalpopulation. Some component of that centralbody fat may be at fault, Dr. Nadler says.“What is learned in the labis translated into patientcare. The patient has theadvantage of research at areally early stage.”Etta Vinikhead of Strelitz Diabetes Center’sEducation DivisionRichard Dollar19 years living with diabetesTisha Jones29 years living with diabetesdiabetes researchwww.eVMS.EDU Fall 200923