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Fall 2008 Newsletter

Message from the Director

I would like to introduce Meng Tan, MD, Clinical Professor of Medicine, who has joined the faculty in the Behavioral, Clinical and Health Systems (BCHS) Intervention Research Core this fall allowing the BCHS core to expand its support for clinical research. He will advise and assist MDRTC investigators with the design and implementation of clinical research protocols, assist in data interpretation, and facilitate the establishment of data safety and monitoring boards. He will also collaborate with diabetes researchers and the Clinical and Translational Science Awards (CTSA) in developing and implementing a registry of subjects potentially interested in diabetes research.

An internist with special interests in diabetes, lipoprotein metabolism and cardiovascular disease, Dr. Tan has held several administrative and clinical positions during his academic career. At Dalhousie University in Canada, he was the Head, Division of Endocrinology and Metabolism, Deputy Head, Department of Medicine, and Chief, Department of Medicine, at one of the adult teaching hospitals. He was also a Professor of Medicine and Biochemistry and Associate Professor of Community Health and Epidemiology at Dalhousie University. At Indiana University School of Medicine he was a Clinical Professor of Medicine, where as volunteer faculty, he taught medical trainees at the Diabetes and Cardiovascular Risk Factor Clinic at the Veterans Affairs Hospital in Indianapolis.

Dr. Tan also worked in the pharmaceutical industry for a number of years. In 1996, he was Medical Director for Diabetes Disease Management for Becton Dickinson and Company. In 1999 he joined Eli Lilly and Company as the Global Medical Director for the Actos Product Team. When he retired from Eli Lilly in 2007, Dr. Tan was a Distinguished Medical Fellow, Lilly Research Laboratories and Global Medical Director of the Diabetes Endocrine Platform Team.

Dr. Tan can be reached by email at mengt@med.umich.edu or by phone at (734) 645-3972.

The MDRTC is also pleased to welcome two new investigators, Pearl Lee, MD, Clinical Lecturer, Internal Medicine and Rumba Banerjee, PhD, Vincent Massey Collegiate Professor of Biological Chemistry and Professor of Biological Chemistry. I would like to take this opportunity to share the research interests of these new members with you.

Dr. Lee is currently exploring the management of diabetes and clinical factors that influence the quality of that management in patients older than 75 years of age. Her research has two complementary components that will make use of both clinical and nationally representative data: the clinical information contained in the UM Health System Diabetes Quality Improvement Initiative Registry and the data from the Health and Retirement Study, a nationally representative health survey of middle aged and older Americans. This approach will provide different and complementary information that will support Dr. Lee’s research.

A principle focus of Dr. Banerjee’s research is to elucidate the regulation of mammalian sulfur and redox metabolism, its links to energy metabolism and its inter-organ integration. To this end, her team has been studying the intracellular regulation of the sulfur metabolic pathway by oxidative stress, nutrients, and androgens and intercellular communication using metabolites of this pathway.

Dr. Banerjee’s laboratory studies:

One area of interest in Dr. Banerjee’s laboratory relevant to insulin-dependent diabetes is in the mechanism of autoimmunity by which regulatory T cells can suppress the proliferation and clonal expansion of effector T cells following activation by antigen presenting cells such as dendritic cells. The lab is elucidating the mechanism by which dendritic cells remodel the extracellular environment and make it more reducing to support proliferation of T cells and how regulatory T cells interfere with this process. It is also examining how effector T cells can modulate the phenotype of astrocytes and endow them with a neuroprotective phenotype and the role of regulatory T cells in this process.

Please join me in welcoming Drs. Tan, Lee, and Banerjee to the MDRTC.
With warm regards,
Bill

MDRTC Core Updates

Animal Phenotyping Core

The newly purchased Minispec LF90II, an NMR-based body composition analyzer for rats and mice, is set up and has been tested on more than 100 animals with body weights ranging from 16 g to 600 g. The machine detects body fat, lean mass and free fluid in conscious animals with no need for anesthesia.

The virtual measuring time per animal is about 2 minutes so that we can have your animals transferred in and out on the same day. In this case, we need to have a 2-way animal transfer approved by UCUCA in advance and your barcode will be carried on through the procedures.

Bottom line, we are ready to take your animals. Current price, $12/animal.

Cell & Molecular Biology Core

The University of Michigan recently agreed to participate in Thermo Fischer Scientific's Genome-wide RNAi Global Initiative, joining 22 other leading academic research centers around the world. Created in 2005, the Global Initiative serves to combine the powerful new capability of high-throughput genome-wide siRNA screening with international scientific exchange and collaboration of its participating institutions to accelerate discovery. U-M's participation has prompted a significant commitment to develop the necessary infrastructure to support this emerging research field.

