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Diabetes, Endocrinology & Metabolism Bookmark and Share

Our Approach

City of Hope’s Department of Diabetes, Endocrinology & Metabolism offers a comprehensive diabetes and endocrinology program combining groundbreaking research and unique treatments with patient education to help people living with diabetes and other endocrine diseases get the medical care and information they need to achieve optimal quality of life.
 
Recognized for its excellence in research, patient care and teaching, the division made its debut in 1971, marking the start of a new era in clinical and basic science diabetes research at City of Hope.
 
 
The Leslie & Susan Gonda (Goldschmied) Diabetes & Genetic Research Center houses City of Hope's comprehensive diabetes research and treatment services.  We are committed to providing the highest quality diabetes clinical care programs and advanced training for physicians and scientists specializing in diabetes care and research.
 
Our diabetes program offers a multidisciplinary approach to advance research initiatives and patient care in several key areas:
 
 
Molecular Genetics and Drug Intervention
As diabetes is a multifactorial disease, understanding its genetic basis and molecular underpinnings is the subject of much ongoing research.  Drug discovery and drug design are focused on inhibiting undesirable reaction processes such as glycation.  Some of our research involves:
 
  • Discovering new genes, molecular signaling and cellular mechanisms that are involved in the development of diabetes and its complications
 
  • Continuing research efforts in inhibition of glycation and advanced glycation endproducts, thereby blocking or reversing long-term complications of diabetes
     

Addressing Complications of Diabetes
Diabetes brings a host of related complications, including nephropathy, neuropathy and cardiovascular disease. Understanding how to prevent and treat them is a vital part of managing diabetes patients. Some of our research in this area includes:
 
  • Advancing research efforts in cellular mechanisms of atherosclerosis and nephropathy
 
  • Clinical research in male sexual dysfunction in patients with cancer and diabetes
 

About Diabetes

Diabetes is a disease in which the body does not produce or properly use insulin. Insulin is a hormone secreted by the islet cells of the pancreas needed to convert sugar and starches into energy needed for daily life. Normally glucose enters your cells because of the action of insulin. It acts as a key and assists glucose transport from the blood to the cell. In people with diabetes, the body does not produce enough insulin or the cells do not properly respond to the insulin, therefore, glucose accumulates in the bloodstream and eventually is excreted in the urine.
 
An estimated 20 million, or approximately 7 percent, of Americans have diabetes, and many more are at risk for developing the disease. With the rate of diabetes steadily increasing, the need for an aggressive search for better treatments and a cure is glaringly apparent.
 
Type 1 diabetes
In the past, this was known as juvenile-onset diabetes, or insulin dependent diabetes mellitus, an autoimmune disease in which the body's own immune system slowly destroys the cells in the pancreas (islet cells) that produce insulin. Insulin is a hormone that works to allow glucose access to the body's cells, thereby providing fuel for metabolic processes. The pancreas of a patient with type 1 diabetes produces little or no insulin and, therefore, such patients must take insulin injections to survive. Type 1 diabetes can occur at any age, but most commonly develops in children between the ages of 5 and 15.
 
Type 2 diabetes
Formerly referred to as adult-onset diabetes, or non-insulin dependent diabetes mellitus, type 2 diabetes is usually found in individuals who are more than 40 years old and overweight. In type 2 diabetes, insulin does not work effectively. Therefore, the insulin produced by the pancreas is not sufficient to keep the blood sugar level normal and the body's cells are unable to properly use glucose.
 
Maturity-onset Diabetes of the Young (MODY)
This form of diabetes is inherited, and can vary in severity. Most often, MODY resembles a very mild version of type 1 diabetes, with continued partial insulin production and normal insulin sensitivity. A person with MODY is typically in their teens or 20s and thin.
 
Gestational diabetes
Gestational diabetes develops during pregnancy in women who have never been diagnosed with diabetes. It occurs when the body is unable to properly use and produce enough insulin during pregnancy and as a result glucose levels rise. Symptoms usually occur during the second or third trimester when the babys body has developed and is growing.
 
Other causes of diabetes
Diabetes may also be caused as a result of organ transplants, certain types of cancers, as well as a host of medications (for cancer and other diseases).
 
If you are concerned about being at risk for diabetes, make sure your physician has done a thorough health history and is aware of all the medications you are taking.
 
Complications of diabetes
Unfortunately, the effects of uncontrolled diabetes can be harmful. Complications stem from damage to blood vessels and nerves throughout the body. As a result, diabetic eye disease, kidney disease, vascular disease and nerve damage can occur.
 
Click here to find out if you are at risk for diabetes.
 
More educational information
For more about diabetes education, visit the American Diabetes Association and/or the Juvenile Diabetes Foundation websites, or contact City of Hope's Department of Diabetes, Endocrinology & Metabolism at 626-256-HOPE (4673), ext. 62251.
 

Diabetes Risk Factors and Symptoms

 
Risk Factors
Early stages of diabetes have few symptoms. If left untreated, however, diabetes can cause serious damage that can lead to blindness, kidney failure, heart attack, stroke and limb amputation. Fortunately, when detected and treated early, diabetes can be controlled.
 
Take this brief quiz to help determine if you are at risk for diabetes:
 
  • Are you overweight?
  • Do you lead a sedentary lifestyle?
  • Are you over the age of 45?
  • Are you a woman who has delivered a baby weighing more than nine pounds at birth?
  • Are you black, Hispanic, American Indian or Asian-American?
  • Do you have a family history of diabetes?
  • Do you have high blood pressure?
  • Is your HDL cholesterol 50 or lower and/or is your triglyceride level 250 or higher?
 
If you answered "yes" to any of these questions, ask your doctor if you should be checked for diabetes.
 
Signs and Symptoms
The signs and symptoms of diabetes may vary significantly from patient to patient in both symptom type and severity. Diabetes often goes undiagnosed for years because many of its symptoms are subtle and may seem harmless. However, detecting diabetes early can lower the risk of developing serious complications later on.
 
The following are common signs and symptoms of diabetes, categorized by type of diabetes (type 1 or 2). Consult your physician if any of the following symptoms occur:
 
  • Symptoms of Type 1 Diabetes
  • Frequent urination
  • Excessive thirst
  • Extreme hunger
  • Unusual weight loss
  • Increased fatigue
  • Irritability
  • Blurry vision
  • Nausea and vomiting
  • Symptoms of Type 2 Diabetes
  • Symptoms mentioned for type 1, plus:
  • Tingling or numbness in legs, feet or skin
  • Frequent skin infections or itchy skin
  • Slow healing of cuts and bruises
  • Frequent yeast infections
 

Diabetes Treatment Approaches

Treatment options and approaches for diabetes are more plentiful than ever.  Treatment is tailored to the individual, with the type of diabetes and its severity determining the optimal course of treatment.
 
Diet and Lifestyle Changes
In mild cases of type 2 diabetes, a program focusing on weight loss, exercise, dietary modification to control blood glucose, and avoiding smoking and excessive alcohol consumption may be sufficient to control or even reverse your diabetes. In more severe cases and in other types of diabetes, other therapies are often necessary, but diet and lifestyle modifications must be followed as well.
 
