NIDDK at 75 Years of Age: Great Triumphs but Concerns for Its Longevity Free

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), originally named the National Institute of Arthritis and Metabolic Disease, has been the national bastion of diabetes research for longer than most of the readership of Diabetes Care and Diabetes can recall. Founded in 1950, this year NIDDK celebrates its 75th year, a lifetime over which it has contributed to innumerable discoveries that have improved the health of millions of Americans, especially those with diabetes. In the July issues of the two journals, we recognize, highlight, and celebrate some of the accomplishments that exemplify the role NIDDK has played over the past 75 years for the benefit of the public’s health.

The most visible aspect of the NIDDK mission has been the funding of research through grants to numerous institutions, particularly the nation’s universities, for investigator-initiated science and its programs that support the Diabetes Research Centers (DRC), Centers for Diabetes Translation Research (CDTR), and Nutrition Obesity Research Centers (NORC), which provide core resources to support the work of researchers across the nation. It also supports an intramural research program focused on discovery science that includes the Phoenix Epidemiology and Clinical Research Branch, which has made important contributions to our understanding of the physiology and genetics of human diabetes through long-standing collaborative research with Native American nations. Beyond simply financing research, NIDDK has focused on strategic planning to ensure priority is given to important research questions, advanced work in health disparities, supported the training and advancement of early-career and mid-career scientists, and provided health care information to the public. Investigators working for, trained at, or funded by NIDDK have accounted for 14 Nobel Prizes and 5 Lasker Awards. The importance of the NIDDK mission has become increasingly vital and relevant, as the last four decades have seen the growth of diabetes into one of the most important noncommunicable diseases of our time.

To commemorate this special anniversary, the two leading journals of the American Diabetes Association have collaborated with NIDDK leadership to highlight specific trials and programs of particular import initiated by the NIDDK that have served as the underpinning of an informed, potent response to the epidemic of diabetes in the U.S. and worldwide. In Diabetes Care, five reviews focus on the achievements of investigators whose collaborative clinical research studies have advanced our understanding of the pathophysiology, prevention, and treatment of diabetes. The first provides an overview of the original major clinical trial supported by NIDDK, the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC), which demonstrated the importance of glucose control in preventing complications in people with type 1 diabetes (1). A second review focuses on the Diabetes Prevention Program (DPP) and its follow-up study, the DPP Outcomes Study (DPPOS), which showed the benefits of an intensive lifestyle intervention and metformin in reducing the risk of progression to type 2 diabetes (2). In a third, lessons on prediction and prevention from the Type 1 Diabetes TrialNet are highlighted, including the development of teplizumab, the first medication to receive regulatory approval to prevent type 1 diabetes (3). Understanding autoimmunity from birth to facilitate the early identification of people at risk for developing type 1 diabetes has been the focus of The Environmental Determinants of Diabetes in the Young (TEDDY) study, an international collaboration that highlights the value of work beyond national boundaries (4). The fifth piece focuses on three NIDDK-funded multicenter initiatives, the SEARCH for Diabetes in Youth (SEARCH) study, Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) study, and Restoring Insulin Secretion (RISE) study, which were charged with addressing the emergence of type 2 diabetes in youth and have described the epidemiology of the condition and demonstrated the more aggressive nature of the disease and its complications in youth compared with adults (5).

In Diabetes, the highlighted contributions focus on five research consortia that brought together investigators from across the country to focus on critical diabetes topics and technologies. The Human Islet Research Network (HIRN) has enhanced knowledge and expanded access to human islet cells, a critical resource now in routine use (6). Similarly, the phase 3 and pilot clinical trials conducted by the National Institutes of Health (NIH) Clinical Islet Transplantation Consortium as well as prior single-center and multicenter trials funded by NIH and Breakthrough T1D contributed to the development of several novel cell-based approaches to type 1 diabetes that are moving (or have already moved) into commercially sponsored clinical trials (7). The NIH Cardiovascular Repository for Type 1 Diabetes (CaRe-T1D) has been a nidus for the study of vascular disease across the spectrum of diabetes (8), and the Accelerating Medicines Partnership Program for Type 2 Diabetes (AMP T2D) has served to connect and accelerate work applying modern genetics to diabetes (9). The DRC program has been in existence for over 50 years and has a long list of specific accomplishments, but in particular this program has fostered the concept and practice of team science and community in diabetes research, to the betterment of the entire research enterprise (10).

While we salute and celebrate the NIDDK and its accomplishments, at the same time we temper these feelings with concerns for what the future holds. Never in the 75 years of its existence has the NIDDK faced a crisis of the magnitude that has recently become apparent. The uninformed and haphazard nature by which reductions are being made in staffing and funding at the NIH and Centers for Disease Control and Prevention (CDC) are of serious concern to all citizens interested in advancing the health of our nation and the world. While scrutiny as to how we spend common resources is an essential government responsibility, as documented in the articles presented here, NIDDK has been enormously effective and efficient. The work of NIDDK has paid off manyfold in improved care for people with diabetes, development of new therapies and diagnostic tools, and strategies for diabetes prevention. Along with the other components of NIH, this national effort is the primary reason that the U.S. is the world leader in biomedical science. This position is well earned but is under serious threat. Without ongoing commitment from the government and the populace at large, future discoveries and public health gains are at risk. Discovery science and clinical research are essential to inform both individual and population health interventions. They are communal goods with communal benefits and have been well served by communal funding. While commercial entities collaborate with and benefit from federally supported research, they have different goals and purposes in the broad medical enterprise. A robust mechanism to fund, direct, and adjudicate science that is dedicated to advancing public health is essential to American progress and continued improvement of our quality of life. The works highlighted in the 10 articles in Diabetes Care and Diabetes draw attention to just some of the triumphs that have come from our robust biomedical research enterprise. NIDDK, as a reflection of work done across the entire NIH, is a prime example of government monies well spent. We are proud to highlight here some of the work supported by NIDDK, to emphasize its importance to the diabetes community, and to lend our voices to the prospect of an equally successful 100th anniversary.