LaTeira Haynes (ldhaynes@ucsd.edu)

Graduate Program:  Biomedical Sciences
Lab PI: Dr. Catherine Hedrick
Undergraduate Institution: Spelman College
Med-into-Grad Clinical training area: Diabetes
Main clinical mentor:
Dr. Sunder Mudaliar  Sunder.Mudaliar@va.gov

Quote:   “This training motivated me to focus my research and made me more passionate about my project. I now have actual people to think of when I work on my project and I think it will make me work harder and smarter."

Rational for Med-into-Grad training:
I am currently studying the role of ABCG1, a cholesterol transport protein, in immune involvement in atherosclerosis. There are polymorphisms in ABCG1 found in type 2 diabetic patients. These polymorphisms may contribute to type 2 diabetics predisposition to develop atherosclerosis. ABCG1 is actively expressed on T cells that are found in atherosclerotic plaques. We believe that ABCG1 activity is important for maintaining an anti-inflammatory T cell subset (T regulatory cells) and preventing the differentiation of an inflammatory subset (TH17 cells). I was interested in the Med-into-Grad program because I am particularly interested in inflammation and atherosclerosis and diabetic patients are known to have chronic inflammation and most die of heart attacks due to atherosclerosis. I hoped that the Med-into-grad program would help me make observations that could help my research or even provide new questions that I could investigate.

Medical training and identification of medically-relevant research issues: 
I was involved in outpatient clinics at the VA hospital. I attended the diabetes and obesity clinics. I shadowed endocrine fellows, lipid pharmacists, and diabetes educators. I learned a lot about the maintenance of diabetes and the therapies. The most important thing I learned in the during my experience was that recent research has shown that strict maintenance of blood glucose levels of type 2 diabetic patients does not reduce their increased risk of heart disease. The connection between diabetes and atherosclerosis needs to be studied more. The inflammatory component of both of these diseases may be a more important component than glucose maintenance. I also learned about a disease that I was previously unaware of in the obesity clinic. Adiposis dolorosa is characterized by inflamed and painful fat. I am now interested in the inflammatory aspect of this disease as well. I may collaborate with a physician on a project to identify the immune cells involved in this disorder.

Potential Research collaborations:
I discussed collaborating with Dr. Herbst to investigate the cytokines and immune cells that are present in the adipose tissue of patients that have adiposis dolorosa. Identifying the immune cells that are present would help identify the main players in the inflammation and how the inflammation is causing pain. I do plan on pursuing this collaboration with Dr. Herbst.

Training in diagnostics & therapeutics, and identification of unmet diagnostic & therapeutic needs:
I learned a great deal about the diagnostics and diagnostic guidelines for diabetes and hyperlipidemia. I also learned a great deal about the therapeutics for diabetes and the complications that can arise with certain forms of treatment. The diagnostic guidelines for diabetes and hyperlipidemia are constantly being revised. The most recent guidelines for diabetes from the American Diabetes Association (ADA) state that diabetes can be diagnosed with a Hemoglobin a1c level of 6.5% or more on 2 separate occasions. Oral glucose tolerance tests and fasting glucose tolerance tests are also used. A fasting glucose level greater than or equal to 126mg/dl or an oral glucose tolerance test of greater than or equal to 199mg/d on 2 separate occasions diagnoses diabetes. When diagnosing hyperlipidemia or hypercholesterolemia, risk factors for cardiovascular disease (CVD) are taken into account before recommending treatment. Risk factors that are evaluated are smoking, hypertension, age and family history. The more risk factors that a patient has the lower the goal LDL should be to prevent CVD. Tests for hypercholesterolemia and diabetes are all blood tests. First line therapies for type 2 diabetes are lifestyle changes while type 2 diabetes has to be treated with insulin. If lifestyle changes fail, type 2 diabetics go on oral agents to maintain their diabetes. Many type 2 diabetics require insulin to treat their diabetes after years of having the disease. Hypercholesterolemia is also treated with lifestyle changes and then oral agents following the failure of lifestyle changes.

The two main treatments of diabetes, oral agents and insulin both have faults. Oral therapies often lose their effectiveness in treating diabetes. A gradual increase in insulin resistance in both type 1 and 2 diabetics results in the need for more insulin to maintain blood glucose. The increase in insulin causes an increase in body weight, which can lead or add to obesity and complicate other components of metabolic disorder. Also, both oral agents and insulin can cause dangerous hypoglycemic episodes in patients. Hypoglycemic episodes can be prevented with new continuous glucose monitors that alert patients of falling glucose levels. However, the problem of insulin resistance is a major problem that has yet to be overcome with therapeutics. More therapies that fight insulin resistance are needed. The greatest problem in the treatment of type 2 diabetes is getting patients to lose weight. The amount of therapies and dosages of drugs go down considerably and often can be completely eliminated with enough weight loss. However, weight loss and the modification of dietary habits prove to be the largest hurdles that prevent good management of blood glucose.

Long term impact: 
This training motivated me to focus my research and made me more passionate about my project. I now have actual people to think of when I work on my project and I think it will make me work harder and smarter.

Student-specific experiences:
The med-into-grad program was very informative and gave me a real world view of the diseases that I study. I was able to actually see the complications that accompany the diseases and the therapies first hand and see how my research could actually help people. The program made me really excited about my research and it’s possible future implications.

Advice for new trainees--Autumn preparatory quarter:
I recommend that future trainees attend the endocrine grand rounds at the VA hospital in the Autumn quarter to meet fellows and attending doctors as well as to learn about cutting edge therapeutics and diagnostics. I also advise future trainees to read up on the different types of drugs and insulin that are used to treat diabetes.

Advice for new trainees—Winter clinical training quarter:
Trainees shouldn’t be too shy when interacting with fellows, attending doctors and there trainees when in the clinic. Take notes and be sure to ask questions when a case a is being presented and attempt to answer some questions that asked during patient presentations. Be sure to dress in business casual attire; wear slacks, never jeans. The fellows are a great resource, stay after clinics are over to speak to them or speak with them before clinics. They know a lot of information and often explain things to you better than the attending doctors can.

Take home perspective on Med-into-Grad at UCSD: 
The med-into-grad program at UCSD is an awesome opportunity that I would recommend to any student interested in clinically applicable research. It is a great experience that can be an asset to your research.