Medications
For type 2 diabetics who don’t respond to dietary and lifestyle changes alone, medications are necessary to prevent hyperglycemia (high blood glucose).  There are many different medications available today that help maintain normal blood glucose levels. These medications work via a variety of mechanisms to lower blood glucose. Some stimulate insulin production by the beta cells of the pancreas, some decrease glucose production in the liver, while others prevent the breakdown of starches into sugars in the intestine.
 
Because of the different mechanisms of action, physicians often prescribe a combination of medications to achieve a more favorable result. A new medication called pramlintide (a synthetic form of the hormone amylin) is now available to treat both type 1 and type 2 diabetics who use insulin. It is administered as an injection, and is highly effective in controlling blood glucose and moderating side effects that often occur with insulin alone.
 
Insulin Therapy
Insulin therapy is the mainstay of type 1 diabetes treatment, and is also used in some cases of type 2 diabetes.  Not so long ago, diabetics had to inject porcine insulin (derived from pigs), which sometimes caused allergic reactions. 
 
Now, recombinant human insulin is the standard treatment, and may be administered in several ways:
 
  • Daily injections
    Patients inject themselves with insulin several times daily, timing the injections to coincide with meals and measurements of blood glucose levels. This is the time-honored way to take insulin, and many patients are used to the routine.
  • Insulin infusion
    In a hospital setting, intravenous infusion of insulin is sometimes used to manage severe hypoglycemia. This is not usually a practical option for self-care.
  • Insulin pump
    The insulin pump has revolutionized insulin therapy for many patients.  It provides a continuous infusion of insulin subcutaneously (under the skin) via a small, unobtrusive, wearable pump. The pump is combined with a glucose monitor, which constantly measures blood glucose levels. The pump can therefore adjust insulin delivery to ensure optimal blood glucose levels sustained over time, and eliminate the sharp spikes and downswings in blood glucose that can occur with other treatment methods.

Other Endocrine Care

The Leslie & Susan Gonda (Goldschmied) Diabetes & Genetic Research Center’s Endocrinology Program is developing an international reputation for excellence in endocrinology research and treatment.
 
Some of the major research initiatives under way in the program include:
 
Endocrine Considerations in Treatment of Non-endocrine Cancers
The Endocrinology Program provides high-quality comprehensive endocrine care for patients undergoing treatment for non-endocrine cancers. Issues addressed include:
 
 
  • Investigation of endocrine complications as a result of chemotherapy, radiation therapy and bone marrow transplant in cancer patients.
  • Management of immunosuppressive therapy-related endocrine complications.
  • Development of clinical practice guidelines for the management of hypothalamic-pituitary endocrine complications after bone marrow transplant.
  • Aggressive prevention and treatment of bone marrow transplant osteoporosis in both men and women.
 

Thyroid Cancer
After thyroid cancer surgery, standard treatment consists of radioiodine to ablate residual tumor cells. However, we have been exploring methods of augmenting or supplanting this therapy. Initiatives include:
 
 
  • Continued clinical research in thyroid cancer exploring new diagnostic and therapeutic alternatives to radioactive iodine therapy
  • Providing compassionate use of recombinant human thyroid stimulating hormone (Thyrogen) for thyroid cancer therapy

     
Neuroendocrine Tumors (carcinoids, pancreatic endocrine tumors, etc.)
These tumors present a significant challenge both at diagnosis and in treatment. Research efforts include:
 
 
  • Advancing the management of neuroendocrine tumors with the use of radioactive iodine MIBG
     
 
Male and Female Sexual Dysfunction (primary and secondary)
 
  • Management of male and female sexual dysfunction in premature gonadal/ovarian failure patients
  • Clinical research in male sexual dysfunction in patients with cancer and diabetes
 

Diabetes Program History

The diabetes scientists at City of Hope have made several landmark contributions to the field of diabetes research and care over the years:
 
 
  • In the 1940s, the late Rachmiel Levine, M.D.,  described the role of insulin in mediating glucose entry into the cell and discovered that the pathophysiological basis for type 2 diabetes was related to a defect in this glucose transport mechanism, a condition termed "insulin resistance."
 
  • In the late 1960s, Samuel Rahbar, M.D., Ph.D., recognized the utility of hemoglobin-A1c measurement as a marker for blood glucose control in the diabetic individual.
 
  • In 1978, Arthur Riggs, Ph.D., and Keiichi Itakura, Ph.D., genetically engineered bacteria to produce unlimited quantities of synthetic human insulin (now called Humulin).
 
 
Landmark Achievements Continue
Today, exciting research continues at City of Hope's Diabetes Research Center, where physicians and scientists are exploring a variety of new investigational treatment approaches.
 
Since the inception of the Leslie and Susan Gonda (Goldschmied) Diabetes and Genetic Building in June 1997, the Department has evolved significantly in basic science research, clinical investigations and clinical care. Most notably, was the establishment of the National Institutes of Health-funded Southern California Islet Cell Resources (SC-ICR) Center, an islet isolation and distribution facility program to support clinical transplantation and basic science research throughout Southern California and beyond. Other significant advances are being made in the areas of islet generation, immune tolerance induction, molecular mechanisms of diabetes complications, as well as new treatments for diabetes complications, endocrine cancers and supportive care for patients with non-endocrine tumors.
 
Physicians and researchers are working hard to continue the legacy of their predecessors by exploring a variety of new research and therapeutic approaches that could potentially lead to a cure for diabetes and have far-reaching implications in the treatment of many other diseases.
 
 
Milestones in Diabetes Research and Treatment:
 
 
  •     1949: Dr. Rachmiel Levine discovers the metabolic effects of insulin
 
  •     1968: Dr. Samuel Rahbar discovers HgbA1c and its role diabetes management
 
  •     1971: City of Hope establishes the Division of Diabetes
 
  •     1978: Drs. Arthur Riggs and Keiichi Itakura first engineer human insulin in the laboratory
 
  •     1982: Dr. Yoko Fujita-Yamaguchi isolates specific cell proteins that join with insulin and mediate its metabolic effects
 
  •     Late 1980s: City of Hope enchances the Clinical Diabetes Care Program
 
  •     1991: City of Hope establishes the Diabetes Education Program
 
  •     1992: City of Hope establishes the Diabetes & Cardiovascular Risk Reduction Program
 
  •     1993: Drs. Rama Natarajan and Jerry Nadler conduct seminal research dealing with diabetic complications and islet cell dysfunction
 
  •     1993: Inaugural Community Diabetes Symposium held
 
  •     1994: City of Hope establishes the Male Sexual Medicine Program
 
  •     1997: Inauguration of Leslie & Susan Gonda (Goldschmied) Diabetes & Genetic Research Center
 
  •     1997: Dr. Barry Forman identifies molecules that promote fat cell formation and affect insulin resistance in patients with type 2 diabetes
 
  •     2000: Inaugural International Rachmiel Levine Symposium on Diabetes and Obesity Research
 
  •     2001: City of Hope establishes the Southern California Islet Consortium
 
  •     2004: Dr. Fouad Kandeel leads first islet cell transplantation at City of Hope
 
  •    2003-2007: City of Hope's is the first program in the nation to train an endocrinologist as an islet transplant physician under UNOS regulations
 
  •     2011: Expansion of the Gonda Center more than doubles the available scientific space for diabetes research
 

Diabetes Supportive Care

Our patients are encouraged to take advantage of the Sheri & Les Biller Patient and Family Resource Center, which offers a wide array of support and educational services. Patients and loved ones may work with a coordinated group of social workers, psychiatrists, psychologists, patient navigators and spiritual care providers at the center, as well as participate in programs such as music therapy, meditation and many others.
 
