Complications to diabetes are just that—biologically complicated. Blood travels to every tissue in the body, so if it contains higher than normal glucose levels, over time this long-term exposure can damage delicate heart, kidney, eye and nerve tissue. Although diabetes complications often occur within 30 years, a significant number of people with type 1 diabetes are free of complications after 50 years or more.
To understand why, in 2005 Joslin launched the 50-Year Medalist Study, the first of its kind. To date, a 1,000 patients from 49 states across the country have enrolled. If potential protective factors can be identified, perhaps these findings can lead to novel treatments benefiting all patients with diabetes.
Some patients have lived successfully with diabetes for more than 75 years. “In 1937 at age 8, I was diagnosed with diabetes,” says Kathryn Ham. “In my early years, I knew both Dr. Joslin and Dr. Priscilla White, who helped me through pregnancy.” She is now in the Medalist Study, headed by Joslin’s Chief Scientific Officer George King, M.D., and Hillary Keenan, Ph.D. The study is supported by the Juvenile Diabetes Research Foundation (JDRF), the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), and donations from Medalists themselves.
Medalists first complete an extensive medical history questionnaire and provide lab data. Findings show as a group they have controlled their blood glucose levels well for many years, with nearly 35 percent escaping serious complications.
Medalists also travel to Joslin, where researchers assess eye, kidney, nerve and heart function; also metabolic changes in blood and the ability to produce insulin. Genetic studies are seeking to understand if there are factors differentiating Medalists from other type 1 diabetes patients. Among exciting discoveries is that most are consistent with typical type 1 diabetes, including genetic factors and clinical characteristics such as high-density “good” cholesterol (HDL) and relatively low body weight.
Approximately 90 percent of Medalists do not have kidney problems. About 40 percent do not have serious eye disease—even after 50 to 80 years. Moreover, 35 percent have factors or genes protecting them from developing diabetic eye disease. Surprisingly, more than 66 percent appear to still produce some insulin. This raises the possibility that many type 1 diabetes patients have protection from beta-cell destruction. A new study of 40 patients is now underway to see if beta cells can be revitalized.
This article was first posted August 24, 2015