Discussion With Dr King of Joslin Medalist Study

Dr. George L. King, M.D., is the Senior Vice President and Director of Research at the Joslin Diabetes Center. He is a Professor of Medicine at the Harvard Medical School. He is also in charge of the Joslin Medalist Study.

Below you will find my questions and Dr. King’s answers.

Question #1…I have no relatives with Type 1. I feel that my diabetes was caused by a series of childhood diseases (measels, mumps and chicken pox) when I was 5. Immediately after that period of time I began displaying the classic symptoms of Type 1. There was a question posed on a diabetes website : “What Caused Your Type 1?”. Most responses listed causes other than a genetic link. Almost all of those individuals who felt that their Type 1 was caused by diseases seemed to have no serious complications. Is it possible that when Type 1 is caused by disease then there is less likelihood of developing complications?

Dr. King’s reply:…“The question of the causes of type 1 diabetes is clearly very important. It is very common to have childhood diseases associated with the onset of diabetes. However, it is unclear whether these childhood diseases are causing type 1 DM. It is clear that if you don’t have the genes which makes you at risk for diabetes, then it is very unlikely that you will develop diabetes. The risk of complications for the eyes, kidney and nervous system is mainly related to glucose control for the non-Medalist diabetic patients. Thus, the type of diabetes is not so critical but the glucose control after getting diabetes is very important.”

Question #2…I have often thought that the presence of C-peptide in long term Type 1 diabetics might explain their longevity and lack of complications. There have been studies that seemed to imply that. I thought that I might have a C-peptide level much like the Study participants whose C-peptides were 0.6 or greater. I asked my doctor to include a C-peptide test in my September lab work. It showed that my C-peptide is less than 0.1. I was disappointed. Your assistant said that there are other participants like me who have a very low C-peptide, but do not have complications. I suppose that there must be some avenue(s), in addition to a low C-peptide, that may explain our lack of complications after 50 years or more.

Dr. King’s reply…“In general, type 1 diabetic patients with residual insulin production have better glucose control and thus fewer complications. However, this relationship does not seem to apply to the Medalists.”[/b]

Question #3…“Creative Peptides” is a biopharmaceutical company founded in 1996 and located in Stockholm, Sweden. Their purpose is to develop drugs which will help treat long-term complications of Type 1 diabetes.
Creative Peptides has developed a product for C-peptide replacement in Type 1 diabetics. Clinical studies involving the use of this product in more than 400 Type 1 diabetics have shown encouraging results with patients having nerve and kidney damage. There were no C-peptide related adverse reactions seen while treating these patients. Positive results have also been seen in a group of more than 160 Type 1 diabetics with peripheral neuropathy. The Swedish company has filed a patent on the product used for C-peptide replacement. I hope they are sucessful with this and other drugs and that Type 1 diabetics can receive C-peptide with great results.

Here is the online link:


Dr. King’s reply…“C-peptide for treatments of diabetic complications. There are some preliminary data to suggest C-peptide may help but it is very unclear. Type 2 diabetic patients have elevated levels of c-peptide yet they have many of the same complications as type 1 diabetic patients. If c-peptide is helpful, I believe the effect will be very small.”

Follow-up:…The Medalists have been Type 1 for 50 years or more and most of them have no complications, or no serious complications. It has been clear to me that the Medalists are a separate group unto themselves in that so many of them have no complications even though they have little or no insulin production. Many of them have not had a history of good diabetes care. I ran very high blood sugar for most of my life, until modern times, but I do not have complications. I gather that most of the Medalists have a similar history. There was no guide to good diabetes control during most of their lifetimes. It seems clear that there has to be some explanation for their success stories. The Joslin Medalist Study is ongoing and there may be very important findings when it concludes in 2011.

Thank you Richard for asking these important questions. I hope the Medalist study will someday reveal some insights about the development of complications and their genetic preconditions.