Visit a nurse educator
In the course of just a few days, a person with diabetes makes hundreds of decisions that can lead to improved or lessened diabetes control. Diabetes is unique in that over 90 percent of a person's success in diabetes management is based on how effectively the patient self-manages the disease. With so much responsibility in the hands of the person with diabetes, plenty of support is needed in order to achieve the best possible diabetes control and long-term health. That’s where a nurse educator comes in.
 
City of Hope employs certified diabetes educators who are part of the health care team. Our diabetes educators are also registered nurses whose role is to be a teacher, counselor and coordinator of care for people with diabetes. The diabetes nurse will make sure the patient and, when possible, the patient's family or other support people understand all doctor's orders and the many aspects of the disease. This may include information about medications, how to monitor and interpret blood glucose levels, the importance of exercise, a realistic food plan, dealing with emotions, and when other health team members need to be called upon. Because diabetes is a chronic, progressive and serious disease, support over the long-term is essential to successful management.
 

Diabetes Education Program

Research clearly shows that complications of diabetes can, in many cases, be prevented if proper education and treatment are given soon after diagnosis.
 
For this reason, City of Hope's Department of Clinical Diabetes, Endocrinology & Metabolism is dedicated to educating and helping people with diabetes manage and take control of their disease.
 
The adult Diabetes Education Program is accredited by the American Diabetes Association. In the four class series, participants learn:
 
  • Proper diet, exercise and lifestyle changes to help manage diabetes
 
  • Latest advances in diabetes research and treatment
 
  • Information to gain a better understanding of the disease, empowering each person to take control of their disease by learning self-management skills
     
 
For information about the program or to enroll:
You may be referred by your primary care physician or refer yourself by calling City of Hope at 800-826-HOPE (4673).  Contact the City of Hope diabetes nurse educator at 626-256-HOPE (4673), ext. 65640, with any questions and/or to obtain a current schedule of classes.
 

Diabetes Resources and Supportive Care

Advances in diabetes research and treatment have made it possible for diabetics to live long and comfortable lives. City of Hope believes that all patients should be active participants in their care. We, therefore, offer a number of useful resources to diabetes patients such as educational newsletters and brochures to keep up-to-date on new therapies and other developments, cookbooks to help patients prepare enjoyable and nutritious meals, and a supportive care program that encompasses medical, psychological, social and spiritual needs of diabetes patients. 
 
City of Hope’s Cookbooks
Each year, the Department of Diabetes, Endocrinology & Metabolism at City of Hope compiles a mouth-watering selection of delicious, healthy recipes tailored to the needs of diabetes patients in its annual cookbook.
 
Click on any link to download a free copy.
 
The best of the best. You'll find the recipes prized the most from the past five years. Try favorites like Chilly Veggie Pizza, Roasted Italian Vegetables, Chicken Piccata and Lemon & Peach Delight.
 
Tempting fare for the holidays or any time, like yummy Spinach Cheese Rolls, delicate Asian Noodle Salad, sumptuous Almond Pork Tenderloin, and delightful Fruit Tartlets.
 
Tiempo de Disfrutar de la Comida
Un libro de recetas para el cuidado de diabetes.
 
Season's Eatings
A holiday cookbook brimming with tasty treats like Turkey Turnovers, Cornish Hens in Cider and Cranberry Chocolate Trifle.

Tiempo de Disfrutar de la Comida
Un libro de recetas para el cuidado de la diabetes y su salud.

Diabetes Outlook
A mouthwatering array of diabetes-friendly recipes including Broccoli & Almond Salad, Chicken Tikka Kebobs, and Tiramisu.

Season's Eatings
An excellent recipe selection including these flavorful dishes: Fresh Orange, Turkey and Pasta Salad; Cranberry Apple Bread; Turkey Divan Casserole and Strawberry Parfait.
 
Holiday Delights
A delicious selection of recipes for diabetes management including Filo Cheese Triangles, Shrimp Quesadillas and Tofu Basil Pesto.
 

Diabetes Professional Education

City of Hope’s Department of Clinical Diabetes, Endocrinology & Metabolism continues to produce breakthrough research that has substantially improved the lives of patients with diabetes and other endocrine disorders.
 
An important commitment of the department is to provide state-of-the-art training for physicians wishing to specialize in endocrinology. To that end, the department offers the Endocrine Fellowship Program in association with Harbor-UCLA Medical Center. Fellows receive rigorous training in all aspects of endocrinology, with heavy emphasis on new therapeutic directions in diabetes treatment and exploration of a wide variety of endocrine cancers.
 
 

Diabetes Basic Science Research

Basic science research in biochemistry and immunology provides the foundation that drives the development of new therapies for diabetes and other endocrine diseases. The Division of Developmental & Translational Diabetes and Endocrine Research and the Division of Molecular Diabetes Research are conducting a number of important basic science research programs, including those described below:
 
Heart and kidney complications of diabetes
Diabetes is the leading cause of kidney failure and a significant risk factor for the development of coronary disease. In fact, heart disease is the No. 1 cause of death in people with diabetes and accounts for nearly half of all diabetes-related deaths. Our researchers are studying mechanisms of atherosclerosis and kidney disease in diabetic animal models and humans. The focus of this research is to develop protective strategies for preventing and reversing these complications.
 
Controlling complications
One mechanism for the development of diabetes complications is the changes in protein and fat structure of body tissues as a result of increased attachment of glucose to these tissue structures, a process known scientifically as the formation of advanced glycation endproducts, or "AGEs." AGE formation has also been found to accelerate the aging process and may contribute to the development of Alzheimer's disease. City of Hope researchers have developed novel compounds that inhibit glycation and AGE formation and are currently testing their safety and effectiveness in preventing diabetes complications and delaying the tissue aging process. Some of these compounds can also break existing AGEs and could therefore potentially reverse existing tissue damage induced by diabetes. 
 
New molecular discoveries
City of Hope researchers have discovered the molecular mechanisms underlying the body's main method of metabolizing and destroying cholesterol. This research may open the door for new drug therapies for patients with abnormally high cholesterol levels, atherosclerosis and diabetes. These researchers also discovered a fat-derived hormone called androstanol that reverses or halts gene activity in the cell nucleus. The discovery of androstanol is expected to transform our current understanding of metabolic diseases and aid the development of future therapies.
 
