Diabetes Research

The Caribbean region has a particularly high prevalence of type 2 diabetes, for reasons that are not entirely understood. Genetics, diet quality, and physical activity have all been suggested as playing a role in the development of type 2 diabetes. Understanding these mechanisms has important implications for preventing the onset of diabetes and facilitating more effective and specific therapies.

Prevention Through Change

Using Lifestyle Intervention and Metformin Escalation (LIME) to Reduce Diabetes PRevalence

LIME is an evidence-based intervention that seeks to decrease the number of people who develop diabetes. The intervention involves two components: lifestyle intervention workshops and metformin escalation. The workshops are based on the Chronic Disease Self-Management Curriculum and focus on diabetes prevention, healthy eating, and increasing physical activity. Our trainers provide practical information, like how to make traditional foods healthy and how to estimate portion size.

LIME is also an implementation science study, with the research team engaging stakeholders, site teams, and study participants throughout the process of designing, implementing, and evaluating the intervention. These partnerships help ensure that the intervention is culturally appropriate, relevant, and sensitive to our Caribbean and Caribbean-descent populations. Research team members, led by Dr. Saria Hassan, work at four intervention sites in Barbados, Puerto Rico, Trinidad & Tobago, and the U.S. Virgin Islands.

Improving Risk Prediction

Identifying Behavioral, Metabolomic, and Microbial Biomarkers for type 2 diabetes

This project, led by Dr. Tore Eid, uses metabolomics and machine learning analyses to examine novel biological markers and dietary components associated with type 2 diabetes status. Using biological samples collected as part of the ECHORN biorepository, 2 studies are underway. First, a cross sectional analysis of serum samples from Wave 1 (2013-2018) of the ECHORN Cohort Study will be used to identify amino acid biomarkers of type 2 diabetes. Second, using Wave 1 and Wave 2 serum samples, we will look at the development of type 2 diabetes among a subset of participants who were normoglycemic or pre-diabetic at Wave 1.

Our central hypothesis for both studies is that novel genomic, metabolomic, and dietary risk profiles – in combination – will predict the development of T2D earlier and more accurately than existing clinical markers. This precision medicine approach can help improve risk prediction for type 2 diabetes in Caribbean populations.

Missing Metformin

Genetic Variants and Metformin Response for Patients with Type 2 Diabetes

Metformin is the first choice of prescription drug for people newly diagnosed with Type-2 diabetes. The medication lowers most patients’ blood sugar levels by acting on the way the body handles insulin. Because of the medication’s effects on the gastric system, many patients do not adhere to the prescribed regimen. Further, there are people who do not experience any benefit from metformin on blood sugar levels, even at maximal doses. Dr. Yuri Clement is leading a study exploring whether polymorphisms — or genetic variants — contribute to people’s clinical responses to metformin. The study team is recruiting participants from primary care health facilities in Trinidad. The findings will be used to advocate for early, active, patient-centered care, especially for people who are at risk for long-term complications from diabetes.

This study was funded through the Yale-TCC pilot project program, which facilitates the translation of precision medicine approaches to real-world settings. Precision medicine is an approach for disease treatment and prevention that takes into account individual variability in genes, environment, and lifestyle for groups of individuals. ECHORN and Yale-TCC support research that utilizes precision medicine to inform the early detection and primary prevention of hypertension and type 2 diabetes in African-descent and Caribbean-descent populations. These projects have clear implications for changes in clinical and public health practice.