It's tough being a teenager. You need discipline to handle things like getting up in the morning, keeping track of your schedule, and remembering to brush your teeth. Consider for a moment how tough it would be if you were a teenager with type 1 diabetes. Not only would you have to remember to get out of bed, you'd have to take blood glucose level readings several times a day, give yourself insulin, and figure out just how much sugar was in that piece of chocolate cake.
These are the challenges that made Justin Altschuler '06 want to work with Kevin Curtis, an emergency medicine physician and researcher at Dartmouth-Hitchcock Medical Center (DHMC). Their project involves a novel clinical trial involving diabetic adolescents at DHMC in Lebanon and at the Hitchcock Clinic in Manchester, N.H. The hope is that a simple substance, cinnamon, might improve blood sugar control.
While type 2 diabetes is in the news, it is type 1 diabetes that poses the greatest risk to young people.
"Type 1 diabetes is caused by an autoimmune response that destroys the cells in the pancreas that manufacture insulin," says Altschuler. "If you think about how it affects adolescents, who have so many issues anyway, and you throw on top of that a chronic illness, things can get very bad." Even normal adolescents will stay out late and do other things to prove their independence, he explains. But diabetic adolescents might refuse to take their insulin because they want to show their parents they're in control. "That's why it's exciting to think there might be a single pill that could be helpful," he says.
But why cinnamon? "A variety of studies have tried to sort out the basic mechanism," says Altschuler. "One study looked at cinnamon in adult, type 2 diabetics," explains Curtis. "It showed that various doses of cinnamon had a beneficial effect on blood sugar." The distinction between type 1 and type 2 diabetes is important, he adds, because the underlying mechanism is different. While type 2 diabetics exhibit increasing resistance to insulin, type 1 diabetics lack what's known as "endogenous insulin." Complications are a function of glucose control for all diabetics, notes Curtis. "Wouldn't it be nice," he says, "if a relatively inexpensive and safe therapy could markedly increase that control?"
It's unusual for an undergraduate to collaborate with a physician on planning and conducting a clinical trial. But Altschuler says, "I've found people here who have put a lot of trust in me. Those people exist at other places but I think they exist in a higher concentration at Dartmouth."
Altschuler, a former Presidential Scholar, is now devoting his last three terms at Dartmouth to the trial as a Senior Fellow.
"You have times of clarity," he says, "when you know what you're doing is the thing you're supposed to be doing and that's what medicine is for me." Pausing for a moment of reflection, he adds, "And you do all this to help others. I like taking care of people—being around them when they need help."
Altschuler's inspiration came in part from Bio 81, a new course in clinical biomedical research designed by Curtis for upperclass undergraduate students interested in medical school. Bio 81 involves faculty from the departments of surgery, neurology, medicine, biostatistics, and emergency medicine. It combines a didactic component, development of individual mock studies, and education and experience with the ethical issues surrounding actual studies. "One of the focuses of the course is for students to develop their own mock studies," Curtis says. "Justin's work was so good that we went further and put together the real thing." In this case, that means what Curtis calls the "gold standard": a randomized, double-blind, placebo-controlled trial.
Curtis has plenty of other things to keep him busy. He's in the midst of conducting six clinical trials, heads emergency medicine research at DHMC, and has previously performed basic science research on brain resuscitation after cardiac arrest. Yet it is teaching, he says, that brings him the greatest reward.
"Dartmouth students will be our future leaders in many fields, including science and medicine," he told Dartmouth Medicine magazine. "If I can play even a small role in shaping their careers, it is an honor."
By LAUREL STAVIS
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Last Updated: 5/30/08