With Native Hawaiian, Pacific Islander and Asian populations facing some of the highest diabetes rates in the nation, the University of Hawaiʻi at 惭腻苍辞补鈥檚 has received a $2.35 million renewal grant from the National Institutes of Health to expand research, strengthen infrastructure and train the next generation of scientists. In its seventh year of funding, the center is part of 东精影业 惭腻苍辞补鈥檚 Centers for Biomedical Research Excellence (COBRE) and continues to focus on tackling this critical public health challenge.

“Diabetes and prediabetes affect nearly half of the U.S. population, and even more so in underserved communities,” said Mariana Gerschenson, professor in the at the (JABSOM), who leads the initiative as principal investigator. “Our goal is to build a sustainable, collaborative center that addresses both the biological mechanisms and health differences associated with diabetes in Hawaiʻi and the Pacific.”

Related 东精影业 News story: $11.7M grant renewal advances diabetes research in Hawaiʻi

Since its inception, the center has played a pivotal role in mentoring seven research leaders and seven pilot investigators. Phase 2 will significantly expand this mission through several key initiatives:

• Investigating diabetic complications: Focused research on complications that occur at higher rates in racial and ethnic minorities.
• Faculty recruitment: Bringing in four new tenure-track faculty members specializing in translational diabetes and insulin resistance research.
• Pipeline development: Supporting pilot projects to cultivate a robust pipeline of future research leaders.
• Community engagement: Strengthening community outreach through an annual symposium and enhanced digital resources.

The renewed award will support key research project leaders, including cell and molecular biology faculty Kathryn Schunke and Michael Ortega, as well as graduate students, postdocs, and the led by Chair Olivier Le Saux.

Innovative research projects

Current research projects at the Diabetic Research Center are exploring innovative solutions and deeper understandings of diabetes, including:

• Developing non-invasive sweat sensors for monitoring complications.
• Studying the genomic links between diabetes and stroke in Native Hawaiians.
• Understanding diabetic autonomic neuropathy using animal models.
• Investigating diabetic renal disease using animal models.

Researchers at the University of Hawaiʻi are working to understand the challenges Native Hawaiian, Pacific Islander, and Filipino adults face in joining prediabetes intervention programs. These groups face higher rates of prediabetes and type 2 diabetes compared to others.

by 东精影业 惭腻苍辞补鈥檚 , in partnership with the Hawaiʻi Department of Health and Hawaiʻi Primary Care Association, looked at the barriers keeping people from joining and staying in these programs.

Why these programs matter

Programs like the National Diabetes Prevention Program Lifestyle Change Program (National DPP LCP) help delay or prevent type 2 diabetes. But many people are hesitant to sign up. Common concerns include time commitments, caregiving duties, and a lack of familiarity with the program.

“Our study gathered insights directly from Native Hawaiian and Filipino adults, who are often left out of research like this,” said lead author Kara Saiki from 东精影业 惭腻苍辞补鈥檚 . “We also highlighted how two rural Hawai驶i programs successfully recruited and retained participants. This can help others better reach these communities.&rdquo

Trusted coaches make a difference

The study found that lifestyle coaches play a key role in encouraging participation. Coaches who are trusted community members provide personalized support and help participants stick with the program.

“Coaches understand the unique challenges our communities face and connect participants to local resources,” said Jermy Domingo, health equity director at the Hawaiʻi Primary Care Association. “Their support makes the program鈥檚 lessons practical and builds trust with participants.”

The bigger picture

The study shows that community-based strategies are essential for improving health and preventing diabetes in underserved groups. By addressing specific challenges and offering personalized support, these programs can better serve Hawaiʻi鈥檚 diverse population.

Changes in lifestyle can help prevent the onset of diabetes and improve overall health. To assist prediabetic island residents make those changes, faculty and students at the University of Hawaiʻi at Hilo (DKICP) are offering a free year-long diabetes prevention program for a second year. Anyone interested can to determine eligibility. Applications will be accepted through April 10, 2023, and space is limited.

The program includes several in-person meetings each month on the 东精影业 Hilo campus, where participants will receive regular health monitoring and personal counseling to assist in making lifestyle changes, achieving weight loss and learning to maintain healthier habits. The first required informational session is April 10, 5–6 p.m., at DKICP in Hale Kihoʻihoʻi, Lecture Hall B.

Practicing pharmacists and DKICP assistant professors, Aryn Meguro and Bryce Fukunaga, will facilitate the program. Both are also lifestyle coaches who are certified through the American Association of Diabetes Educators. The program will include student pharmacists operating the Pacific Island Mobile Health Screening Clinic.

