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Joslin 50 - Year Medalist Study

50 - Year Medalist Study Background

Hyperglycemia is a major cause of diabetic vascular and neuropathic complications.  However, a significant number of diabetic patients, known as the Joslin 50-Year Medalists, remain free from various complications such as nephropathy and proliferative retinopathy after 50 years or more of diabetes.

Joslin Diabetes Center’s 50-Year Medal Program recognizes individuals who have lived with insulin-dependent diabetes for 50 or more years to honor their accomplishments in diabetes management.

For the first time, a large number of individuals who have survived fifty or more years with type 1 diabetes are being studied to determine factors, which may allow them to be resistant to the ravaging effects of diabetes. With support from JDRF, the Joslin Diabetes Center in Boston is currently studying Medalists from within the United States in an effort to identify these factors.  We have been characterizing genetic, environmental, psychological and physiological factors, which may contribute to survival with extreme duration of diabetes. The Medalist population provides a unique opportunity to study individuals with extreme duration of diabetes.

In the first phase of the study, which took place seven years ago, we asked Medalists to complete an extensive medical history questionnaire and provide some laboratory data from their doctor.  The results from these questionnaires and lab results provided the very interesting finding that close to 50% appear to have escaped serious complications, which occur in almost all diabetic patients by 30 years of duration.  These complications include eye disease (retinopathy), kidney disease (nephropathy) and nerve disease (neuropathy).  The results showed that as a group, Medalists have controlled their blood glucose levels very well for many years.  In addition, hemoglobin A1c, a measure of chronic glucose control, does not seem to correlate with the various complications described above.  These are very exciting findings which have been published in the journal Diabetes Care in 2007.

In the five years since the start of the second phase of the Joslin 50-Year Medalist study, we have studied approximately 550 Medalists with the support of JDRF. These Medalists traveled to Joslin Diabetes Center in Boston for the study.  We have been examining the status of complications with respect to eye, kidney, nerve and heart function.  Metabolic changes in blood and the ability to produce insulin in the Medalists are also studied.  Genetic studies are underway to determine whether these extraordinary survivors have typical type 1 diabetes or a different, yet unknown type of diabetes.  Data from over 500 people have been analyzed and have led to very exciting discoveries.  These new findings have shown that most Medalists have clinical and laboratory findings consistent with “typical” type 1 diabetes.  This includes genetic factors as well as other clinical characteristics, such as weight, high good cholesterol levels and relatively low body weight. The eye studies, which took pictures of the back of the eye, showed that about 40% of the Medalists do not have serious eye disease even after 50-80 years of type 1 diabetes and less than 10% of the Medalists have any kidney problems.  From a complications point of view, these findings are very exciting since they showed that 40% of the Medalists have factors or genes, which are protecting the Medalists from developing diabetic eye disease.

In addition to the exciting findings regarding diabetic complications, the results from the Medalists have also yielded an unexpected finding regarding pancreatic functions.  Surprisingly, over 66% of Medalists appear to still produce some insulin.  This finding can be important and exciting since it suggests that some type 1 diabetic patients may still make insulin even after 50 years of diabetes.  These findings have been confirmed through metabolic and post-mortem studies of generous Medalists.  This raises the possibility that many type 1 diabetes patients have protection from beta-cell destruction.   While our results so far have been promising more participants are needed to complete the picture of how 50-Year Medalists are able to defy the odds remaining free of complications and retaining some insulin production.

 

 

Page last updated: September 22, 2014