Current research programs performed by scientists in the Division of Developmental & Translational Diabetes and Endocrine Research and the Division of Molecular Diabetes Research:
 
Ismail Al-Abdullah, Ph.D.: Islet cell isolation.
 
Sanjay Awasthi, M.D.: Diabetes and cancer.
 
Kevin Ferreri, Ph.D.: Islet cell transplantation, epigenetics, and diabetic biomarkers.
 
Wendong Huang, Ph.D.: Genetic and epigenetic regulation of diabetes. Stem cell and drug development for diabetes.
 
Janice Huss, Ph.D.: Characterization of transcriptional mechanisms regulating skeletal muscle metabolic adaptations during growth and differentiation and in response to physiologic stress, and the etiologic role of orphan nuclear receptors in obesity and type 2 diabetes.
 
Fouad R. Kandeel, M.D., Ph.D.: Islet cell transplantation.
 
Hsun Teresa Ku, Ph.D.: In vitro differentiation of human and mouse embryonic stem cells towards pancreatic lineage cells. Identification, purification and characterization of embryonic and adult pancreatic stem/progenitor cells.
 
Chih-Pin Liu, Ph.D.: Development of methods to induce immune tolerance.Identification of novel cellular and molecular targets to improve cell-based therapy for diabetes.
 
Yoko Mullen, M.D., Ph.D.: Extrahepatic islet transplantation. Prevention of islet loss for transplantation.
 
Rama Natarajan, Ph.D.: Identification of the molecular mechanisms underlying the accelerated cardiovascular and renal disease observed in diabetic patients, role of epigenetics and microRNAs, and inflammatory responses in islet destruction.
 
Ivan Todorov, Ph.D.: Islet cell proliferation, differentiation and cryopreservation. Aging in the human pancreas.
 
Defu Zeng, M.D.: Induction of immune tolerance towards transplanted islets.

 

 

Diabetes Research and Clinical Trials

City of Hope has promoted an aggressive program of pioneering research in all aspects of endocrine diseases, from decoding their genetic and molecular underpinnings to developing pharmaceutical and biological-based therapies for their management. Management of these diseases encompasses a myriad of considerations. Leading-edge techniques such as islet cell transplantation may one day result in a cure for type 1 diabetes. But until a cure is found, optimal therapies must be found to keep the disease in check. Type 2 diabetes is prevalent in the United States, and islet cell transplantation is not a solution because type 2 diabetes is not insulin dependent. Therefore, research centers on drug therapies to both control diabetes itself and prevent its attendant complications such as heart disease, stroke, limb amputations and blindness.
 
Promising research is also taking place in non-diabetic endocrine disorders. Thyroid cancer rates continue to rise, perhaps due to environmental factors. While most types of thyroid cancer are treatable surgically, diligent follow-up is necessary to prevent recurrence. New methods of destroying residual thyroid tissue after surgery such as Thyrogen (thyrotropin) are thus being tested. Neuroendocrine tumors such as carcinoids and pheochromocytoma are also being treated with new investigational therapies.
 
City of Hope’s multidisciplinary team of basic science and clinical researchers consistently strives to develop novel and effective therapies to better the lives of patients with diabetes and other endocrine disorders.

Diabetes Clinical Research

At City of Hope, our mission is always to ensure that advances in basic science research are rapidly translated to clinical settings so patients benefit from novel therapies. The Department of Clinical Diabetes, Endocrinology & Metabolism is conducting a number of important clinical research programs, including those described below:

 

Glucose testing devices
City of Hope physicians are using state-of-the-art technologies (such as the glucose sensor, a subcutaneous device that provides continuous readings of blood glucose over three days) to study the blood glucose profiles of patients. Information gained from these studies can be used to develop proper drug treatment regimens and improve diabetes control.

 

Diabetes prevention trial
City of Hope physicians are conducting a research study to better understand type 1 diabetes and its onset in the relatives of patients with the disease. Recent studies have shown that type 1 diabetes may be caused by the destruction of islet cells in the pancreas as a result of an allergic-type reaction in which the immune system “attacks” islet cells through an islet cell antibody. Other studies also show that the tendency to have type 1 diabetes is inherited.

 

Treatment of malignant pheochromocytoma with radiation
Pheochromocytomas are rare tumors of the adrenal gland that produce large amounts of catecholamines (adrenaline and related chemicals). Preferably the tumor is removed with surgery, however, this may not be successful if the tumor has spread from the adrenal gland. In these cases, patients are treated with chemotherapy or exposure to a radioactive chemical. City of Hope physicians are evaluating the effectiveness of using a radioactive metaiodobenzylguanidine (MIBG) to treat patients with malignant pheochromocytoma, which may reduce the patient’s need for antihypertensive medication and reduce the size of their tumors.

 

 

Use of Thyrogen to detect and treat thyroid cancer
 
Detection
Thyroid cancer is usually managed with surgery or radioactive treatment with iodine-131. Often after surgery, patients are given thyroid hormone treatment replacement medication and take radioactive iodine scanning tests to detect the return of the disease. Currently, patients must stop taking thyroid hormone treatment replacement medication before the radioactive iodine scans are performed, but this often causes physical and emotional discomfort. City of Hope physicians are providing patients with a drug called Thyrogen (thyrotropin) to those who require radioactive iodine scanning, without having to stop their thyroid hormone treatment replacement medication.

 

Treatment
Thyrogen is approved by the FDA as part of the actual treatment of thyroid cancer. After surgical removal of the thyroid (thyroidectomy), standard treatment consists of administering radioiodine to ablate, or destroy, remnants of thyroid tissue. Thyrogen is then administered in combination with radioiodine to improve ablation of residual thyroid tissue, thus providing an important tool in preventing disease recurrence.

 

 

Clinical Research Programs
 
Neuropathy therapies
City of Hope physicians are participating in several national trials for use of new pharmacological agents in treatment of diabetic peripheral neuropathy, a common and distressing long-term diabetes complication.
 

Diabetes, Endocrinology & Metabolism Team

Support this program

It takes the help of a lot of caring people to make hope a reality for our patients.  City of Hope was founded by individuals’ philanthropic efforts 100 years ago. Their efforts — and those of our supporters today — have built the foundation for the care we provide and the research we conduct. It enables City of Hope to strive for new breakthroughs and better therapies, ultimately helping more people enjoy longer, better lives.

For more information on supporting this specific program, please contact our Donor Relations Department at 800-667-5310 or developmentrelations@coh.org. Or, to make a gift that supports all the research at City of Hope, donate online now.
 
We thank you for your support.
 
 
 

Diabetes, Endocrinology & Metabolism

Our Approach

City of Hope’s Department of Diabetes, Endocrinology & Metabolism offers a comprehensive diabetes and endocrinology program combining groundbreaking research and unique treatments with patient education to help people living with diabetes and other endocrine diseases get the medical care and information they need to achieve optimal quality of life.
 
Recognized for its excellence in research, patient care and teaching, the division made its debut in 1971, marking the start of a new era in clinical and basic science diabetes research at City of Hope.
 
