By Emily Ford
Salisbury Post
KANNAPOLIS ó A groundbreaking medical study gearing up at the N.C. Research Campus could revolutionize the way doctors care for people with type 2 diabetes.
“This is going to advance our care by light years,” said Dr. Tony Walden of NorthEast Endocrinology.
Walden and five other Kannapolis and Concord physicians who treat patients with diabetes met Tuesday with leaders from the MURDOCK Study, named for campus mastermind David H. Murdock.
Murdock gave Duke University $35 million last year to jumpstart the research, which is expected to have global impact.
For 15 years, Walden has treated people with type 2 diabetes, the kind that develops later in life often related to obesity. The Centers for Disease Control and Prevention has said the staggering increase in type 2 diabetes is a national epidemic.
It’s one of the first diseases that the MURDOCK Study, which stands for Measurement to Understand the Reclassification of Disease Cabarrus/Kannapolis, will tackle.
Walden called the study, and his chance to participate in it, “the gift of a professional lifetime.”
He said the landmark study should infinitely advance the scientific understanding and treatments for type 2 diabetes and the metabolic syndrome.
Informed consent
Duke leaders and doctors met at Restaurant 46 and talked about how to proceed.
Specifically, they discussed how to obtain consent from thousands of local people with type 2 diabetes who might participate in the study by granting access to their medical history. Some would eventually be asked to give a blood sample.
Principle investigator Dr. Geoff Ginsburg emphasized that Duke wants not only consent but “truly informed consent” from patients. The consent process must adequately educate patients before they agree to participate, Duke leaders said.
“We must address the integrity of patient data,” Ginsburg said.
During upcoming small group workshops, local doctors and nurses plus Duke representatives will determine how to best obtain informed consent, as well as how researchers will reach out to the community.
While clinical trials are still years away, the study will involve patients and physicians within a few months. “It’s a great opportunity,” said Dr. Craig Speiser of NorthEast Endocrinology. “I’m looking forward to learning more.”
Preventing disease
Using a relatively new science called genomics, MURDOCK investigators hope to individualize medicine. If they succeed, doctors will have new genetic tests that can accurately predict which patients will develop type 2 diabetes.
“Which for me would be a tremendous benefit,” Walden said.
Doctors could then help patients prevent the disease with lifestyle changes like diet and exercise, as well as medication.
Today, doctors don’t know who will develop type 2 diabetes, or who might suffer severe complications including eye and kidney disease and even stroke.
The MURDOCK Study could change all that.
“By doing the very specific population studies that Duke will do using genomics and metabolomics, this problem will be clarified,” Walden said. “We will know which patients are likely to develop complications of this type.”
Armed with test results based on a patient’s own genetic profile, doctors could choose treatments more effectively, enabling them to better predict how a patient will respond to certain medications.
Duke investigators said the the local medical community has received them enthusiastically.
“They don’t want to be left out,” said Victoria Christian of the Duke Translational Research Institute, which will open a temporary office in downtown Kannapolis in February.
Murdock will build a permanent home for Duke on the N.C. Research Campus.
Christian expects 40 local physicians to become involved in the study. Doctors want a figurative “M” on their front door, announcing their participation in MURDOCK, she said.
“There is very high interest,” said Dr. Jeanette McCarthy, the faculty leader of the study’s first phase. “They are very motivated.”
But physicians clearly expect Duke to keep them informed of developments as the study progresses.
“When you have that ‘M’ stamp on your practice, you should be in the loop,” said Dr. Mark Robinson of Cabarrus Family Medicine.
The Duke team said communication and collaboration with local physicians are paramount. Christian said she even hopes to see a peer review paper co-authored by Duke investigators and local physicians published within a year.
Patient database
Concord and Kannapolis already have a patient database that investigators could tap into, if those patients give consent. Local physicians have been following about 7,000 diabetics who are part of a disease management program.
“So we already have a good idea of who might be good participants,” said Dr. Harold Thomas of Kannapolis Internal Medicine.
Physicians themselves will not conduct the research, Ginsburg said. MURDOCK investigators will have a presence in local clinics, which will be compensated for their space and time on a per-subject basis.
A timeline and study plan for Horizon 1, the first phase of the MURDOCK Study, will be ready by the end of the month, Christian said.
Research has already started. Three months, investigators for the first time ever began applying molecular tools to tissue and blood samples that have been stored at Duke for decades, said McCarthy, the faculty leader.
This research will help produce the questions that the MURDOCK Study hopes to answer.
Hispanics and diabetes
Dr. Leonor Corsino, an endocrinology fellow at Duke University Medical Center, was excited to hear at Tuesday’s meeting that Hispanic patient populations are skyrocketing in Kannapolis and Concord.
Corsino specializes in type 2 diabetes in Hispanics. She is trying to find a genetic reason for the kidney and eye diseases that often plague diabetics, especially among the Latino population.
“Hispanics are affected at two times the normal rate, so any improvement would decrease the huge burden of diabetes,” she said.
The Duke team will include dozens of people like Corsino who will work on the MURDOCK for years to come.
Murdock himself will meet many of them this month.
Christian is planning to bring the nine leading investigators to town in a few weeks to present the Horizon 1 study plan to Murdock and his science adviser, Dr. Andrew Conrad.
A small busload of statisticians, bioinformaticians and others will accompany them.
After Murdock and Conrad sign off, Duke will release the study plan and timeline to the public.
While local patients will benefit first from results of the MURDOCK Study, people around the globe who suffer from diabetes also stand to gain, Walden said.
“Many in the United States and in the Southeast will benefit, not just Cabarrus County and Kannapolis,” he said. “This research will be beneficial to the best understanding of type 2 diabetes to help patients worldwide.”
Other physicians who attended Tuesday’s meeting included Dr. James Holt of NorthEast Endocrinology and Dr. Thea Pfiefer of NorthEast Pediatric Endocrinology.
Contact Emily Ford at eford@salisburypost.com.