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Carla Greenbaum Part 1, Predicting And Prevention Of Type 1 Diabetes

In part 1 of this Exclusive Interview, Dr. Carla Greenbaum explains the mission of her research in relation to efforts to cure type 1 diabetes in a conversation with Diabetes in Control Publisher Steve Freed during the ADA meeting in San Diego, California.

Carla Greenbaum, MD is Director of the Diabetes Research Program at Benaroya Research Institute at Virginia Mason in Seattle, WA.

Transcript of this video segment:

Steve Freed: This is Steve Freed with Diabetes in Control and we’re here at the American Diabetes Association 77th scientific session 2017. We’re here to present you some really exciting interviews with some of the top endos from all across the world. And we have a special guest with us, Carla Greenbaum, MD. First, tell us a little bit about what you do, your type of practice.

Carla Greenbaum: Sure, thanks for asking and I’m thrilled to be part of Diabetes in Control, which is a great service I think to the community. I work at the diabetes program at the Benaroya Research Institute, which is in Seattle. So my job is primarily clinical research. I do see patients but primarily my job is really doing research and I’ve been doing that for almost 30 years now. The whole idea is that for many years we’ve been looking to find ways we can predict who is going to get type 1 diabetes and what we can do to prevent people from getting the disease and that’s our area of research.

Steve Freed: Type 1?

Carla Greenbaum: Type 1 diabetes is our focus. Benaroya Research Institute is all about immune diseases. We actually study across autoimmune diseases, so type 1 diabetes, multiple sclerosis, rheumatoid arthritis, because what we learn from one disease is very applicable to another. So that’s our entire research focus of our entire institution.

Steve Freed: What’s the title of your presentation here?

Carla Greenbaum: I was talking about disease modifying therapies in type 1 diabetes.

Steve Freed: I always like to say “when are we going to have a cure?” and the answer is in 5 years.

Carla Greenbaum: And 5 more dollars right? That’s what it is.

Steve Freed: And they’ve been saying that for over 50 years.

Carla Greenbaum: Sure.

Steve Freed: But your research isn’t about a cure for diabetes.

Carla Greenbaum: Well, it’s actually related.

Steve Freed: Yeah it is related. It’s how to prevent type 1 diabetes, which is almost because in 100 years there won’t be anybody with diabetes so I guess in one way it’s a cure for diabetes but not for those that already have it.

Carla Greenbaum: Well, I’d like to just if I may correct you a little bit on that.

Steve Freed: Sure, absolutely.

Carla Greenbaum: You know for people that are living with diabetes who may not have enough of their own beta cells, there’s of course a tremendous amount of work where people are trying to make more beta cells. But this simultaneous problem that has to be solved is how to keep the immune system from destroying them. So all the work that we are doing in prevention is really saving beta cells that people already have. The same problem is going to be coming when we give people new beta cells back. So really it’s the same thing. We’re still all working for the cure. It’s just a different population of people that we are testing in. In some ways it’s a much easier population. They already have their beta cells. We don’t have to go out and give them some.

Steve Freed: My question is nothing to do with anything and that is, I don’t know if you’re familiar, this goes back at least I don’t know 12 years ago and there was research, it’s called INGAP by Dr. Aaron Vinik. And he sits on our board and [is a] great guy and they are still doing research, and the philosophy of that at the time was basically how to keep the bucket half full. You know where the immune system is going to attack it but hopefully this drug, this INGAP drug, would keep filling it up halfway so that you know you wouldn’t have type 1 diabetes technically. And then a lot of research has gone to say that beta cells aren’t really dead, they’re just inactive. They’re in suspended mode and if we can bring them back to life, it may not be 100%, it may not even be 80%, but we don’t need 80%. Where is your research relative to all that?

Carla Greenbaum: Well, I think it’s important to know, we’ve known forever right? That type 1 diabetes is a disease both of the beta cell and of the immune system. Like all other immune diseases though, immune therapy does change the course of those diseases. So while we’re looking to try to find agents that actually support the beta cells and make them happier and make them last longer, we’re still going to have to keep the immune system at bay. So ideally we will apply combination types of therapies. When Dr. Vinik’s INGAP gets to be something that we can test, we would be eager to do it. What we’ve done so far… I’m chair of Type 1 Diabetes Trial Net, which is a large (your tax dollars) NIH-funded international clinical trial network, and our job is to identify people who are going to get clinical type 1 diabetes and try as many trials with the different therapies as we can to see if we can slow and stop that disease. If we had a therapy that we could test that we think focuses on the beta cell, we’ll be right there doing it. At the moment, most of the trials have some form of immune modulation or immune therapy because that is a part of the disease.

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