research

diabetes

summary

Our diabetes research group interacts closely with The Royal Children's Hospital diabetes clinic, which provides primary care for approximately 1500 metropolitan and regional children with Type 1 diabetes.

Our group forms part of the Centre for Hormone Research at the Murdoch Childrens Research Institute and has an active diabetes research program that aims to address the day to day needs of our clinic population and the broader paediatric diabetic community.

In particular, our research efforts over the last five years have focused upon the impact of diabetes upon the developing brain, mental health and quality of life. We have also actively participated in clinical outcome, epidemiologic and pre-diabetes intervention studies.

group leader(s)

Fergus Cameron

Professor Fergus Cameron
Diabetes
Murdoch Childrens Research Institute
Royal Children's Hospital
Flemington Road
Parkville Victoria 3052

T +61 3 9345 6972
F +61 3 9347 7763
E fergus.cameron@rch.org.au

group leader biography

current research projects

Project 1: Investigating the commonest co-morbidity of diabetes - poor mental health outcomes

Evolving around a 15 year neuropsychological follow-up study of newly diagnosed patients, we have used demographic, neurocognitive and behavioural indices, combined with magnetic resonance imaging techniques, to quantify neuropsychological and functional outcomes in patients with Type 1 diabetes. A consistent finding has been the relationship between early severe hypoglycaemic episodes and poor diabetes control and later impairment, particularly higher cortical function. Our laboratory studies have demonstrated gene expression patterns in response to neuronal glucose impairment, as well as in vitro neuroprotective properties of IGF-I during glucose deprivation. The studies have resulted in a number of publications, oral presentations and plenary lectures at both national and international diabetes meetings. We are now at the stage of trialling psychological intervention strategies in both pre-pubertal and adolescent patients.

Project 2: Research into the commonest cause of death- cerebral oedema in the context of diabetes ketoacidosis (DKA)

Diabetic ketoacidosis remains the leading cause of diabetes-related death in Australia and in most developed countries. The main cause of death is cerebral oedema - the mechanisms of which remain unknown. We formed a collaborative effort with Prof. Terrie Inder, an international expert in the biochemistry of brain injury, to try and understand the pathophysiology of cerebral oedema after early tests showed some preliminary data indicating that changes in idiogenic cerebral osmolytes may have a pivotal role. The clinical studies were combined with basic in vitro cell culture work which demonstrated a key role for idiogenic osmols. This is consistent with and supportive of the in vivo MRI/MRS findings.

Project 3: Research into using new diabetes technologies to improve glycaemic stability and lessen the cerebral insult of diabetes.

There is currently significant debate around the importance of glycaemic variation in determining the risk of microvascular pathology and its impact upon neurocognition. In particular the diathesis hypothesis has moved the focus away from only looking at hypoglycaemia as the main contributor of insult to brain ontogeny and hyperglycaemia. Glycaemic variation is now also considered as potentially damaging. We have used the emerging technologies of continuous insulin delivery and glucose sensing to investigate strategies of optimal insulin delivery as a means of specifically reducing glycaemic variation. Some pilot studies in the laboratory are exploring the impact of glucose fluctuations on neuronal survival.

Project 4: INIT II - A clinical study of intranasal insulin (Diabetes Prevention).

Type 1 diabetes is an autoimmune disease. Damage to the insulin producing cells in the pancreas may results in type 1 diabetes. This process is found to begin months to years before the lack of insulin causes symptoms of diabetes. It is possible to check the presence of antibodies in the blood - these antibodies can identify components of the beta-cell autoantigens. The 'pre-clinical" stage provides a window of opportunity for preventing type 1 diabetes. The trial will determine if an intranasal insulin vaccine will stop the immune attack on B cells and prevent diabetes. People who have a positive blood test for antibodies are eligible. We are screening and currently recruiting people from the ages of 4 to 30 years. Participants must have a first-degree relative affected with the condition. All participants will have a 3 monthly hospital follow up for the first year and a 6 monthly follow up, for the following four years.

Project 5: AdDIT (Adolescent Type 1 Diabetes Cardio-Renal Intervention Trial).

AdDIT (Adolescent Type 1 Diabetes Cardio-Renal Intervention Trial) is a large multi-centre, multi-national intervention study looking at the effect of ACE inhibitors and statins in adolescents with Type 1 Diabetes and high albumin excretion. It is funded by Diabetes UK, the JDRF and BHF. If you would like more information about this study at MCRI please contact Nicole Mathewson (9345 5620) or Professor Fergus Cameron (9345 5522).

team members

Claire Bingley - RESEARCH NURSE
Andrew Boucher - RESEARCH AFFILIATE
Mary Boyle - Volunteer
Janine Cooper - RESEARCH ASSISTANT
Anna Crack - RESEARCH AFFILIATE
Michael Crombie - Master of Psychology (UoM Psych)
Clair Cullen - RESEARCH ASSISTANT
Rebecca Gebert - RESEARCH AFFILIATE

Heather Gilbertson - RESEARCH AFFILIATE
Caroline Nadebaum - Research Assistant
Elisabeth Northam - Senior Research Fellow
Michele O'Connell - RESEARCH AFFILIATE
Jennifer Papoutsis - Research Assistant
Shannon Scratch - Research Assistant
Anna Serlachius - Honorary Research Fellow
Mary White - Clinical Research Fellow

publications

Gilbertson HR., Rogers EJ., Ukoumunne OC. Determination of a Practical pH Cutoff Level for Reliable Confirmation of Nasogastric Tube Placement. JOURNAL OF PARENTERAL AND ENTERAL NUTRITION 35 (4) : 540 - 544(2011) PubMed
Jenkins AJ., Krishnamurthy B., Best JD., Cameron FJ., Colman PG., Hamblin PS., O'Connell MA., Rodda C., Teede H., O'Neal DN. An Algorithm Guiding Patient Responses to Real-Time-Continuous Glucose Monitoring Improves Quality of Life. DIABETES TECHNOLOGY & THERAPEUTICS 13 (2) : 105 - 109(2011) PubMed
Knight SJ., Northam EA., Cameron FJ., Ambler GR. Behaviour and metabolic control in children with Type1 diabetes mellitus on insulin pump therapy: 2-year follow-up. Diabetic Medicine 28 (9) : 1109 - 1112(2011) PubMed
O'Connell M., Donath S., Cameron F. Poor adherence to integral daily tasks limits the efficacy of CSII in youth. PEDIATRIC DIABETES 12 (6) : 556 - 559(2011) PubMed
Ponsonby AL., Pezic A., Cochrane J., Cameron FJ., Pascoe M., Kemp A., Dwyer T. Infant anthropometry, early life infection, and subsequent risk of type 1 diabetes mellitus: a prospective birth cohort study. PEDIATRIC DIABETES 12 (4) : 313 - 321(2011) PubMed
Raile K., O'Connell M., Galler A., Werther G., Kuhnen P., Krude H., Blankenstein O. Diabetes caused by insulin gene (INS) deletion: clinical characteristics of homozygous and heterozygous individuals. EUROPEAN JOURNAL OF ENDOCRINOLOGY 165 (2) : 255 - 260(2011) PubMed
Serlachius A., Fydenberg E., Northam E., Cameron F. A Qualitative Study Exploring Coping Strategies in Youth With Type 1 Diabetes. Children Australia 36 (3) : 144 - 152(2011)