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The Honolulu Science Café meets monthly during the academic year. Presented by the ARCS (Achievement Rewards for College Scientists) Foundation of Honolulu and hosted at the Pho Viet Manoa restaurant, the most recent Science Café featured JABSOM’s Cell and Molecular Biology Professor Mariana Gerschenson, PhD.
Dr. Gerschenson, Director of the Diabetes Research Center at JABSOM and the Principal Investigator of the NIH-funded COBRE-Diabetes, explained how pre-diabetes progresses to diabetes. With approximately 10 percent of the population in Hawaiʻi diagnosed with diabetes, it’s a topic that is timely and relevant. We caught up with her before her talk in front of a packed restaurant.
Q: Tonight’s talk is about how pre-diabetes progresses into full-blown diabetes. So, how does it typically happen?
A: It’s a complex process, but we’re primarily discussing adult-onset diabetes, also known as Type 2. It arises from a combination of genetic predisposition and lifestyle factors, mainly being overweight or obese. While we’re still uncovering all the mechanisms, inflammation and the body’s carbohydrate metabolism play crucial roles. About 70% of individuals diagnosed with pre-diabetes will eventually develop Type 2 diabetes in their lifetime. As people age, some lose the capacity to produce sufficient insulin, or their cells become less responsive to it, which further increases the risk.
Q: What are the main concerns with high blood sugar levels in diabetic patients?
A: Elevated blood glucose is harmful over time. To provide context, a person with diabetes can have blood sugar levels that are more than double the normal range. This excess sugar harms blood vessels and organs, leading to complications such as nerve damage, vision loss, and cardiovascular disease.
Q: What are some preventative measures individuals can take to avoid pre-diabetes progressing to diabetes?
A: Simple lifestyle changes can be very effective. Regular physical activity—like walking—can make a significant difference. You don’t need a gym membership. Moderation in eating habits is also essential. For example, enjoying a small piece of cake instead of the whole dessert can be beneficial. Additionally, reducing your overall food intake by one third and walking regularly can help prevent more serious long-term health consequences.
Q: How prevalent is diabetes in Hawaiʻi, and are there specific demographic groups disproportionately affected?
A: Diabetes is a significant public health concern in Hawaiʻi, with an overall rate of about 11%, and pre-diabetes affects 38% of the population. However, these rates are higher among specific ethnic groups. The prevalence among Native Hawaiians, Pacific Islanders, Japanese, and Filipino populations ranges from 13% to 14%. For individuals of Samoan descent, the rate is approximately 25%. These disparities arise from both genetic factors and increased levels of body fat distribution within these communities.
Q: How important is federal funding, like that from the National Institutes of Health (NIH), for diabetes research and overall medical advancements?
A: It’s absolutely critical. For example, GLP-1 receptor agonist drugs like Ozempic—now widely used to treat Type 2 diabetes—were developed based on NIH-funded research into a hormone found in the saliva of Gila monsters that mimics the body’s own GLP-1 hormone. I don’t think people realize how essential federal funding is for drug development, vaccines, and other innovations. In Hawaiʻi, this funding supports the development of research infrastructure and the training of early-career scientists. My research has focused on carbohydrate metabolism—specifically how the products of glucose breakdown are processed in the mitochondria, which act as the cell’s powerhouses. That’s the work I’ve been doing here in Hawaiʻi for the last 22 years and what I’ll be presenting tonight.
Q: Why is it important to have discussions about diabetes in community settings like a Science Cafe rather than just a lecture hall?
A: Community engagement is crucial for expanding the reach of scientific knowledge. Events like this allow people to learn about the research taking place at the University of Hawaiʻi and the Diabetes Research Center in a relaxed, informal setting. Many individuals only have brief conversations with their doctors, and with a shortage of endocrinologists, it’s vital to empower the public. We aim to encourage people to be proactive—check their fasting glucose with over-the-counter meters and take action early. With awareness and appropriate monitoring, people can prevent complications that may affect their eyes, kidneys, heart, and brain. Diabetes increases health risks, but with proper care, individuals can live long and healthy lives.