Joslin Diabetes Center, Mass.

I'm Dr. Ronald Kahn at the Joslin Diabetes CenterJoslin Diabetes Center in Boston, the world's largest center for diabetes research and clinical care. Here we have research programs that try to address problems related to type 1 diabetes, the insulin dependent form that often occurs in children, type 2 diabetes, what we used to call adult onset diabetes, although this can occur at any age, and also diabetes complications, which can affect both type 1 and type 2 diabetic patients.

There are many important challenges in each of these areas. For example, in the area of type 1 diabetes, we have large research teams working on understanding the basic immune system that controls this disease, since this is an autoimmune destruction of pancreatic beta cells. We must also learn how these cells grow and replicate so we that we can hope someday to either repair the damage or replace these damaged cells.

In type 2 diabetes, we have a completely different challenge. This is a disease where there is insulin resistance; that is, the tissues of the body don't respond to insulin normally. Here we have to understand how does insulin signal through its receptor to control cellular function and what goes wrong in this process. This is complicated by the fact that in type 2 diabetes there's also components of inflammation as particularly relates to obesity where fat tissues seems to accumulate macrophages and lymphocytes -- cells that stimulate the immune response.

And finally we must consider the problem of diabetes complications. These are problems that affect both the small blood vessels of the eye and the kidney and the nerve, as well as the large blood vessels affecting the limbs and the heart. We have to understand how does insulin resistance or insulin deficiency and hyperglycemia -- that is, the high blood sugar of diabetes -- lead to an increased risk of these complications. One of the laboratories at the Joslin is particularly interested, for example, in studying the enzyme protein kinase C. This is an intracellular enzyme that is activated by high blood sugar and may lead to this damage. It is only through integrating findings in all of these areas that we will really begin to unravel this very complex disease and its complications. And also begin to attack each of these problems, because our ultimate hope, of course, is to both prevent and cure these disorders.

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