A doctor's hand is shown writing the word diabetes on glass

Tackling diabetes locally and globally

K. M. Venkat Narayan, Ruth and O. C. Hubert Professor of Global Health and head of Emory's Global Diabetes Research Center, has studied type 2 diabetes since the early 1990s, when it was considered a disease of adults in affluent countries. Its incidence quadrupled from 1980 to 2014; now 415 million adults worldwide have diabetes.

It accounted for 12 percent of health expenditures in 2010, or at least $376 billion  and is expected to hit $490 billion in 2030.

Good news: the disease is substantially preventable through exercise, a healthy diet, and weight loss. The challenge for Narayan and his fellow researchers is to, as he says, "figure out how to translate and scale up the implementation of that knowledge into population-wide interventions that work. We also need to find ways to improve outcomes for disenfranchised populations."

A new center

Narayan and his team are tackling some of these issues through the newly established Georgia Center for Diabetes Translation Research, which also involves Georgia Institute of Technology and Morehouse School of Medicine.

A key insight comes from Ralph DiClemente and his work at Rollins School of Public Health in HIV prevention. In the case of HIV, simply informing people about their risk was not enough. Instead, says DiClemente, "we have to be able to motivate people to adopt healthy behaviors."

Given that most of us eat three times a day, technologies such as text-messaging apps — which were useful in HIV interventions — are being deployed to fight diabetes. Community strategies provide another layer of support. Coaches at YMCAs, churches, and community groups can be trained to offer diet and exercise interventions.

A new protocol

For those who might be unaware of the effects of the disease on their vision, Yousuf Khalifa  chief of ophthalmology at Grady Memorial Hospital  has initiated a screening program for diabetic retinopathy at four of the hospital's primary care clinics and the diabetes center.

Khalifa's advocacy resulted in a special nonmydriatic camera and new medical record protocol that has paid dividends: Of more than 6,000 patients screened in the past nine months, 3.5 percent had end-stage diabetic retinopathy, more than twice the national average, a condition that results in blindness. These high-risk patients then were made a priority at the heavily trafficked Grady eye clinic.

A new reach in fighting an old foe

With about 75 percent of the burden of diabetes falling to low- and middle-income countries but more than 95 percent of the research being conducted in wealthier ones, Narayan and others are working to build up the research base in places such as India and Pakistan.

The Emory Global Diabetes Research Center is taking a hard look at questions such as: Can interventions successful in the US be useful in poorer countries? Why are thinner people in some countries developing diabetes; is this a different form of the disease? Does it derive from historic undernutrition? If so, early-life interventions could make the difference.

A portrait of Venkat Narayan with students talking

Georgia Diabetes Translation Research Center

With a $2.5 million grant from the National Institute of Diabetes and Digestive and Kidney Disease, the Georgia Diabetes Translation Research Center began work in February 2017, combining expertise from Emory and local partners to close gaps in diabetes detection, prevention, and care.

Read more
Physician Yousuf Khalifa poses at Grady Memorial Hospital

Foreseeing risk of blindness

A new screening program has been implemented in four of Grady Memorial Hospital's primary care clinics to flag patients with diabetic retinopathy. Despite issues related to homelessness, the majority of patients identified through the protocol have followed through with the vision-saving treatment.

Read more
A map shows the country of India

What it will take to defeat diabetes

Even as diabetics in this country are living longer and suffering fewer complications, worldwide the illness is one of the biggest public health threats we face. Emory is putting substantial resources to the fight and finding much room for hope.

Read more
Annual Report