MUSC Welcomes New Chief of Endocrinology
Noted diabetes researcher Timothy J. Lyons, M.D., who joined MUSC in early 2017 as division chief of endocrinology, is a man with a mission. Thirty years ago, when he was a fellow at MUSC, he worked with John Colwell, M.D., then the division chief, to help launch a landmark trial of patients with type 1 diabetes — the Diabetes Control and Complications Trial (DCCT). As an MUSC faculty member in the 1990s, he began to collect samples from trial participants for study in the laboratory. In the early 2000s, he left MUSC to take a position as division chief of endocrinology at the University of Oklahoma, where he built a multispecialty diabetes center, supported by millions in funding from governmental and philanthropic sources, and worked with local Native American tribes to improve their diabetes care. Now back at MUSC, Lyons will be the first to hold the John Colwell Endowed Chair in Endocrinology and will continue the work that his mentor started, realizing the potential of DCCT long-term data to yield invaluable insights into the vascular complications of diabetes.
The DCCT trial randomized 1400 patients with type 1 diabetes at 28 sites to aggressive glucose management or much less intensive standard management to evaluate whether tight glucose control would reduce complications, which include eye and kidney damage, heart attack and stroke. Although the trial was supposed to continue for ten years, it was stopped in its ninth year by its safety oversight committee because eye damage in patients who received aggressive management of their glucose was reduced by 70 percent. Aggressive management of glucose levels became the new standard of care for reducing the shorter-term complications of type 1 diabetes. “Those findings changed the management of type 1 diabetes worldwide,” says Lyons.
Although the trial ended decades ago, 95 percent of the patients continue to be followed up yearly as part of an observational study. The goal of the study is to understand whether the aggressive management provided during the years of the trial helped protect patients against the longer-term complications of diabetes, such as cardiovascular disease. Results thus far point to highly significant reductions in cardiovascular disease and early mortality in those whose glucose level was aggressively managed during the trial.
As more data about long-term outcomes in the DCCT participants become available, the specimens that Lyons obtained in the 1990s become ever more valuable because basic science findings can now be correlated with the clinical course of the patients from which they were obtained. With access to both the clinical and basic science data, MUSC diabetes researchers are uniquely positioned to begin to understand the vascular complications of diabetes. “In the DCCT samples, in particular, MUSC has something that is absolutely unique here,” explains Lyons. “No one else has gotten anything like that.”
It was a desire to safeguard the legacy of that trial that brought Lyons back to MUSC. “The patients are starting to get old in DCCT, but so are the investigators — I came back to make sure we keep it alive and recruit in the next generation of investigators. We collected all of these samples and clinical data and they are in our hands, and it is up to us to make sure it comes to fruition or we could lose the whole thing.” Lyons is not about to let that happen. He is already busy recruiting young investigators to work on the study, which he estimates will continue to yield insights for at least another 20 years.