TTUHSC El Paso Professor’s Research Could Transform Diabetes Prevention

“Eureka” moments still happen in scientific research.

David P. Cistola, MD, PhD, had his moment in August 2014 when he and his research team discovered a blood biomarker that identifies individuals who could be at risk for Type 2 diabetes and prediabetes.

That discovery could revolutionize how the early changes that lead to diabetes are detected—giving patients the opportunity to make lifestyle modifications or initiate therapies that prevent the disease from developing in the first place.

The biomarker, water T2, is extremely sensitive to changes in metabolic health. As water is the most abundant molecule in blood, water T2 can be measured using a small drop of blood from a finger stick.

People who test positive in conventional glucose screening tests already have Type 2 diabetes or prediabetes. Both conditions are associated with a decline in the pancreas’ capacity to secrete insulin. However, there is an earlier, hidden stage where pancreatic insulin secretion is still adequate and glucose levels remain normal. Water T2 detects this hidden stage.

The water T2 test has parallels with cancer screening, where the goal is to detect individuals in stage 1, rather than stages 2 or 3 after the disease has spread. “Stage 1” in the progression toward Type 2 diabetes is characterized by insulin resistance and chronic inflammation, as well as barely sufficient insulin secretion, said Cistola, TTUHSC El Paso professor and director of the Center of Emphasis in Diabetes and Metabolism. If not corrected, these processes will progress and gradually destroy insulin-producing cells, causing other abnormalities throughout the body that can later become diabetic complications.

The National Institutes of Health (NIH) recently awarded Cistola a two-year, $229,500 grant to validate and expand upon his initial findings, which were published in the Journal of Translational Medicine. The grant will support the validation of water T2 using biobanked samples from subjects who participated in the PREMIER Study, a randomized clinical trial.

The blood samples are being provided by the National Heart, Lung, and Blood Institute, the division of the NIH that awarded the grant.

Cistola’s initial T2 biomarker study involved 72 participants. The validation study, started in August 2018 and currently in progress, will expand the sample size to 810 people, with 4,860 individual samples to be analyzed in TTUHSC El Paso’s lab. The samples were originally collected, frozen and biobanked in the early 2000s as part of the PREMIER study.

The parent study recruited people with mild to moderately elevated blood pressure and then randomly assigned them to three different treatment groups to see which lowered blood pressure

The treatments were diet, physical activity or lifestyle coaching. Pharmaceuticals were not involved.

By testing blood samples from the three intervention groups, Cistola will be able to show how the T2 measurement is affected by different lifestyle changes.

If the water T2 improves with a reduction in insulin resistance and inflammation, then it’s a very powerful tool for monitoring changes in metabolic health, Cistola said.

Cistola is hopeful that one day, thanks to this research, patients can be screened for metabolic health using this simple and rapid test during a routine doctor’s visit.