Past participants have said that being part of a cohort and feeling accountable to and supportive of them was a major benefit of this program, and last year鈥檚 cohort of 20 participants lost a total of 278 pounds, explained Meguro.

“Participants said that the connections they formed with each other throughout the year were very valuable, along with the lifestyle coaching and informational support,” she said. “They also ended the program with an overall better understanding of their health, how to make lifestyle improvements, and how to create plans to assure they continue in those healthy habits.”

or email Meguro at arynm@hawaii.edu.

Hawaiʻi has the highest life expectancy at birth, according to the Centers for Disease Control and Prevention. Still, that success is not reflected in Native Hawaiian and other Pacific Islander (NHOPI) populations. State data show NHOPI have seven to 10 years less in life expectancy than other Hawaiʻi residents, and researchers from the University of Hawaiʻi at M膩noa (JABSOM) and other 东精影业 health sciences units are investigating the sources of the disparities and ways to close the gap.

The National Institutes of Health (NIH) awarded researchers a five-year, $22,557,840-million U54 grant to foster research into health disparities and to conduct three large studies to explore genetic, environmental and socio-economic related disparities in health and health-care access for specific communities in Hawaiʻi. Specifically, the studies focus on the long-term impact of COVID-19, the role of exercise with type 2 diabetes and dietary impacts on the Native Hawaiian population.

JABSOM Dean Jerris Hedges and Thompson School of Social Work & Public Health Dean Emeritus Noreen Mokuau serve as multiple principal investigators for Ola HAWAIʻI.

Hedges said, “This grant helps unite 东精影业 and community members seeking to improve health in Hawaiʻi through sound science.”

“Funding from the NIH is the premiere form of health research funding because everything you do for NIH connects back to the larger, national agenda on public health and healthcare,” said Mokuau.

Based at JABSOM, Ola HAWAIʻI (Ola means health or to heal in Hawaiian, and HAWAIʻI stands for Health And Wellness Achieved by Impacting Inequalities) collaborates with community and 东精影业 M膩noa partners. Ola HAWAIʻI investigators seek to close the health and longevity gap between NHOPI and the rest of Hawaiʻi‘s population through biomedical, behavioral and clinical research.

“It’s about seeding ideas that best benefit the people of Hawaiʻi, in areas such as cardiovascular health, diabetes and COVID-19,” Mokuau added. “The John A. Burns School of Medicine is the essential leader in the state of Hawaiʻi for health, in general, and in reducing health care disparities in particular. Ola HAWAIʻI‘s work focuses on the kinds of research that help us find new interventions and treatments to support underserved populations who sometimes have less direct access to health care.”

“As we conduct research that will lead to interventions which help people, at some point, we begin to extend and enhance lives. That’s what this is about.”

The three projects part of the grant include:

Exercise, Exosomes & Metabolic Health in Type-2 Diabetes

Native Hawaiians and other Pacific Islanders are disproportionately affected by type 2 diabetes. While exercise can successfully reduce the risk of developing type 2 diabetes, the exercise benefits for the NHOPI population are not as significant when compared to Whites. This study will investigate the role that nano-sized sacs play in lowering the risk of diabetes while identifying exercise and lifestyle guidelines that could be tailored for the NHOPI population. Noemi Polgar, Nicholas James and Scott Ferguson are the principal investigators.

MALAMA: Backyard Aquaponics to Promote Healthy Eating & Reduce Cardiometabolic Risk

Native Hawaiians have the highest mortality rates of cardiometabolic diseases, like heart disease and diabetes. Researchers are testing the efficacy of MALAMA, a culturally-grounded, family-centered backyard aquaponics program that’s planted in multiple Native Hawaiian communities. The goal is to reduce food insecurity, while increasing the consumption of healthy foods, which could lower the risk of cardiometabolic diseases in the Native Hawaiian population. Jane Chung-Do and Heidi Ilima Ho-Lastimosa are the principal investigators.

Factors Responsible for the Development of Post-Acute Sequelae of Acute COVID Infection in Hawaiʻi

Nearly a third of people who recover from acute COVID-19 will have what’s known as long-COVID. Many of those with long-COVID also have pulmonary problems like persistent cough and labored breathing. Researchers are investigating the change in the body’s function that causes disease, and how social and psychological situations could contribute to long-term outcomes, particularly for Native Hawaiians and other Pacific Islanders and Filipinos. Gehan Devendra and Juwon Park are the principal investigators.

