Dr Sangita Sharma is a Centennial Professor and Endowed Chair of Aboriginal Health in the Faculty of Medicine and Dentistry at the University of Alberta and has over 22 years of experience working with multiethnic populations (eg Inuit, Inuvialuit and First Nations in Alberta, Northwest Territories (NT) and Nunavut (NU) and Alaska Natives, Apache and Navajo in the USA) focusing on chronic disease, diabetes and cancer prevention research. Sharma obtained her PhD from the University of Manchester Medical School in 1996 and since then she has worked with numerous populations in over 20 countries. Since moving to Canada in 2010, she has been leading a multi-disciplinary research group examining the risk factors for cancer, heart disease, diabetes, and obesity among Indigenous populations in Canada and around the world. As a Principal Investigator, Sharma has been awarded research funding for over 50 projects and was awarded the Silver Medal by the British Nutrition Society in 2010 for her health intervention program “Healthy Foods North” which was implemented in six communities in the NT and NU, in partnership with Inuit and Inuvialuit communities. Sharma has over 125 peer-reviewed scientific publications, including one recently in The Lancet Oncology (15:504-516, 2014) for her work studying cancer incidence in Indigenous populations through her Alberta Innovates-Health Solutions funded project “Cancer ACCESS”, currently underway in the NT in Inuvik and Fort Good Hope. Currently, she is also running the “WHY ACT NOW” program in Edmonton to improve nutrition and physical activity in Aboriginal and new Canadian youth, funded in part by the Alberta Diabetes Institute. Other projects underway include the CIHR funded “MATERNAL” studying factors affecting pre- and post-natal maternal health in Northern Canada and NIH funded ASTHMA studies.
A better means of assessing islet transplant success – Since islet transplantations began taking place there has been ‘scoring’ of graft success, typically based on patient glycemic control parameters. Not surprisingly, the most accurate means of assessing graft performance are based on more complex metabolic measurements like mixed-meal tolerance tests (MMTTs) that are not as practical in routine clinical settings. Approaches that are too simplistic such as basic fasting glucose and C-peptide levels are confounded by exogenous insulin or poor gylcemia. To date, the BETA score has been most useful, and is essentially the arithmetic sum of scores (0 for diabetes range, 1 for intermediate, 2 for normal) for 4 components: fasting glucose, HbA1c, stimulated C-peptide and absence of endogenous insulin or oral hypoglycemic agent. However, this approach has limited sensitivity due in part to the categorical scoring of the parameters.
Dr Peter Senior, Medical Director of the Clinical Islet Transplant Program, along with a team that included Dr James Shapiro and postdoctoral fellows Drs. Tolu Olateju and Richard Oram developed a new scoring system – the BETA 2 score. The basis of this score was continuous variables for common patient test values in a single, fasting blood sample - glucose, C-peptide, hemoglobin HbA1c and insulin dose. By using the measurements from 183 transplant patients that underwent MMTTs, and stepwise forward linear regression, the researchers were able to derive a mathematical formula for BETA 2 scores, with values over 20 reflecting insulin independence and scores under 15 reflecting glucose intolerance (see equation below).
In follow-up validation testing with 114 transplant recipients undergoing MMTTs 12 months after transplantation, BETA 2 scoring had over 82% sensitivity and specificity for correctly discriminating between these two groups. Results of this research show promise for the BETA 2 scoring system and warrant additional studies to validate its use (American Journal of Transplantation, doi:10.1111/ajt.13807, 2016).