Together with the Life Sciences Institute, the Medical School (including the departments of Pathology and Internal Medicine), the Cancer Center, and the Michigan Institute for Clinical Health Research, the Michigan Diabetes Research and Training Center has identified funding to purchase the requisite technology and Thermo's library of mouse and human RNAi's for screening.

Effective September 1, Martha Larsen is leading the day-to-day scientific and operational activities for the High Throughput Screening (HTS), RNAi and High Content Screening efforts within the Center for Chemical Genomics. This includes efforts to recruit and hire the additional scientific staff required for the start-up of RNAi and High Content screening. The requisite personnel are planned to be in place this fall with the RNAi library and equipment arriving before the end of the year. We anticipate the equipment for the high content screening efforts to arrive by mid- to late-fall and should be operational by the end of the year.

Funding/Award Opportunities

Update: MDRTC Pilot and Feasibility (P&F) Studies
The MDRTC received 11P&F applications. Funding is up to $50,000 for one year. The applications are currently undergoing peer review. The MDRTC Grants Advisory Council meets in November to select the applications that will be funded. It is anticipated that P/FS projects will be funded in December, 2008.

Update: Diabetes Interdisciplinary Study Program (DISP)
The MDRTC and the Michigan Comprehensive Diabetes Center (MCDC) received 3 DISP applications for studies that promote interdisciplinary collaboration among researchers. Proposals are for one year of support with funding up to $100,000.
The applications are currently undergoing peer review and the MDRTC Grants Advisory Council will meet in November. One DISP project will be funded in December, 2008.

Centers for Disease Control and Prevention 2007 Diabetes Fact Sheet

The Centers for Disease Control and Prevention released its new 2007 Diabetes Fact Sheet in late June. The following are a few of the statistics contained in the Fact Sheet:

Prevalence of diabetes in the United States, all ages, 2007
Total: 23.6 million people or 7.8% of the population have diabetes
Diagnosed: 17.9 million people
Undiagnosed: 5.7 million people

Prevalence of diagnosed and undiagnosed diabetes among people aged 20 years or older,
United States, 2007
Age 20 years or older: 23.5 million or 10.7% of all people in this age group have diabetes
Age 60 years or older: 12.2 million or 23.1% of all people in this age group have diabetes
Men: 12.0 million or 11.2% of all men aged 20 years or older have diabetes
Women: 11.5 million or 10.2% of all women aged 20 years or older have diabetes

Get the latest diabetes statistics by visiting the CDC's Web site: http://main.diabetes.org/site/R?i=GnGuGiiVrGgOyYwu3YwIGw.

News and Events

The MDRTC is co-sponsoring two upcoming symposia:

MICHIGAN METABOLOMICS AND OBESITY CENTER SYMPOSIUM

Hold the Dates: October 14-15, 2008

Date: October 14, 2008
Time: 4:00 - 5:00 p.m.
Location: Forum Hall, Palmer Commons
Speaker: Eric E. Schadt, PhD
Executive Scientific Director, Genetics - Rosetta Inpharmatics LLC
Topic: Gene Networks Reflecting Tissue-Tissue Interactions Highlight Novel Causal Pattern of Association with Disease

Date: Wednesday, October 15, 2008 Time: 8:00 AM - 4:00 PM

Location: Forum Hall, Palmer Commons

Co-sponsors

Featured Speakers: Arul Chinnaiyan, MD, PhD, University of Michigan, Mary-Ellen Harper, PhD, University of Ottawa, Liangyou Rui, PhD, University of Michigan, Alan D. Attie, PhD, University of Wisconsin, Patricia K. Smith, PhD, University of Michigan - Dearborn, Dana Dolinoy, PhD University of Michigan, Karen E. Peterson, ScD, University of Michigan

For complete information and registration please visit the MMOC website at: www.med.umich.edu/mmoc or contact Sandra Wankel at (734) 647-2271 / wankel@umich.edu.

