Dr. Griffin P. Rodgers plans to push forward his agenda of “vigorous, multi-pronged research efforts” in the areas of diabetes, obesity, and endocrinology, even if his budget pushes back a bit.
On April 1, Dr. Rodgers was named the new director of the National Institute of Diabetes and Digestive and Kidney Diseases, overseeing a budget of $1.8 billion and a staff 650 scientists and administrators. The Bush administration's proposed fiscal 2008 budget would essentially “flatline” that amount for the fourth year in a row. At press time, the U.S. House of Representatives had voted to provide a modest $26-million budget increase for the institute, and the Senate was not expected to take a vote until after its August recess.
Regardless of the final budget allocation, Dr. Rodgers aims to maximize it. “I think federally funded research really plays an indispensable role in [improving the] understanding, prevention, and treatment of disease. And with the budget provided to us, we are actively pursuing a wide range of promising research avenues,” he said in an interview.
Dr. Rodgers outlined five “core principles” that guide his vision for basic, translational, and clinical research in the areas of diabetes, obesity, and other endocrine diseases:
▸ Maintain a vigorous, investigator-initiated research portfolio. “The innovativeness and problem-solving capability of individual investigators are crucial for research progress,” he noted.
Among the diabetes-related priorities are those that will increase understanding of the mechanisms of genes associated with both type 1 and type 2 diabetes, and how the pathways involved might lead to treatment, prevention, or cure. The application of new technologies, such as proteomics and metabolomics, to the study of diabetes and its complications also ranks high on the priority list.
In obesity, NIDDK intends to fund investigator-driven research that illuminates the regulation of appetite and energy expenditure via hormone signaling, as well as the behavioral and environmental factors contributing to the problem.
▸ Support pivotal clinical studies and trials. Translation of results from two major groundbreaking NIDDK-funded studies—the Diabetes Control and Complications Trial (DCCT) and the Diabetes Prevention Program (DPP)—will remain an institute priority. These ongoing efforts include the DCCT follow-up study, the EDIC (Epidemiology of Diabetes Interventions and Complications) trial, and the DPP Outcomes Study.
Two new studies, both focusing on young people, could have major implications for public health policy and clinical management, respectively.
The HEALTHY trial is a multistate initiative based in 42 middle schools, aimed at determining if changes in food services and physical education classes, along with activities that encourage healthy behaviors, can lower risk factors for type 2 diabetes. Results from that study are expected in 2009.
The other study, called TODAY (Treatment Options for Type 2 Diabetes in Adolescents and Youth), is investigating the best treatments for type 2 diabetes in children. It is still accepting patients. (See box.) Other clinical studies are looking at behavioral approaches to reducing obesity in adults in the general population, and in minority groups in particular.
Strategies to maximize research dollars include the funding of ancillary studies to supplement ongoing large clinical trials, as well as supporting a central repository for biologic materials, derived from those trials, that can be accessed by the broader research community. “We look at these as ways of really extending the investments we've already made in clinical trials. The goal is to derive the maximum benefit from our prior investments,” Dr. Rodgers said.
▸ Preserve a stable pool of talented new investigators. Over the past several years, applications from new investigators for regular research (RO1) grants have received a two-percentage-point advantage in funding consideration, compared with applications from established investigators. And more recently, new investigator applications that just miss the general funding line—commonly called the “payline”—have received second-chance individual consideration via an approach called “special emphasis funding.” New investigators may also receive short-term support, called R56 awards, that assist them in collecting preliminary data in order to subsequently submit a revised, stronger application for a longer-term regular research grant in the next cycle.
Unfortunately, “we've had to make across-the-board cuts in the size of grants to preserve a payline that has been declining somewhat over the years,” Dr. Rodgers said. Another goal is to “preserve a cadre of new investigators so we really don't lose a generation of investigators during this period of some resource allocation challenges.”
▸ Foster exceptional research, training, and mentoring opportunities. Maintaining a pipeline of NIDDK-focused investigators is critically important, Dr. Rodgers said. To that end, competitive institutional research training awards will be given to pediatric endocrinologists involved in diabetes research.