 
The Leslie & Susan Gonda (Goldschmied) Diabetes & Genetic Research Center houses City of Hope's comprehensive diabetes research and treatment services.  We are committed to providing the highest quality diabetes clinical care programs and advanced training for physicians and scientists specializing in diabetes care and research.
 
Our diabetes program offers a multidisciplinary approach to advance research initiatives and patient care in several key areas:
 
 
Molecular Genetics and Drug Intervention
As diabetes is a multifactorial disease, understanding its genetic basis and molecular underpinnings is the subject of much ongoing research.  Drug discovery and drug design are focused on inhibiting undesirable reaction processes such as glycation.  Some of our research involves:
 
  • Discovering new genes, molecular signaling and cellular mechanisms that are involved in the development of diabetes and its complications
 
  • Continuing research efforts in inhibition of glycation and advanced glycation endproducts, thereby blocking or reversing long-term complications of diabetes
     

Addressing Complications of Diabetes
Diabetes brings a host of related complications, including nephropathy, neuropathy and cardiovascular disease. Understanding how to prevent and treat them is a vital part of managing diabetes patients. Some of our research in this area includes:
 
  • Advancing research efforts in cellular mechanisms of atherosclerosis and nephropathy
 
  • Clinical research in male sexual dysfunction in patients with cancer and diabetes
 

About Diabetes

About Diabetes

Diabetes is a disease in which the body does not produce or properly use insulin. Insulin is a hormone secreted by the islet cells of the pancreas needed to convert sugar and starches into energy needed for daily life. Normally glucose enters your cells because of the action of insulin. It acts as a key and assists glucose transport from the blood to the cell. In people with diabetes, the body does not produce enough insulin or the cells do not properly respond to the insulin, therefore, glucose accumulates in the bloodstream and eventually is excreted in the urine.
 
An estimated 20 million, or approximately 7 percent, of Americans have diabetes, and many more are at risk for developing the disease. With the rate of diabetes steadily increasing, the need for an aggressive search for better treatments and a cure is glaringly apparent.
 
Type 1 diabetes
In the past, this was known as juvenile-onset diabetes, or insulin dependent diabetes mellitus, an autoimmune disease in which the body's own immune system slowly destroys the cells in the pancreas (islet cells) that produce insulin. Insulin is a hormone that works to allow glucose access to the body's cells, thereby providing fuel for metabolic processes. The pancreas of a patient with type 1 diabetes produces little or no insulin and, therefore, such patients must take insulin injections to survive. Type 1 diabetes can occur at any age, but most commonly develops in children between the ages of 5 and 15.
 
Type 2 diabetes
Formerly referred to as adult-onset diabetes, or non-insulin dependent diabetes mellitus, type 2 diabetes is usually found in individuals who are more than 40 years old and overweight. In type 2 diabetes, insulin does not work effectively. Therefore, the insulin produced by the pancreas is not sufficient to keep the blood sugar level normal and the body's cells are unable to properly use glucose.
 
Maturity-onset Diabetes of the Young (MODY)
This form of diabetes is inherited, and can vary in severity. Most often, MODY resembles a very mild version of type 1 diabetes, with continued partial insulin production and normal insulin sensitivity. A person with MODY is typically in their teens or 20s and thin.
 
Gestational diabetes
Gestational diabetes develops during pregnancy in women who have never been diagnosed with diabetes. It occurs when the body is unable to properly use and produce enough insulin during pregnancy and as a result glucose levels rise. Symptoms usually occur during the second or third trimester when the babys body has developed and is growing.
 
Other causes of diabetes
Diabetes may also be caused as a result of organ transplants, certain types of cancers, as well as a host of medications (for cancer and other diseases).
 
If you are concerned about being at risk for diabetes, make sure your physician has done a thorough health history and is aware of all the medications you are taking.
 
Complications of diabetes
Unfortunately, the effects of uncontrolled diabetes can be harmful. Complications stem from damage to blood vessels and nerves throughout the body. As a result, diabetic eye disease, kidney disease, vascular disease and nerve damage can occur.
 
Click here to find out if you are at risk for diabetes.
 
More educational information
For more about diabetes education, visit the American Diabetes Association and/or the Juvenile Diabetes Foundation websites, or contact City of Hope's Department of Diabetes, Endocrinology & Metabolism at 626-256-HOPE (4673), ext. 62251.
 

Risk Factors/Symptoms

Diabetes Risk Factors and Symptoms

 
Risk Factors
Early stages of diabetes have few symptoms. If left untreated, however, diabetes can cause serious damage that can lead to blindness, kidney failure, heart attack, stroke and limb amputation. Fortunately, when detected and treated early, diabetes can be controlled.
 
Take this brief quiz to help determine if you are at risk for diabetes:
 
  • Are you overweight?
  • Do you lead a sedentary lifestyle?
  • Are you over the age of 45?
  • Are you a woman who has delivered a baby weighing more than nine pounds at birth?
  • Are you black, Hispanic, American Indian or Asian-American?
  • Do you have a family history of diabetes?
  • Do you have high blood pressure?
  • Is your HDL cholesterol 50 or lower and/or is your triglyceride level 250 or higher?
 
If you answered "yes" to any of these questions, ask your doctor if you should be checked for diabetes.
 
Signs and Symptoms
The signs and symptoms of diabetes may vary significantly from patient to patient in both symptom type and severity. Diabetes often goes undiagnosed for years because many of its symptoms are subtle and may seem harmless. However, detecting diabetes early can lower the risk of developing serious complications later on.
 
The following are common signs and symptoms of diabetes, categorized by type of diabetes (type 1 or 2). Consult your physician if any of the following symptoms occur:
 
  • Symptoms of Type 1 Diabetes
  • Frequent urination
  • Excessive thirst
  • Extreme hunger
  • Unusual weight loss
  • Increased fatigue
  • Irritability
  • Blurry vision
  • Nausea and vomiting
  • Symptoms of Type 2 Diabetes
  • Symptoms mentioned for type 1, plus:
  • Tingling or numbness in legs, feet or skin
  • Frequent skin infections or itchy skin
  • Slow healing of cuts and bruises
  • Frequent yeast infections
 

Treatments

Diabetes Treatment Approaches

Treatment options and approaches for diabetes are more plentiful than ever.  Treatment is tailored to the individual, with the type of diabetes and its severity determining the optimal course of treatment.
 
Diet and Lifestyle Changes
In mild cases of type 2 diabetes, a program focusing on weight loss, exercise, dietary modification to control blood glucose, and avoiding smoking and excessive alcohol consumption may be sufficient to control or even reverse your diabetes. In more severe cases and in other types of diabetes, other therapies are often necessary, but diet and lifestyle modifications must be followed as well.
 
Medications
For type 2 diabetics who don’t respond to dietary and lifestyle changes alone, medications are necessary to prevent hyperglycemia (high blood glucose).  There are many different medications available today that help maintain normal blood glucose levels. These medications work via a variety of mechanisms to lower blood glucose. Some stimulate insulin production by the beta cells of the pancreas, some decrease glucose production in the liver, while others prevent the breakdown of starches into sugars in the intestine.
 