DEVELOPMENTAL ORIGIN OF HEALTH AND DISEASE SYMPOSIUM

Hold the Date: Friday, October 17th, 2008

Location: Forum Hall, Palmer Commons

Featured Speakers: Shuk-Mei Ho,PhD, University of Cincinnati, Keith Latham, PhD, Temple University, Claudine Junien, Inserm, Paris, France, Michael Joseph Meaney,PhD, McGill University, Douglas M. Ruden, PhD, Wayne State University, Atul Singhal, MRC, London, UK, Stephen J. Suomi, PhD, National Institutes of Health, DHHS

Sponsors: Division of Pediatric Endocrinology, Department of Pediatrics
Co-Sponsors:

For more information please contact Amanda Howard (Email: amanhowa@med.umich.edu) or visit the MDRTC website at http://www.med.umich.edu/mdrtc/news_events/index.html

Citing the MDRTC in publications is critical for continued funding

In order to assure recognition of NIH support for your research, all publications that use MDRTC core services or result from research funded by a Pilot and Feasibility Grant under this grant must cite the grant as a source of support. Please also remember to cite the MDRTC whenever you receive advice from any of the Core directors or staff, when you receive financial support from the MDRTC for the use of a core that is shared with other centers (i.e. Animal Phenotyping Core, Vector Core, Protein Structure Core, etc.) and as appropriate, in collaborative studies where you might not be the first author writing the paper. Failure to acknowledge MDRTC support in publications could seriously compromise our position with NIH and NIDDK. We ask that you include in the Acknowledgement section of manuscripts the following:

“This work utilized ______Core(s) of the Michigan Diabetes Research and Training Center funded by Grant No. NIH5P60DK020572 from the National Institute of Diabetes and Digestive and Kidney Diseases.”

or

“This research was supported by a Pilot and Feasibility Grant from the Michigan Diabetes Research and Training Center (NIH Grant 5P60-DK20572)”.

JAMA Call for Diabetes Papers

Because of the continued challenges of diabetes and its associated comorbidities, JAMA will devote an entire issue to diabetes in April 2009. JAMA is inviting authors to submit manuscripts reporting original research (original contributions, preliminary reports, and research letters), systematic reviews, special communications, and commentaries on any topic related to diabetes and its comorbidities. JAMA is also welcoming articles addressing the economic implications, policy aspects, and ethical considerations relative to diabetes. Special consideration will be given to randomized trials of new therapies and to research reports addressing the management of diabetes, including glycemic monitoring and new technologies for diabetes care; genetic aspects and prevention; islet cell/pancreatic transplantation and related effects of diabetes on cardiovascular and oncologic disorders.

Manuscripts received by November 1, 2008, will have the best chance of consideration for publication in the diabetes theme issue of JAMA. High-quality articles also may be published in other issues of JAMA or if not suitable for JAMA, may be referred (with the authors' permission) for consideration for publication in one of JAMA’s Archives specialty journals. Please consult the instructions for authors for preparing and submitting manuscripts.
http://jama.ama-assn.org/cgi/content/full/300/4/441#REF-JED80040-13

In the News

The July 1 issue of the Detroit Free Press contained an article about startling new figures from the Centers for Disease Control & Prevention, on the rising tide of diabetes in the U.S. The story is accompanied by a map that shows the current rates of diabetes in each county of Michigan. William Herman, MD, MPH, was quoted in the story.

A new vision screening device has been developed by two UM researchers, Victor Elner, PhD and Howard Petty PhD. Already shown to give an early warning of eye disease, could give doctors and patients a head start on treating diabetes and its vision complications, a new study shows. The instrument, invented at the U-M Kellogg Eye Center, captures images of the eye to detect metabolic stress and tissue damage that occur before the first symptoms of disease are evident.

As concern about children’s health grows along with their waistlines, Joyce Lee, MD, MPH warns that the childhood obesity epidemic could lead to large numbers of younger adults developing type 2 diabetes, leading to a greater number of diabetes complications, and ultimately, lower life expectancy. Details of Dr. Lee’s article featured in the July issue of the Archives of Pediatric & Adolescent Medicine appeared in U.S. News & World Report, Reuters Health, and Forbes in July.

U-M saved Medicare $$ while improving care of heart, diabetes patients
Older patients with heart disease and diabetes are getting better treatment than ever at the University of Michigan Health System – even while U-M’s care for Medicare patients is costing less, a new report shows. The data come from the second year of a national project undertaken by 10 large physician groups, including the U-M Faculty Group Practice.

The results were announced in Washington, D.C., by the Centers for Medicare and Medicaid Services. CMS oversees the Medicare system and launched the project to encourage innovation, efficiency and the development of quality improvement efforts that might be used by doctors and hospitals nationwide. U-M was one of only two participating groups that achieved both of the project’s aims: to provide the highest-quality care on all 27 of the project’s heart and diabetes measures, and to contain health care spending growth for all traditional Medicare patients, including those with costly chronic illnesses.