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University of Hawaiʻi at M膩noa Native Hawaiian biomedical researcher Alika Maunakea of the (JABSOM) is leading a new study involving a diverse multidisciplinary collaboration probing the socioecological determinants of diabetes risks in Native Hawaiians and Pacific Islanders (NHPI) in Hawaiʻi. The National Institutes of Health awarded the study a five-year, $3.3 million grant in response to the National Institute on Minority Health and Health Disparities “Social Epigenomics” R01 funding opportunity announcement.

Appearing as early as the age of 35 on average, NHPI minorities suffer from Type-2 diabetes mellitus鈥攎ore than in any other racial or ethnic populations in Hawaiʻi. Although social determinants of health such as socioeconomic status are implicated in contributing to this increased prevalence at the population-level, little is known about the underlying biological mechanisms that determine how these adverse social factors might influence the risk of developing diabetes at the individual-level. This public impact research is seeking to fill these gaps in knowledge.

Although recent advances in medicine allow for more accurate diagnoses of diabetes, early detection and risk assessment remains very limited. “Identifying the cell and molecular changes that occur as a result of social factors that precede diabetes will be a game changer—allowing us to predict how soon an individual might be developing diabetes before the disease manifests. This work is part of the future of personalized medicine,” Maunakea said.

The study “Socioecological Determinants of Immunoepigenetic Signatures of Diabetes Risk in Indigenous Communities,” involves a multidisciplinary team of scientists from JABSOM, (东精影业ERO), , University of California San Francisco and Rutgers University.

First study of its kind

“This study has many firsts,” said Maunakea, an associate professor in the . “It will be the first study to examine the relationship between immune cell epigenetics and the gut microbiome; it is the first to gather cell and molecular data relevant to diabetes in a social network setting; and it is the first epigenome and microbiome study to engage a relatively young group of individuals in the Native Hawaiian and Pacific Islander population. We hope this study will be the first of many that will help us move the dial back against diabetes and establish health equity in our culturally rich communities, which must start by enabling prevention.”

“Our preliminary data from previous studies has shown that NHPIs who changed certain social or lifestyle factors, such as diet and health behaviors, also experienced significant improvements to their health at the molecular level,” said Ruben Juarez, a professor in economics and social networks expert at 东精影业ERO. “The interaction between these social factors and biological processes will be examined to understand their collective impact on diabetes risk.”

JABSOM Dean Jerris Hedges added, “This project highlights the role of high-impact team science at the University of Hawaiʻi addressing the needs of Native Hawaiian and Pacific Islander communities that are among the most affected by diabetes.”

This research is an example of 东精影业 惭腻苍辞补鈥檚 goal of (PDF), one of four goals identified in the (PDF), updated in December 2020.

For the first time, Hawaiʻi professionals have been chosen for the exclusive Robert Woods Johnson Foundation (RWJF) Clinical Scholars Program. Seven of those chosen are University of Hawaiʻi faculty.

is a national leadership development program for multidisciplinary health care providers who tackle complex health problems affecting their communities. The program funds projects with the ultimate goal of making America a healthier nation while developing a network of leaders.

This year, Hawaiʻi is the only state with two teams. The Hawaiʻi teams are focused on addressing issues on diabetes and housing insecurity as well as elderly health care.

(JABSOM) Assistant Professor Dee-Ann Carpenter leads the team, “Empowering Hawaiʻis Homeless: Diabetes and Pre-Diabetes Education and Resilience Initiative.” Collaborating with Marjorie Mau (JABSOM), Camlyn Masuda (东精影业 Hilo Daniel K. Inouye College of Pharmacy), Aukahi Austin Seabury (I Ola Lāhui) and Francie Julien-Chinn (东精影业 M膩noa Myron B. Thompson School of Social Work), the team will be working with the JABSOM Hawaiʻi Homeless Outreach and Medical Education (HOME) Project to develop an education and resilience program for homeless people who are pre-diabetic or diabetic.

“We hope to be able to effectively train future students, residents, volunteers and shelter staff to be better prepared for serving the homeless populations who either have diabetes mellitus (DM) or are pre-diabetic,” said Carpenter. “In addition, this is a great opportunity to learn from a wonderful organization about leadership both as individuals and as a team. I personally am looking forward to this training.”

“The KOKUA Project: K奴puna Outreach and Knowledge in Underserved Areas” team is led by Pia Lorenzo (JABSOM) in collaboration with Robin Miyamoto (JABSOM) and Chad Kawakami (东精影业 Hilo Daniel K. Inouye College of Pharmacy). Their project aims to improve the care of the k奴puna in underserved rural communities, especially since Hawaiʻi鈥檚 aging population is growing rapidly while the state does not have enough geriatric specialists to meet their complex needs.

