There is something about the everyday that implies simplicity. Given its prevalence in the lives of so many people, it can be easy to forget how complex a condition type 2 diabetes truly is. Complex in the range of treatment options—medications, diets, technology, all heavily tailored for each patient—but also in the growing list of subtypes and range of susceptibilities. Today, 100 years after the discovery of insulin, 3,500 years after diabetes was first described by ancient Egyptians, questions remain. “We still don’t know the key underlying component that causes the β-cell to fail,” Kristina Utzschneider says. “We’re missing something.”
Untangling the world’s intricacies has always appealed to Utzschneider. As a kid growing up in Stockton, California, she was part of a special fourth grade honors class. “Physiological psychology,” she says. “We learned about the brain—even dissected a sheep’s brain. I loved it.” While an undergrad at Georgetown University, Utzschneider first found herself drawn to international relations before switching to premed. Her love of science ultimately led to a bachelor's degree in neurobiology from the University of California, Berkeley and a medical degree from Harvard Medical School.
During her first year at Harvard, Utzschneider conducted a research project on hypoglycemia unawareness with a professor at Joslin Diabetes Center. While a career in clinical research seemed like a natural fit, Utzschneider made a surprising detour after medical school, deciding instead to go into private practice.
“I enjoyed working with patients with diabetes,” she says. “Diabetes care is very nuanced, with components that make it quite complex. Motivating patients and working within their barriers—it’s an interesting challenge.”
After 5 years of general practice, Utzschneider began an endocrine fellowship at University of Washington, where she is currently an associate professor of medicine. Her clinical research program is based at the VA Puget Sound in Seattle, where she also serves as director of diabetes care and is a practicing endocrinologist.
As a researcher, Utzschneider is primarily focused on β-cell dysfunction.
“Many of our studies look at different interventions, such as medications or diets, to see their impact on β-cell responses,” she says. “Over the last 7 years, I’ve looked at different components of secretion using oral glucose tolerance tests, which give a surprising amount of information for such a simple test.”
In a forthcoming study, Utzschneider hopes to fine-tune the very definition of type 2 diabetes.
“We want to look at type 2 diabetes heterogeneity and see if large data sets will help us better understand and hone in on subtypes,” she says.
“Are there specific biological pathways that lead to each subtype? And then how can we translate that knowledge into more personalized medicine? One day we may be able to plug specific phenotypes or lab values into a computer and see research-based data that says, ‘oh, this patient will respond best to drug A or drug C.’”
Given its complexity, type 2 diabetes has a wide range of treatment options which include increasingly intricate devices.
“The big changes over the last few years are really amazing,” she says. “GLP-1s, ultra-fast insulins, automated insulin pumps. I have so many patients who, after I’ve convinced them to use a continuous glucose monitor—it basically changed their life. They’ve finally gotten their diabetes under control by watching their diet and using this device.”
“I think that in the next 5 to 10 years our knowledge of subtypes will change how we approach patient management and we’ll have a pump that does everything with little to no input from the patient,” she adds. “Everything’s moving very quickly.”