In part 5 of this Exclusive Interview, Jamie Uribarri talks with Diabetes in Control Publisher Steve Freed during the ADA 2017 Scientific Sessions in San Diego, CA about high AGE diets and kidney disease, and the limitations of clinical research.
Jamie Uribarri, MD, is a physician and clinical investigator at The Icahn School of Medicine at Mount Sinai in New York
Transcript of this video segment:
Freed: Being a nephrologist, do you see that it plays a major role in kidney function, especially for people with diabetes who are at risk for kidney failure?
Uribarri: Absolutely. That is why the majority of those patients die, if they don’t end up in dialysis, they die from cardiovascular disease. Take a patient with diabetes and CKD, and that is a combination for cardiovascular disease for almost certain over the next few years. That is why I am involved in this area because it touches very much into what I do on a daily basis. And of course, I am convinced that this is the story. As you know, if you are not convinced that what you do is important, why should I be doing it?
Freed: Is there a way to measure this?
Uribarri: Well, that complicates the issue because, of course, and we do measure it. There are different ways to measure it. There are some… mass spectrometry, which are a little bit more complicated. But the problem is that all of these still remain in the realm of research that no commercial laboratory will do it. So, no, if a practicing physician wants to measure AGE in a clinic, it would not be possible right now. That complicates the issue a bit and second, there are many AGEs, so you have to know which compound action you are measuring. So whenever I give results, I go into the description of the method that we use to measure and what compounds we actually measure.
Freed: So if there are drugs out there that we know that can reduce inflammation would that be a benefit to the patient?
Uribarri: Yes, they should be, but again, any time that you act with a drug, you have to test it. You have to do clinical trials and have to put the drug versus the placebo or control agent and see what the effect would be on AGEs and on outcome. The problems is that you know , to prove things, we have done this very well-regulated in terms of high AGE vs. low AGE. But what is the population that we do in our trials? We take a group of 20-30 diabetic patients and randomize them. So it is a relatively small number of people. We follow them for how long? For a few months. It is a relatively small number of patients. So therefore, we can only use small models. To see real outcomes, you need to take a very large number of people and follow them for very prolonged periods of time. But that is something that requires a lot of money. We just don’t have it and it is unlikely that we are going to have it in the near future.
Freed: Well, obviously, we’re looking for money for kidney failure, for A1C reduction, and for hypertension. It reaches a point where like you said, if you are lower on the food scale, it’s more difficult to generate income especially from NIH when they are cutting funds. That puts you really at the bottom of the list. So I imagine it’s very frustrating for you not to be able to do some of the studies that you would like to do.
Uribarri: Yes, absolutely, that is a significant limitation.