Because of the different mechanisms of action, physicians often prescribe a combination of medications to achieve a more favorable result. A new medication called pramlintide (a synthetic form of the hormone amylin) is now available to treat both type 1 and type 2 diabetics who use insulin. It is administered as an injection, and is highly effective in controlling blood glucose and moderating side effects that often occur with insulin alone.
 
Insulin Therapy
Insulin therapy is the mainstay of type 1 diabetes treatment, and is also used in some cases of type 2 diabetes.  Not so long ago, diabetics had to inject porcine insulin (derived from pigs), which sometimes caused allergic reactions. 
 
Now, recombinant human insulin is the standard treatment, and may be administered in several ways:
 
  • Daily injections
    Patients inject themselves with insulin several times daily, timing the injections to coincide with meals and measurements of blood glucose levels. This is the time-honored way to take insulin, and many patients are used to the routine.
  • Insulin infusion
    In a hospital setting, intravenous infusion of insulin is sometimes used to manage severe hypoglycemia. This is not usually a practical option for self-care.
  • Insulin pump
    The insulin pump has revolutionized insulin therapy for many patients.  It provides a continuous infusion of insulin subcutaneously (under the skin) via a small, unobtrusive, wearable pump. The pump is combined with a glucose monitor, which constantly measures blood glucose levels. The pump can therefore adjust insulin delivery to ensure optimal blood glucose levels sustained over time, and eliminate the sharp spikes and downswings in blood glucose that can occur with other treatment methods.

Other Endocrine Care

Other Endocrine Care

The Leslie & Susan Gonda (Goldschmied) Diabetes & Genetic Research Center’s Endocrinology Program is developing an international reputation for excellence in endocrinology research and treatment.
 
Some of the major research initiatives under way in the program include:
 
Endocrine Considerations in Treatment of Non-endocrine Cancers
The Endocrinology Program provides high-quality comprehensive endocrine care for patients undergoing treatment for non-endocrine cancers. Issues addressed include:
 
 
  • Investigation of endocrine complications as a result of chemotherapy, radiation therapy and bone marrow transplant in cancer patients.
  • Management of immunosuppressive therapy-related endocrine complications.
  • Development of clinical practice guidelines for the management of hypothalamic-pituitary endocrine complications after bone marrow transplant.
  • Aggressive prevention and treatment of bone marrow transplant osteoporosis in both men and women.
 

Thyroid Cancer
After thyroid cancer surgery, standard treatment consists of radioiodine to ablate residual tumor cells. However, we have been exploring methods of augmenting or supplanting this therapy. Initiatives include:
 
 
  • Continued clinical research in thyroid cancer exploring new diagnostic and therapeutic alternatives to radioactive iodine therapy
  • Providing compassionate use of recombinant human thyroid stimulating hormone (Thyrogen) for thyroid cancer therapy

     
Neuroendocrine Tumors (carcinoids, pancreatic endocrine tumors, etc.)
These tumors present a significant challenge both at diagnosis and in treatment. Research efforts include:
 
 
  • Advancing the management of neuroendocrine tumors with the use of radioactive iodine MIBG
     
 
Male and Female Sexual Dysfunction (primary and secondary)
 
  • Management of male and female sexual dysfunction in premature gonadal/ovarian failure patients
  • Clinical research in male sexual dysfunction in patients with cancer and diabetes
 

History

Diabetes Program History

The diabetes scientists at City of Hope have made several landmark contributions to the field of diabetes research and care over the years:
 
 
  • In the 1940s, the late Rachmiel Levine, M.D.,  described the role of insulin in mediating glucose entry into the cell and discovered that the pathophysiological basis for type 2 diabetes was related to a defect in this glucose transport mechanism, a condition termed "insulin resistance."
 
  • In the late 1960s, Samuel Rahbar, M.D., Ph.D., recognized the utility of hemoglobin-A1c measurement as a marker for blood glucose control in the diabetic individual.
 
  • In 1978, Arthur Riggs, Ph.D., and Keiichi Itakura, Ph.D., genetically engineered bacteria to produce unlimited quantities of synthetic human insulin (now called Humulin).
 
 
Landmark Achievements Continue
Today, exciting research continues at City of Hope's Diabetes Research Center, where physicians and scientists are exploring a variety of new investigational treatment approaches.
 
Since the inception of the Leslie and Susan Gonda (Goldschmied) Diabetes and Genetic Building in June 1997, the Department has evolved significantly in basic science research, clinical investigations and clinical care. Most notably, was the establishment of the National Institutes of Health-funded Southern California Islet Cell Resources (SC-ICR) Center, an islet isolation and distribution facility program to support clinical transplantation and basic science research throughout Southern California and beyond. Other significant advances are being made in the areas of islet generation, immune tolerance induction, molecular mechanisms of diabetes complications, as well as new treatments for diabetes complications, endocrine cancers and supportive care for patients with non-endocrine tumors.
 
Physicians and researchers are working hard to continue the legacy of their predecessors by exploring a variety of new research and therapeutic approaches that could potentially lead to a cure for diabetes and have far-reaching implications in the treatment of many other diseases.
 
 
Milestones in Diabetes Research and Treatment:
 
 
  •     1949: Dr. Rachmiel Levine discovers the metabolic effects of insulin
 
  •     1968: Dr. Samuel Rahbar discovers HgbA1c and its role diabetes management
 
  •     1971: City of Hope establishes the Division of Diabetes
 
  •     1978: Drs. Arthur Riggs and Keiichi Itakura first engineer human insulin in the laboratory
 
  •     1982: Dr. Yoko Fujita-Yamaguchi isolates specific cell proteins that join with insulin and mediate its metabolic effects
 
  •     Late 1980s: City of Hope enchances the Clinical Diabetes Care Program
 
  •     1991: City of Hope establishes the Diabetes Education Program
 
  •     1992: City of Hope establishes the Diabetes & Cardiovascular Risk Reduction Program
 
  •     1993: Drs. Rama Natarajan and Jerry Nadler conduct seminal research dealing with diabetic complications and islet cell dysfunction
 
  •     1993: Inaugural Community Diabetes Symposium held
 
  •     1994: City of Hope establishes the Male Sexual Medicine Program
 
  •     1997: Inauguration of Leslie & Susan Gonda (Goldschmied) Diabetes & Genetic Research Center
 
  •     1997: Dr. Barry Forman identifies molecules that promote fat cell formation and affect insulin resistance in patients with type 2 diabetes
 
  •     2000: Inaugural International Rachmiel Levine Symposium on Diabetes and Obesity Research
 
  •     2001: City of Hope establishes the Southern California Islet Consortium
 
  •     2004: Dr. Fouad Kandeel leads first islet cell transplantation at City of Hope
 
  •    2003-2007: City of Hope's is the first program in the nation to train an endocrinologist as an islet transplant physician under UNOS regulations
 
  •     2011: Expansion of the Gonda Center more than doubles the available scientific space for diabetes research
 

Supportive Care

Diabetes Supportive Care

Our patients are encouraged to take advantage of the Sheri & Les Biller Patient and Family Resource Center, which offers a wide array of support and educational services. Patients and loved ones may work with a coordinated group of social workers, psychiatrists, psychologists, patient navigators and spiritual care providers at the center, as well as participate in programs such as music therapy, meditation and many others.
 