“I鈥檝e experienced first-hand the heartache of too many of our k奴puna falling through the cracks due to systems issues despite the best efforts of dedicated health care professionals. Being a part of the RWJF Clinical Scholars program enables our team to get in the trenches with our colleagues fighting the good fight in underserved community health care centers,” said Lorenzo. “But now, with the RWJF鈥檚 support, we are able to help in a different way, and hopefully, in a way that creates a bigger and more lasting impact.”

—By Deborah Manog Dimaya

A health condition strongly associated with diabetes may be linked to lower odds of developing Alzheimer’s disease, according to the surprising results of a new public health study from the .

The condition, called insulin resistance, is considered a precursor to Type 2 diabetes. The new study showed that Japanese men in their 70s and 80s with insulin resistance had lower odds of developing Alzheimer’s and dementia than men who did not have insulin resistance.

“Our findings suggest that more research is needed to better understand the relationship between insulin resistance and cognitive disorders such as Alzheimer’s disease in older adults,” said Thomas Lee, lead author of the study and an assistant professor of with the in the Myron B. Thompson School of Social Work.

Surprising results

Normally, the cells of the body respond to insulin by taking up sugar from the blood and using it for energy. But in people with insulin resistance, the cells of the body do not respond properly to insulin, leaving too much sugar in the blood.

In the study, Lee and his colleagues looked at data from the health records from 1,544 Japanese men participating in an ongoing study called the , which began in 1991 and is focused on studying the risk factors associated with neurodegenerative disorders.

At the start, study participants underwent a physical exam that included blood tests. None had Alzheimer’s disease at baseline. Three years later, another physical exam was done and, by then, 80 men had developed Alzheimer’s. The researchers compared the men who had developed the disease with those who had not.

After adjusting for factors, such as hypertension (high blood pressure) and smoking, the link between insulin resistance and a lower odds of dementia held.

Previous studies had linked Type 2 diabetes with an increased risk of Alzheimer’s disease, but how exactly the link may work is not clear. The researchers noted that the new study excluded men with Type 2 diabetes at the onset, which may have affected the results.

“Alzheimer’s disease is a debilitating condition and there are projected to be 84 million cases worldwide by 2040,” said Kamal Masaki, a co-author on the study and professor of with the 东精影业 Mānoa . “We need a better understanding of the roles of blood sugar and insulin in this disease.”

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—By Theresa Kreif

Data collected by the and , to capture the relationship between ʻāina (land/environment) and ola (health/life) from individuals living in Waiʻanae, show promise that getting a community involved in preventing type 2 diabetes can reduce their disease risk.

While scientists monitored health data from 392 people across Oʻahu, the majority lived in Waiʻanae, including 259 individuals of Native Hawaiian or Pacific Island ancestry—those at highest risk in Hawaiʻi for type 2 diabetes.

The 东精影业 study partnered with MAʻO Organic Farms in Waiʻanae, which provides educational and employment opportunities to young people in the area. These “interns” work the land and also receive tuition waivers. It is a program that the researchers and the community-based organization suspected would improve health among the interns, because they are active, working the land in ways their ancestors did, consuming healthier food—farm fresh—all while getting an education.

Many of the interns agreed to take part in the study, which measured body mass index, blood pressure, mental health, gut microbiome composition, diet, social economics, health behaviors and social network influences. It is among the interns that the preliminary results showed a 60 percent decline in risk for type 2 diabetes.

The study leaders are Alika Maunakea, a Waiʻanae-born associate professor at the (JABSOM), an expert in epigenetics (the molecular interaction between the environment and genes, and how changes in this interaction are involved in diseases that are disproportionately prevalent in Native Hawaiian and Pacific Island populations), and Ruben Juarez, an associate professor in the and . Juarez is a mathematical economist researcher with expertise in social networks and behavior.

“Studies like ours allow grassroot community-based organizations that do not explicitly target health, but definitely impact it, to be valuable partners in the healthcare system,” said Maunakea. “That enables sustainable health care by shifting the focus from treatment to prevention-oriented approaches in the real-world.”

Read more on the .

—By Tina Shelton

Researchers from the and found that patients who have type 2 diabetes in addition to other chronic diseases have a lower survival rate for colorectal cancer.

A published in the International Journal of Cancer investigated the survival rates of colorectal cancer patients with or without type 2 diabetes, and with additional diseases such as heart disease or stroke. The findings showed type 2 diabetes alone does not significantly affect survival for colorectal cancer patients. However, patients with type 2 diabetes as well as other chronic diseases had a lower survival rate.

