High average glucose - or blood sugar - is the alleged culprit causing much of the damage in the bodies of the millions of children diagnosed with diabetes. But based on recent molecular biology studies, Mark Clements, MD PhD, Endocrinology, Assistant Professor of Pediatrics/Endocrinology, University of Missouri-Kansas City School of Medicine, theorizes that the focus on chronic hyperglycemia (high average blood sugar) may be wrong, or least wrong to a degree.

     "It is possible that high blood sugar on average over a long period of time may not only fail to tell us the whole story, but may not be the most important thing in determining our risk for complications in diabetes," says Dr. Clements. "The rise and fall of the glucose over the day may be the biggest factor, or at least an equally important one."

     Funded by a Katharine Berry Richardson (KBR) award, Dr. Clements is building something that doesn't currently exist -- an animal model to study the impact of glucose variability on chronic complications. "We are building a model of glucose variability in the diabetic rat with the goal of creating different treatment groups that allow us to look at high glucoses on average versus glucose variability over many months and how they each impact the development of chronic complications," says Dr. Clements.

     This is all made possible thanks to new continuous glucose biosensor monitoring technology that allows researchers to see glucose fluctuations minute by minute.

     Dr. Clements will also be looking at several additional outcomes including markers of oxidative stress in the blood of these animals, gene expression analysis of the white blood cells to look for markers of cardiovascular inflammation, and physiologic markers for cataract formation, proteinuria, hypertension, and tissue damage.

     "As soon as we demonstrate the degree to which glucose variability plays a role in complications, we'll then be able to look at various interventions in the oxidative stress response to see whether we can have an impact on the rate of complications," says Dr. Clements.

     In the process of completing his fellowship in Pediatric Endocrinology, Mark Clements, MD PhD, has not abandoned his first interest in basic science, as he has continued to stay involved through his research in diabetes.

     "I'm getting back to my roots I guess, and one of the many things I'm good at is taking a clinical problem and developing a way to study it at a basic science level or model level," says Dr. Clements.

     Dr. Clements is a graduate of the Medical Scientist Training Program at the Washington University in St. Louis School of Medicine. He also holds a doctorate degree in Neuroscience.

     "I'm involved in science because I'm motivated to make a difference," says Dr. Clements. "Our research may impact Type 1 and Type 2 diabetes, and Type 2 diabetes is one of the fastest growing health problems around the world. Anything we can do to make a difference in the health of these patients could have a huge effect, a huge impact."