Visit a nurse educator
In the course of just a few days, a person with diabetes makes hundreds of decisions that can lead to improved or lessened diabetes control. Diabetes is unique in that over 90 percent of a person's success in diabetes management is based on how effectively the patient self-manages the disease. With so much responsibility in the hands of the person with diabetes, plenty of support is needed in order to achieve the best possible diabetes control and long-term health. That’s where a nurse educator comes in.
 
City of Hope employs certified diabetes educators who are part of the health care team. Our diabetes educators are also registered nurses whose role is to be a teacher, counselor and coordinator of care for people with diabetes. The diabetes nurse will make sure the patient and, when possible, the patient's family or other support people understand all doctor's orders and the many aspects of the disease. This may include information about medications, how to monitor and interpret blood glucose levels, the importance of exercise, a realistic food plan, dealing with emotions, and when other health team members need to be called upon. Because diabetes is a chronic, progressive and serious disease, support over the long-term is essential to successful management.
 

Education Program

Diabetes Education Program

Research clearly shows that complications of diabetes can, in many cases, be prevented if proper education and treatment are given soon after diagnosis.
 
For this reason, City of Hope's Department of Clinical Diabetes, Endocrinology & Metabolism is dedicated to educating and helping people with diabetes manage and take control of their disease.
 
The adult Diabetes Education Program is accredited by the American Diabetes Association. In the four class series, participants learn:
 
  • Proper diet, exercise and lifestyle changes to help manage diabetes
 
  • Latest advances in diabetes research and treatment
 
  • Information to gain a better understanding of the disease, empowering each person to take control of their disease by learning self-management skills
     
 
For information about the program or to enroll:
You may be referred by your primary care physician or refer yourself by calling City of Hope at 800-826-HOPE (4673).  Contact the City of Hope diabetes nurse educator at 626-256-HOPE (4673), ext. 65640, with any questions and/or to obtain a current schedule of classes.
 

Resources

Diabetes Resources and Supportive Care

Advances in diabetes research and treatment have made it possible for diabetics to live long and comfortable lives. City of Hope believes that all patients should be active participants in their care. We, therefore, offer a number of useful resources to diabetes patients such as educational newsletters and brochures to keep up-to-date on new therapies and other developments, cookbooks to help patients prepare enjoyable and nutritious meals, and a supportive care program that encompasses medical, psychological, social and spiritual needs of diabetes patients. 
 
City of Hope’s Cookbooks
Each year, the Department of Diabetes, Endocrinology & Metabolism at City of Hope compiles a mouth-watering selection of delicious, healthy recipes tailored to the needs of diabetes patients in its annual cookbook.
 
Click on any link to download a free copy.
 
The best of the best. You'll find the recipes prized the most from the past five years. Try favorites like Chilly Veggie Pizza, Roasted Italian Vegetables, Chicken Piccata and Lemon & Peach Delight.
 
Tempting fare for the holidays or any time, like yummy Spinach Cheese Rolls, delicate Asian Noodle Salad, sumptuous Almond Pork Tenderloin, and delightful Fruit Tartlets.
 
Tiempo de Disfrutar de la Comida
Un libro de recetas para el cuidado de diabetes.
 
Season's Eatings
A holiday cookbook brimming with tasty treats like Turkey Turnovers, Cornish Hens in Cider and Cranberry Chocolate Trifle.

Tiempo de Disfrutar de la Comida
Un libro de recetas para el cuidado de la diabetes y su salud.

Diabetes Outlook
A mouthwatering array of diabetes-friendly recipes including Broccoli & Almond Salad, Chicken Tikka Kebobs, and Tiramisu.

Season's Eatings
An excellent recipe selection including these flavorful dishes: Fresh Orange, Turkey and Pasta Salad; Cranberry Apple Bread; Turkey Divan Casserole and Strawberry Parfait.
 
Holiday Delights
A delicious selection of recipes for diabetes management including Filo Cheese Triangles, Shrimp Quesadillas and Tofu Basil Pesto.
 

Professional Education

Diabetes Professional Education

City of Hope’s Department of Clinical Diabetes, Endocrinology & Metabolism continues to produce breakthrough research that has substantially improved the lives of patients with diabetes and other endocrine disorders.
 
An important commitment of the department is to provide state-of-the-art training for physicians wishing to specialize in endocrinology. To that end, the department offers the Endocrine Fellowship Program in association with Harbor-UCLA Medical Center. Fellows receive rigorous training in all aspects of endocrinology, with heavy emphasis on new therapeutic directions in diabetes treatment and exploration of a wide variety of endocrine cancers.
 
 

Diabetes Basic Science Research

Diabetes Basic Science Research

Basic science research in biochemistry and immunology provides the foundation that drives the development of new therapies for diabetes and other endocrine diseases. The Division of Developmental & Translational Diabetes and Endocrine Research and the Division of Molecular Diabetes Research are conducting a number of important basic science research programs, including those described below:
 
Heart and kidney complications of diabetes
Diabetes is the leading cause of kidney failure and a significant risk factor for the development of coronary disease. In fact, heart disease is the No. 1 cause of death in people with diabetes and accounts for nearly half of all diabetes-related deaths. Our researchers are studying mechanisms of atherosclerosis and kidney disease in diabetic animal models and humans. The focus of this research is to develop protective strategies for preventing and reversing these complications.
 
Controlling complications
One mechanism for the development of diabetes complications is the changes in protein and fat structure of body tissues as a result of increased attachment of glucose to these tissue structures, a process known scientifically as the formation of advanced glycation endproducts, or "AGEs." AGE formation has also been found to accelerate the aging process and may contribute to the development of Alzheimer's disease. City of Hope researchers have developed novel compounds that inhibit glycation and AGE formation and are currently testing their safety and effectiveness in preventing diabetes complications and delaying the tissue aging process. Some of these compounds can also break existing AGEs and could therefore potentially reverse existing tissue damage induced by diabetes. 
 
New molecular discoveries
City of Hope researchers have discovered the molecular mechanisms underlying the body's main method of metabolizing and destroying cholesterol. This research may open the door for new drug therapies for patients with abnormally high cholesterol levels, atherosclerosis and diabetes. These researchers also discovered a fat-derived hormone called androstanol that reverses or halts gene activity in the cell nucleus. The discovery of androstanol is expected to transform our current understanding of metabolic diseases and aid the development of future therapies.
 
Current research programs performed by scientists in the Division of Developmental & Translational Diabetes and Endocrine Research and the Division of Molecular Diabetes Research:
 
Ismail Al-Abdullah, Ph.D.: Islet cell isolation.
 
Sanjay Awasthi, M.D.: Diabetes and cancer.
 