Project leader Caroline Blaum, MD – Associate Professor of Internal Medicine, Associate Chief of Geriatric Medicine and a Research Scientist at the VA Ann Arbor Healthcare System -- notes that many faculty and staff from the Faculty Group Practice and Hospitals & Health Centers worked together to make the changes possible. Both entities are under the larger umbrella of the U-M Health System, which makes collaboration easier. “The innovative thinking and willingness to do what’s right for patients regardless of the prospect of direct reimbursement has truly been exceptional,” she says. “And ultimately, we have been able to show that innovations can pay off in both improved care for patients and savings for Medicare.”

As a result, U-M will get to keep $1.24 million of the funding that Medicare would have otherwise spent on the care of U-M patients in that year, and will also earn more than $460,000 as an incentive for providing high-quality care.

This is the second year that U-M has achieved both sizable savings and high scores on health care quality benchmarks as part of the project, even as the project was expanded to include patients with heart failure and coronary artery disease. Two more years’ worth of data remain to be collected and analyzed.

The report is based on data from approximately 20,000 Medicare participants who received nearly all their care at U-M during the year that began April 1, 2006. It does not include those who were enrolled in a Medicare Advantage plan offered by a private health plan, nor Medicare participants who received only limited care at U-M. But the improvements made for the project are helping many other patients.

The project’s formal name is the Medicare Physician Group Practice Demonstration. It is Medicare’s first Pay for Performance Demonstration Project to work directly with physician groups. It began by focusing on the quality of care of patients with diabetes, but in the second year was expanded to include heart failure and coronary artery disease – both chronic heart conditions that carry a very high risk of emergency hospitalization, and other care, if not managed appropriately.

Because of its participation in this project, U-M is also automatically participating in another Medicare project, the Physician Quality Reporting Initiative or PQRI. In fact, the $460,000 that U-M earned for achieving high-quality care on 27 benchmarks is being paid through PQRI. The dollars U-M earned for saving Medicare money are calculated using a separate formula.

U-M’s success in both years of the project can be largely attributed to efforts to redesign the way patients are cared for, to enhance coordination and efficiency and reduce the need for emergency care and repeat hospital stays.

In the first year of the project, U-M implemented a number of new tactics to help improve care for Medicare patients, most of which are still in place today. In the second year, that effort was expanded and a number of new programs made their debut. Among them:

Sub-acute Care Service: This program brings U-M physicians and nurse practitioners specializing in geriatric care directly into certain nursing homes in the Ann Arbor, Ypsilanti, Canton and Plymouth, Mich., areas. The clinicians help patients discharged from U-M hospitals to these nursing homes, and their work has already decreased the number of days patients spend in the hospital.

CHOICES (Creating Healthcare Options to Inpatient Care and Emergency Services): This effort provides a nurse practitioner and social worker who can travel to a patient’s home soon after he or she goes home from the hospital, to help with issues such as diabetes management. This program is available to a large number of U-M patients who need specialized in-home care soon after being discharged from the hospital, to help them until they can see their regular doctor.

Expanded Inpatient Geriatrics Consult Service: This service makes it easier for U-M geriatricians, who specialize in the care of older adults, to assist other U-M physicians in assessing and managing the needs of older hospitalized patients – no matter what their main reason for being in the hospital.

Emergency Medicine Consult/Referral Service: Designed for any patient seen at the U-M Emergency Department who needs follow-up care of any kind, this program helps ensure that they get appointments at U-M clinics. The program’s staff members make telephone contact with patients soon after they return home, and coordinate their scheduling while also alerting their primary care physician and processing insurance authorizations.

U-M’s Faculty Group Practice is the only organization in Michigan taking part in the project. It was chosen for several reasons, including demonstrated success in chronic care management, diabetes quality and organizational structure. For more information on the project, visit www.cms.hhs.gov/DemoProjectsEvalRpts. Click on “Medicare Demonstrations” and then search for “Medicare Physician Group Practice Demonstration.”

The other physician groups participating in the project are Billings Clinic (Montana), The Everett Clinic (Washington), Dartmouth-Hitchcock Clinic (New Hampshire), Forsyth Medical Group (North Carolina), Geisinger Clinic (Pennsylvania), Integrated Resources for the Middlesex Area (Connecticut), Marshfield Clinic (Wisconsin), Park Nicollet Health Services (Minnesota), and St. John’s Health System (Missouri).

Accolades to MDRTC Members

Christin Carter-Su, PhD was named as one of Molecular Endocrinology’s Outstanding Reviewers for 2007.