Joslin Investigator Details

A Harvard Medical School Affiliate

Welcome to the Joslin Research Website


	Joslin Investigator:

Dr. Edward Horton

Investigator Specifics:

Professional Details:

CV not available

Member of Section:

Core Director:

Current Fellows, Students, or Lab Members:

John Doupis, MD, PhD

Ahmed Elshebiny, M.D.

Susan Herzlinger, MD

Past Fellows, etc.:

Ebaa Al-Ozairi

Taher Bennani

Lais Monzillo

Amr Moussa

Mohamed Othman

Sriurai Porramatikul

Geetha Soodini

Nynke van der Zijl

Errol Van Rensburg, M.D.

Related Resources:

General Clinical Research Center

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Clinical Trials Unit

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Joslin Resources

Edward S Horton, MD

Investigator

Joslin Diabetes Center

Section Head: Clinical Research

Joslin Diabetes Center

3/1/1993 -

Bridging Joslin Labs and Patients' Lives

The scope of activities in the Section on Clinical Research is broad and ranges from multi-center trials such as the follow-up study to the Diabetes Control and Complications Trial to studies testing new medications, medical devices and diagnostic products. Edward S. Horton, M.D., Vice President of Joslin Diabetes Center, heads the Section on Clinical Research and also directs the outpatient Clinical Research Center. Both the Section on Clinical Research and the Clinical Research Center at Joslin are involved in a broad range of projects that are integral parts of research programs in other sections. Studies to prevent type 1 diabetes, for example, are conducted through the Section on Immunology and Immunogenetics, but study subjects are seen in the Clinical Research Center.

Multi-center Trials Underway

Three large multi-center trials are either underway or just completed under the auspices of the Section on Clinical Research. Alan Jacobson, M.D., served as the principal investigator for Joslin's participation in the recently completed Diabetes Control and Complications Trial (DCCT) and is now heading Joslin's participation in the EDIC (Epidemiology of Diabetes Intervention and Complications) trial, which will serve as a follow-up study to the DCCT. The DCCT was, perhaps, the most important clinical study in diabetes since the discovery of insulin. In the DCCT, researchers discovered that the rates of diabetes complications in the eye, nerves and kidney could be decreased in patients with type 1 diabetes by 50 percent or more by use of intensive diabetes treatment (i.e. taking three or more insulin injections daily or using an insulin pump, while adjusting medication in response to four or more blood sugar readings daily) versus conventional treatment (one or two injections per day and less frequent blood sugar monitoring). In the EDIC study, former participants in the DCCT are being followed for up to 10 years more to determine if the rates of development or progression of longterm diabetes continue to vary so widely between the two groups.

In another national multi-center clinical trial just getting underway, the Diabetes Prevention Program is designed to screen large populations of individuals at increased risk for developing type 2 diabetes. This study will focus on individuals with a family history of type 2 diabetes; with a prior history of gestational diabetes; and those who are members of high risk populations such as African Americans, Hispanics, Asian Americans and Native Americans. The goal will be to identify individuals with impaired glucose tolerance (an early indicator of developing type 2 diabetes) who can be randomized to one of four treatment groups testing whether intensive lifestyle modifications (weight loss and increased exercise), treatment with the oral anti-diabetes drugs metformin or troglitazone, or treatment with an inactive placebo will prevent the development of type 2 diabetes. All individuals will receive basic instruction on diet, exercise and lifestyle changes to improve their chances of preventing diabetes. Only those in the first group will be provided with an intensive program for lifestyle modification that will have intensive instruction and follow-up using a case manager approach to test the impact of this non-drug intervention in preventing progression of impaired glucose tolerance to diabetes. Dr. Horton is the principal investigator for this study, which is being conducted at several sites in the Boston area, including Joslin, Brigham and Women's Hospital, South Cove Community Health Center and the Roxbury Heart Center. Other researchers participating in this study from Joslin include Drs. Alan Jacobson, James Warram, Om Ganda, Fannie Smith, and EnriquŽ Caballero as well as collaborators at Brigham and Women's Hospital.

In addition to these large multi-center trials, a large number of studies are being conducted to test new products and treatments. Clinical trials in the past have tested the effects of various drugs to lower blood sugars, including troglitazone, metformin and acarbose, as well as a new rapid-acting insulin analog, Lispro. All have since received approval by the Food and Drug Administration. In addition, trials are underway to evaluate the effectiveness of insulin-like growth factor I (IGF-I) and amylin on regulating glucose in people with diabetes. Other drugs being studied include miglitol, zopolristat, and pimazidine to treat diabetes complications.

Links with Other Sections

Because of its central role in translating basic research into clinical practice, this Section serves as an effective bridge between the basic science programs at Joslin and the research and development of new clinical tools. Numerous collaborations have been established between members of the Clinical Research Section and other units, including the Section on Immunology and Immunogenetics; the Section on Genetics and Epidemiology; the Section on Clinical Physiology; the Section on Metabolism, the Section on Cellular and Molecular Physiology and the Section on Vascular Cell Biology. Other Senior Physicians who are Section Members include: James Rosenzweig, M.D., Ramachandiran Cooppan, M.D., Om P. Ganda, M.D., Joseph Wolfsdorf, M.D., Elizabeth Bashoff, M.D., Howard Wolpert, M.D, Richard S. Beaser, M.D., and Florence Brown, M.D.

Selected References:

DCCT Research Group, The Effect of Intensive Treatment of Diabetes on the Development and Progression of Long-term Complications in Insulin-Dependent Diabetes Mellitus, N Engl J Med., 1993, 329: 977-986.

DCCT Research Group, Absence of Glycemic Threshold for the Development of Long-term Complications in the DCCT, Diabetes, 1996, 45: 1289-1298.

Kotsanos, J., Vignati, L., Huster, W., Andrejasich, C., Boggs, M., Jacobson, A., et al, Health-Related Quality-of-Life Results from Multinational Clinical Trials of Insulin Lispro: Assessing Benefits of a New Diabetes Therapy, Diabetes Care, 1997, 20: 948-958.

Veves, A., Saouaf, R., Donaghue, V.M., Mullooly, C.A., Kistler, J.A., Giurini, J.M., Horton, E.S., Fielding, R.A., The Relationship of Regular Exercise to Maximal Aerobic Capacity and Endothelial Function in Young Type 1 Diabetic Patients, Diabetes, (in press).

Biographical Sketch:

Dr. Horton is Professor of Medicine at Harvard Medical School, Vice President of Joslin Diabetes Center, and Director of the Section on Clinical Research at Joslin. Dr. Horton received his medical degree from Harvard Medical School and completed residency training at Dartmouth and Duke University. Dr. Horton has had a long and distinguished career in diabetes, and is the recipient of numerous awards and honors, including serving as President of the American Diabetes Association and President of the American Society of Clinical Nutrition. Before coming to Joslin in 1993, Dr. Horton was Chairman of the Department of Medicine at the University of Vermont.