Kevin Ferreri, Ph.D.: Islet cell transplantation, epigenetics, and diabetic biomarkers.
 
Wendong Huang, Ph.D.: Genetic and epigenetic regulation of diabetes. Stem cell and drug development for diabetes.
 
Janice Huss, Ph.D.: Characterization of transcriptional mechanisms regulating skeletal muscle metabolic adaptations during growth and differentiation and in response to physiologic stress, and the etiologic role of orphan nuclear receptors in obesity and type 2 diabetes.
 
Fouad R. Kandeel, M.D., Ph.D.: Islet cell transplantation.
 
Hsun Teresa Ku, Ph.D.: In vitro differentiation of human and mouse embryonic stem cells towards pancreatic lineage cells. Identification, purification and characterization of embryonic and adult pancreatic stem/progenitor cells.
 
Chih-Pin Liu, Ph.D.: Development of methods to induce immune tolerance.Identification of novel cellular and molecular targets to improve cell-based therapy for diabetes.
 
Yoko Mullen, M.D., Ph.D.: Extrahepatic islet transplantation. Prevention of islet loss for transplantation.
 
Rama Natarajan, Ph.D.: Identification of the molecular mechanisms underlying the accelerated cardiovascular and renal disease observed in diabetic patients, role of epigenetics and microRNAs, and inflammatory responses in islet destruction.
 
Ivan Todorov, Ph.D.: Islet cell proliferation, differentiation and cryopreservation. Aging in the human pancreas.
 
Defu Zeng, M.D.: Induction of immune tolerance towards transplanted islets.

 

 

Research/Clinical Trials

Diabetes Research and Clinical Trials

City of Hope has promoted an aggressive program of pioneering research in all aspects of endocrine diseases, from decoding their genetic and molecular underpinnings to developing pharmaceutical and biological-based therapies for their management. Management of these diseases encompasses a myriad of considerations. Leading-edge techniques such as islet cell transplantation may one day result in a cure for type 1 diabetes. But until a cure is found, optimal therapies must be found to keep the disease in check. Type 2 diabetes is prevalent in the United States, and islet cell transplantation is not a solution because type 2 diabetes is not insulin dependent. Therefore, research centers on drug therapies to both control diabetes itself and prevent its attendant complications such as heart disease, stroke, limb amputations and blindness.
 
Promising research is also taking place in non-diabetic endocrine disorders. Thyroid cancer rates continue to rise, perhaps due to environmental factors. While most types of thyroid cancer are treatable surgically, diligent follow-up is necessary to prevent recurrence. New methods of destroying residual thyroid tissue after surgery such as Thyrogen (thyrotropin) are thus being tested. Neuroendocrine tumors such as carcinoids and pheochromocytoma are also being treated with new investigational therapies.
 
City of Hope’s multidisciplinary team of basic science and clinical researchers consistently strives to develop novel and effective therapies to better the lives of patients with diabetes and other endocrine disorders.

Diabetes Clinical Research

Diabetes Clinical Research

At City of Hope, our mission is always to ensure that advances in basic science research are rapidly translated to clinical settings so patients benefit from novel therapies. The Department of Clinical Diabetes, Endocrinology & Metabolism is conducting a number of important clinical research programs, including those described below:

 

Glucose testing devices
City of Hope physicians are using state-of-the-art technologies (such as the glucose sensor, a subcutaneous device that provides continuous readings of blood glucose over three days) to study the blood glucose profiles of patients. Information gained from these studies can be used to develop proper drug treatment regimens and improve diabetes control.

 

Diabetes prevention trial
City of Hope physicians are conducting a research study to better understand type 1 diabetes and its onset in the relatives of patients with the disease. Recent studies have shown that type 1 diabetes may be caused by the destruction of islet cells in the pancreas as a result of an allergic-type reaction in which the immune system “attacks” islet cells through an islet cell antibody. Other studies also show that the tendency to have type 1 diabetes is inherited.

 

Treatment of malignant pheochromocytoma with radiation
Pheochromocytomas are rare tumors of the adrenal gland that produce large amounts of catecholamines (adrenaline and related chemicals). Preferably the tumor is removed with surgery, however, this may not be successful if the tumor has spread from the adrenal gland. In these cases, patients are treated with chemotherapy or exposure to a radioactive chemical. City of Hope physicians are evaluating the effectiveness of using a radioactive metaiodobenzylguanidine (MIBG) to treat patients with malignant pheochromocytoma, which may reduce the patient’s need for antihypertensive medication and reduce the size of their tumors.

 

 

Use of Thyrogen to detect and treat thyroid cancer
 
Detection
Thyroid cancer is usually managed with surgery or radioactive treatment with iodine-131. Often after surgery, patients are given thyroid hormone treatment replacement medication and take radioactive iodine scanning tests to detect the return of the disease. Currently, patients must stop taking thyroid hormone treatment replacement medication before the radioactive iodine scans are performed, but this often causes physical and emotional discomfort. City of Hope physicians are providing patients with a drug called Thyrogen (thyrotropin) to those who require radioactive iodine scanning, without having to stop their thyroid hormone treatment replacement medication.

 

Treatment
Thyrogen is approved by the FDA as part of the actual treatment of thyroid cancer. After surgical removal of the thyroid (thyroidectomy), standard treatment consists of administering radioiodine to ablate, or destroy, remnants of thyroid tissue. Thyrogen is then administered in combination with radioiodine to improve ablation of residual thyroid tissue, thus providing an important tool in preventing disease recurrence.

 

 

Clinical Research Programs
 
Neuropathy therapies
City of Hope physicians are participating in several national trials for use of new pharmacological agents in treatment of diabetic peripheral neuropathy, a common and distressing long-term diabetes complication.
 

Diabetes, Endocrinology & Metabolism Team

Diabetes, Endocrinology & Metabolism Team

Support This Program

Support this program

It takes the help of a lot of caring people to make hope a reality for our patients.  City of Hope was founded by individuals’ philanthropic efforts 100 years ago. Their efforts — and those of our supporters today — have built the foundation for the care we provide and the research we conduct. It enables City of Hope to strive for new breakthroughs and better therapies, ultimately helping more people enjoy longer, better lives.

For more information on supporting this specific program, please contact our Donor Relations Department at 800-667-5310 or developmentrelations@coh.org. Or, to make a gift that supports all the research at City of Hope, donate online now.
 
We thank you for your support.
 
 
 
Our Programs and Treatments

City of Hope is a national leader in cancer treatment and prevention. Read more...

Our treatment facilities are located throughout our 100+ acre grounds in Duarte, California as well as in  Antelope Valley, South Pasadena, Santa Clarita and Palm Springs.
City of Hope combines compassionate care with the best and most innovative science. Our 100+ acre campus is designed to meet the full range of needs of our patients and families. This guide is designed to help you take advantage of all that is offered at City of Hope - Duarte.
Clinical Trials
Our aggressive pursuit to discover better ways to help patients now – not years from now – places us among the leaders worldwide in the administration of clinical trials.
 
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