PNR&D continues collaborative mission in India

The Program for Neurology Research & Discovery’s mission of worldwide collaboration continued this summer, connecting Mount Pleasant, Michigan, with Chennai, India, through the work of medical students Sam Jackson and Mutshipay Mpoy.

The pair, rising second-year students in the Central Michigan University College of Medicine, traveled to India as part of a University of Michigan-led team of medical researchers working to improve the understanding and treatment of diabetes.

Sam Jackson, left, and Mutshipay Mpoy in Ann Arbor.

Sam Jackson, left, and Mutshipay Mpoy in Ann Arbor.

The study is led by PNR&D Director Eva Feldman, MD, PhD, a world-renowned leader in the field of diabetic neuropathy. Jackson’s work in diabetic neuropathy began as a U-M undergrad, when he began working with Dr. Feldman in the PNR&D. Mpoy, who was born in the Democratic Republic of Congo and fled to the United States as a refugee in 2000, has always had a passion to improve and care for underrepresented communities internationally.

The study is being conducted in collaboration with Dr. Vijay Viswanathan, director of the MV Diabetes Hospital in Chennai. Its goal is to improve understanding the mechanism of diabetic neuropathy – or nerve damage – the most common complication of diabetes.

According to Jackson, one of the interesting findings seen in the clinic is that patients may present with neuropathy without having full-on diabetes. Many patients develop this complication in what’s known as the pre-diabetic state, indicating that there may be other factors contributing to the progression of the nerve damage. In order to better understand this, this team of scientists has been screening patients in this early state of diabetes, looking not only at their sugar levels, but also other metabolic parameters including blood pressure, waist circumference, and various fat levels in their blood in order to identify other clues that may be factors in the development of this devastating disease.

“I’ve been repeatedly asked a very important question by my friends and family, ‘Is diabetes even a problem over there?’” Jackson said. “And the resounding answer is, ‘YES!”

Jackson said India reported more than 69 million cases of diabetes in 2015, more than double the U.S., which has around 30 million. One estimate shows that more than 1 million Indians die due to diabetes each year, and the problem seems to be getting worse. Due to poverty and certain cultural practices, the complications of diabetes seen in India can be more extreme than often seen elsewhere. Many people in India walk barefooted, which can be especially dangerous for people with diabetic neuropathy who cannot feel any pain if they cut or burn a foot. Additionally, bacteria love the excess sugar found in diabetic wounds, so infections of these undetected ulcers are very common. Diabetes also damages the blood vessels making it difficult for the body to transport blood and immune cells to the injury to naturally heal the wound. On top of all of this, many of the patients are extremely poor and avoid seeking medical treatment until absolutely necessary. This combination of loss of sensation, increased infection, impaired wound healing, and inability to access health care often add up to amputation, Jackson said.

By gaining a better understanding of diabetes and its complications, health care workers in the India as well as the U.S. can better predict and prevent serious complications such as these.

“Being able to see and experience what the health care system is like in India has been very eye opening,” Jackson said. “I did not grow up thinking I would be doing this kind of medical work abroad, but now I am more motivated than ever to do well in order to go back there. It really has been a life changing experience for me.”

Mpoy agreed.

“This experience has rekindled my love for medicine, reaffirming why I decided to go into medicine in the first place. It has reinforced my desire to work overseas in global health.”