Two teams from Duke Medicine and its Center for Personalized Medicine have won research funding from the US Air Force Medical Support Agency for efforts to explore the use of personalized treatment and prevention strategies in the fight against diabetes and heart disease, two of the most widespread and chronic illnesses facing society today. With $3.2 million in Air Force funding, the Duke teams will conduct the research in primary care clinics at California's Travis and McClellan Air Force Bases.
“The forward thinking of the Air Force in advancing personalized medicine in the care of our military personnel and their families is what drives us to partner with them,” said Dr. Geoff Ginsburg, executive director of the Center for Personalized Medicine and of genomic medicine at the Duke Institute for Genome Sciences & Policy (IGSP). “This Air Force program gives our strategy, focused on implementation and outcomes research, a significant boost.”
The grant is part of Cooperative Agreement Award #FA8650-13-2-6374 and will be used for research by Duke University School of Nursing and IGSP.
In one study, researchers will ask whether knowledge of genetic risks for type 2 diabetes and coronary heart disease together with health coaching will help active duty Air Force personnel and their families make positive changes in diet and exercise. The second study will explore whether the use of pharmacogenetic testing for statins in treating high cholesterol results with fewer side effects. Both studies focus on personalized approaches to medicine with each patient’s genetic information informing treatment and approach to managing these chronic illnesses.
“Many people want to change habits to lower their risk of diseases like diabetes and heart disease, but they aren’t always successful with a one-size fits all approach. We want to see if people will make real changes in their health habits when they know about their own risk, both genetic and standard risk factors, and have one-on-one assistance in implementing those changes in health coaching,” said Dr. Allison Vorderstrasse, a researcher at Duke University School of Nursing.
The researchers will recruit 400 patients from Air Force health clinics and divide them into four groups. One group will receive the standard risk assessment only. The second will receive genetic testing in addition to the standard assessment. The third group will receive health coaching along with the assessment, and the fourth one will have all three. For each patient, researchers will monitor changes in diet and exercise as well as fitness levels, glucose, blood pressure, and body mass index to determine which method results in the greatest impact on the participants’ health.
Dr. Ruth Wolever, who joins Vorderstrasse on the study, said health coaching combined with genetic testing could prove to be an effective combination.
“Health coaches focus on mind, body, and spirit and helps clients make changes that support a healthier lifestyle as well as encouraging insight and clarity through inquiry and personal discovery,” said Dr. Wolever.
In the second effort, Dr. Deepak Voora and colleagues from the IGSP will explore how to help patients adhere to their prescriptions for high cholesterol, a condition that can lead to heart disease and stroke. For many patients, cholesterol-lowering medications called statins are a first-line of defense and prevent cardiovascular disease. However, recent evidence shows that more than 40 percent of patients stop filling their statin prescriptions within a year, leaving them at higher risk for hospitalizations, increased health care costs, and premature death. A common reason for discontinuing statin use is muscle pain, which can be severe.
Dr. Voora and others found that people experiencing such side effects of statins often carry a particular gene variant and better tolerate other drugs. His team will ask whether testing patients for this gene and writing prescriptions accordingly can help keep people on their medications and improve outcomes for patients with prior side effects.
“Keeping patients taking what can be life-saving drugs is an ongoing issue for many health care providers,” Dr. Voora said. "If we can show that a patient’s genes can help in finding the optimal cholesterol-lowering drug, we can make a real impact in the lives and health of millions of people."
Diabetes, high cholesterol, and coronary heart disease are each widespread, affecting millions of Americans every year, and costing tens of millions in related health care costs. The Centers for Disease Control report that heart disease is the leading cause of death for both men and women and causes 600,000 deaths every year. That adds up to one in every four deaths caused by heart disease. Currently, nearly 26 million Americans have diabetes and the numbers continue to increase. The CDC estimates that as many as 1 in 3 US adults could have diabetes by 2050 if current trends continue. Likewise 71 million American adults have high LDL or “bad” cholesterol and 2 out of every 3 adults with high LDL do not have the condition under control.