Dr. Hertzel Gerstein
Director of endocrinology and metabolism
McMaster University, Hamilton

When McMaster University scientist Dr. Hertzel Gerstein began researching diabetes in the early 1990s, there was no word for the abnormal glucose levels that are prevalent among diabetic and pre-diabetic patients. So he invented a word to describe it – dysglycemia – and today it’s in use by medical professionals around the world.

In fact, Gerstein has been at the centre of most of the world’s largest diabetes-related clinical trials in recent years. And central to all of Gerstein’s research is a focus on patients – or as he prefers to term it – partners in research.

“Early in my career I spent time researching in a lab. I quickly realized that it just wasn’t for me.  I discovered I loved and missed interacting with patients. And I knew that I wanted to conduct research that was relevant to people with diseases, not just to doctors or other researchers. Research has to be important to your grandmother, to your spouse, to your parents. If those people can’t understand the importance of your research, then it’s probably not as important as you might think it is,” he says.

And Gerstein’s research is very important to the alarmingly increasing number of people with diabetes in Canada and around the world, When Gerstein first embarked on his diabetes research career following graduation from the University of Toronto medical school in 1981, less than three per cent of adult Canadians suffered from diabetes; today that number has increased to more than 10 per cent and it continues to grow.  Diabetes is one of the most pervasive diseases of the 21st century, and care and treatment now eats up nearly one billion dollars in health care costs in Ontario and as much as $200 billion in the USA.

“Type 2 diabetes also accounts for a large portion of all heart attacks, strokes, deaths and other health problems in Canada,” says Gerstein. "An abnormal glucose level is now well-established as a risk factor for future heart attacks and strokes and deaths from cardiovascular disease." Gerstein says glucose levels should be considered in the same way as cholesterol levels or blood pressure. "It's a marker for cardiovascular risk in everybody, not just in people with diabetes"

Gerstein believes one of the main reasons for the spike in diabetes is that we have created a “diabetes-prone society. We live in environments (cities and suburbs) that don’t encourage physical activity and we have a food economy that promotes high-calorie/low cost food. We’ve created a dangerous environment, a perfect storm where diabetes can flourish.”

And while there are several promising drug therapies on the horizon that could help alleviate or, in some instances, prevent diabetes, a healthy lifestyle is a key prerequisite. . "We know that if people are able to make positive changes to their lifestyle, they can markedly reduce their risk of diabetes and abnormal glucose levels," he says.

Gerstein, working in partnership with top international scientists, has spent the past 20 years researching the root causes diabetes, testing new drugs and new treatments, and most important, finding ways to prevent diabetes, cure it or drive it into remission.

Gerstein’s international clinical research trials are titled with words that could well populate a Barack Obama speech: DREAM, HOPE, MICRO HOPE, ACCORD and ORIGIN. These are large, international clinical trials and Canada is at the forefront, continuing a 100-year tradition of diabetes discovery. Ontario is home to Nobel Prize Laureate Sir Frederick George Banting who, in the early 1920s, working with his assistant Charles Best, discovered “a thick brown muck” they would call insulin, a discovery that would revolutionize the lives of millions of diabetics.

As Canadian lead investigator of the DREAM study (Diabetes Reduction Approaches with Medications), Gerstein was at the forefront of a global clinical trial, sponsored by Glaxo Smith Kline, involving more than 5,000 patients worldwide testing ways to prevent Type 2 diabetes. The DREAM study demonstrated that the drug rosiglitazone could reduce the chances of developing the disease by as much as 60 per cent when taken by those most at risk. The results have potentially major implications for future health care, particularly as aging ‘baby boomers’ reach the greatest at-risk years for the onset of type 2 diabetes.

The DREAM study is just one of many projects McMaster University’s director of endocrinology and metabolism has on the go these days. As Deputy Director of the Population Health Research Institute and the Population Health Institute Chair in Diabetes Research, Gerstein is currently leading or involved in 13 international clinical trials. Created in 1999, the Population Health Research Institute works with large international clinical trials to understand the causes of chronic diseases and how they can be prevented or treated.

The 12,000-patient ORIGIN (Outcome Reduction with an Initial Glargine Intervention) is examining if a new insulin preparation and/or omega 3 fatty acids reduces cardiovascular events in people with diabetes or those who are likely to develop it. This and several other trials are being conducted in collaboration with McMaster cardiologist professor Dr. Salim Yusuf, a pioneer in the development of meta-analysis and its application to large-scale clinical trials. Gerstein’s work with Yusuf goes back 15 years, a collaboration he calls “rich and wonderful.”

“These trials provide important information about whether or not novel medications can both prevent and treat dysglycemia and its consequences. They are directly applicable to people with diabetes and people at risk of diabetes. We’re identifying therapies and approaches that can be implemented immediately,” he says.

Gerstein has received a great deal of recognition for his ground-breaking research. Gerstein is also the recipient of the 1999 Canadian Diabetes Association’s Frederick G. Banting Award, their 2007 Best Award and their 1999 Young Scientist Award. In 2006, Gerstein was a finalist in the Maclean's magazine Readers' Choice Poll for Achievement of the Year in Healthcare for his role in the DREAM research project.

Gerstein has taken his research and his knowledge to the streets as founder and director of Diabetes Hamilton, a novel community-based resource that is helping thousands of Hamiltonians better manage their disease.  “The goal of Diabetes Hamilton is to create a more diabetes-friendly environment here,” he says. Patients and health care providers receive information and resources they need to help them manage their disease and live healthier lives. It’s one more way that patients can become partners in healthcare, he says.

Gerstein is confident there will be even more advances in diabetes research in the not-too-distant future. “We have now set the stage for a cure. We know we can prevent diabetes in 60 to 70 percent of cases with intensive lifestyle and drug therapies. The question now is ‘Can we reverse diabetes, or even cause it to go away?’ That’s the next step.”

At a Glance

The researcher: Dr. Hertzel Gerstein is director of endocrinology and metabolism at McMaster University in Hamilton, Deputy Director of the Population Health Research Institute and the Population Health Institute Chair in Diabetes Research.

The Breakthrough:  Gerstein has been at the centre of most of the world’s largest diabetes-related clinical trials in recent years. He is also founder and director of Diabetes Hamilton, a community-based resource that is helping thousands of Hamiltonians better manage their disease. Patients and health care providers receive information and resources they need to help them manage their disease and live healthier lives.

Worth Repeating:  “We have now set the stage for a cure. We know we can prevent diabetes in 60 to 70 percent of cases with intensive lifestyle and drug therapies. The question now is ‘Can we reverse diabetes, or even cause it to go away?’ That’s the next step.” Dr. Hertzel Gerstein, McMaster University’s director of endocrinology and metabolism, Deputy Director of the Population Health Research Institute and the Population Health Institute Chair in Diabetes Research.

Connect With the Researcher:  http://fhs.mcmaster.ca/medicine/endocrinology/faculty_member_gerstein.htm