The researchers looked at 24 years of health data of more than 215,000 adults from California and Hawaiʻi who participated in the to identify predictors of survival. Among 3,913 new cases of colorectal cancer, the 707 participants with type 2 diabetes were compared to those without type 2 diabetes.

“The multiethnic cohort is an excellent resource that allows us to study diseases in diverse ethnic groups,” said Yvette Amshoff, lead author and education coordinator at the 东精影业 Cancer Center. “Relationships between type 2 diabetes and colorectal cancer have been studied before, with most studies finding a lower chance of survival of those with both diseases. However, in our study population of Caucasian, African American, Native Hawaiian, Latino and Japanese, only Latinos with a history of type 2 diabetes had worse survival. This shows a possible disparity in healthcare that should be addressed.”

Added , study co-author and associate professor of in the Office of Public Health Studies, “The findings that participants with additional diseases and possibly those with long-term type 2 diabetes experience higher mortality are significant to policymakers and health-care providers, because they encourage screening and early detection in colorectal cancer patients to help increase life spans.”

Colorectal cancer is the second leading cause of cancer death in men and third among women in Hawaiʻi. There is an average of 224 deaths from colorectal cancer each year in the state, with an average of more than 700 new cases diagnosed each year, according to the 东精影业 Cancer Center’s . In the U.S., colorectal cancer is the fourth most commonly diagnosed disease. By 2040, 642 million people worldwide are predicted to have type 2 diabetes.

In addition to Amshoff and Grandinetti, research team members include , a professor of at the 东精影业 Cancer Center, and collaborators at the University of Southern California’s Keck School of Medicine and Norris Comprehensive Cancer Center.

—By Nana Ohkawa

The has been awarded a major federal grant to establish a Center for Biomedical Research Excellence on Diabetes. The $11.2 federal grant, which may be renewed for two additional five-year cycles after its initial five-year period, will intensify Hawaiʻi-based research into a disease that currently affects 155,000 adults and children—1 in 9 individuals in Hawaiʻi.

Additionally, Hawaiʻi has 460,000 with pre-diabetes, a condition that increases the risk of developing diabetes. Diabetes is marked by high blood sugar, which can lead to eye complications, kidney disease, nerve damage, high blood pressure, stroke, and heart disease.

东精影业 has organized a team of scientists and physicians as part of the new Center of Biomedical Research Excellence in Diabetes at the (JABSOM); this center will span departmental and campus borders. The director is , who is a professor of (CMB) and JABSOM director of . She is the principal investigator of the sponsored grant. The deputy director is , an endocrinologist and professor in the , and , director of the center’s resources core and associate professor of CMB.

Diabetes and ethnic minorities

The team’s research will include the study of pre-diabetes and diabetes through clinical studies and pre-clinical research. Hawaiʻi’s multi-ethnic population will be a focus of this grant.

“Diabetes is a deadly, rapidly expanding threat in America, and Native Hawaiians and Pacific Islanders population is up to two times more likely than other ethnic groups in the islands,” said , JABSOM dean. “We are extremely grateful to Hawaiʻi’s U.S. Congressional Delegation and to University of Hawaiʻi leaders who championed this project out of great concern over the physical toll of diabetes.”

Diabetes attacks Americans of racial and ethnic minorities with a particular vengeance. JABSOM research has shown that 22.4 percent of Native Hawaiians have diabetes, with an additional 15 percent of them diagnosed with impaired glucose tolerance, pre-diabetes. The occurrence of diabetes is also higher among people of Pacific Island and certain Asian ancestries. The cause of those inexplicable disparities will be part of the research focus. The goal is to further understand pre-diabetes and diabetes to develop preventions and improve treatments.

Gerschenson, a second-generation diabetes researcher, is an internationally known scientist who studies metabolic diseases (diabetes, high blood pressure, obesity, and high cholesterol) and mitochondria (batteries of mammalian cells that make energy). She is the first minority woman (Hispanic) to lead a Center of Biomedical Research Excellence at 东精影业. Mau, who is of Native Hawaiian ancestry, has devoted her career treating patients with diabetes and metabolic disorder, and leading research into diseases which disproportionately strike Hawaiʻi’s people. Two other senior investigator mentors (Le Saux and Takashi Matsui) similarly were former trainees on similar center grants.

“JABSOM is a national leader in elevating women to leadership positions in Medicine. Early career investigators supported by this grant will benefit from the leadership provided by these successful minority women and colleagues who themselves have been trained under former Center of Research Excellence grants,” said Hedges.

For a video on the center and investigators, .

—By Tina Shelton