A University of Alabama at Birmingham medical student engaged in a summer fellowship discovered a previously uncategorized sub-group of patients with type 2 diabetes that might bring about changes in clinical practice. The findings, published online in February in Diabetes Care, a journal of the American Diabetes Association, suggest that physicians will need to be on the lookout for patients presenting with the characteristics of the new subgroup.
In 2012, during the summer between her first and second years of medical school, Leah Strickland did a research fellowship through a diabetes research training grant at UAB. She compared 10 women with Type 2 diabetes who had a condition known as partial lipodystrophy of the limbs (PLL) against a control group of 10 women with diabetes without lipodystrophy.
Lipodystrophy refers to the loss of subcutaneous adipose tissue, or fat beneath the skin. It has been identified in diabetic patients before and is usually seen in the torso. Strickland’s research showed that there was a distinct group of woman who had Type 2 diabetes, PLL, no family history of lipodystrophy and a marked increase in insulin resistance and triglyceride levels.
“These patients did not fit in any of the described categories,” said Strickland. “They had acquired fat loss in their arms and legs but not in their torsos. They had no family history of lipodystrophy, which was unusual. It was really a new pattern.”
Strickland and her faculty mentor on the project, W. Timothy Garvey, M.D., professor and chair of the Department of Nutrition Sciences, believe the subgroup is uncommon; about one in 1,000 patients with Type 2 diabetes will likely be affected.
“This previously unrecognized subgroup of diabetic patients should lead to a change in clinical practice,” said Garvey. “They are extremely insulin resistant. They are likely to have abnormal liver tests, indicating fat in the liver. They have high triglycerides. They are a difficult patient group to treat, and physicians will need to begin testing for these variables in their diabetic patients and treat accordingly.”
Strickland presented the findings at a National Institutes of Health Diabetes Network meeting at Vanderbilt University in August of 2012.
‘This is the classic progression of science: recognizing a pattern in clinical observation, conducting the research and finding new knowledge,” said Garvey. “With that knowledge, we gain a better understanding of disease. The more we understand diseases such as diabetes, the more likely we are to develop new treatments, new prevention strategies or possibly a cure.”
Garvey said it was unusual for a medical student to be able to begin a research project and bring it to its conclusion in the short timeframe of a summer internship.
“It was extremely rewarding to be able to participate in the whole range of activities involved in this project, from collecting and analyzing data, to writing the manuscript, presenting the results and then seeing the findings published in a scientific journal,” said Strickland.
Garvey believes students like Strickland embody what an academic medical center is all about.
“We need more of what we call physician-scientists in the practice of medicine, people who are a mix of clinical practitioner and research investigator,” said Garvey. “That is where we will discover new therapies, new treatments and new knowledge.”