The demand for diabetes research funding clearly exceeds the funds available. In the United States, 23.6 million children and adults (7.8 percent of the population) have diabetes, and we spent $174 billion on diagnosed diabetes alone in 2007 (the most recent year for which data are available). It is imperative that we take action, but where is the research funding coming from? Can it possibly be sufficient, and how is it being spent? 

From the idea stage, to preclinical (basic) investigations, to clinical trials and beyond, the scientific research required to understand a disease and develop a treatment is formidable and expensive. Once a proposed treatment has been found to be effective using test tubes or animal models, it then moves on to human clinical trials. Clinical trials help researchers find ways to prevent, detect, diagnose, control, and treat illnesses. The researchers and physicians involved in clinical trials must adhere to a strict set of rules that are designed and enforced by the National Institutes of Health (NIH) and the Federal Drug Administration (FDA). 

Clinical studies examine drugs in four steps, called Phase 1 through Phase 4. Phase 1 studies test a potential new compound or drug with a small number of volunteers to determine the best dose and evaluate side effects. Phase 2 studies test a drug with known doses and side effects, using a larger number of volunteers to learn more about how the body uses the drug and how the drug helps control the condition. Phase 3 (premarketing) and 4 (postmarketing surveillance) studies are typically randomized, controlled, multicenter trials comparing the new drug with a commonly used drug or the "gold standard" of care.

Federal Funding

The National Institutes of Diabetes and Digestive and Kidney Diseases (NIDDK) is one of a number of branches of the National Institutes of Health (NIH) that support diabetes research. The NIDDK budget estimate for 2010 is approximately $1.9 billion. Six hundred and twenty-five million of that total will be used for research related to diabetes, endocrinology, and metabolic disease; $484 million will go to digestive diseases and nutrition; and $150 million is earmarked for research specifically on type 1 diabetes.  These numbers were obtained from the NIDDK 2011 Budget Request.

Others federal institutes funding diabetes research include:

• National Eye Institute - diabetic eye disease
• National Heart, Lung, and Blood Institute - heart disease and vascular health
• National Institute on Aging - gerontology
• National Institute of Allergy and Infectious Disease - transplantation
• National Institute of Child Health and Human Development - gestational and type 1 diabetes, endocrinology, and nutrition
• National Institute of Dental and Craniofacial Research - periodontal complications of diabetes
• National Institute of Neurological Disorders and Stroke - stroke
• National Institute of Nursing Research - patient care, education, health promotion, and disparities
• Office of Behavioral and Social Sciences Research - behavioral aspects of health issues

Other government agencies include the Agency for Healthcare Research and Quality (AHRQ), which funds research in healthcare cost and quality, including diabetes care, and the Centers for Disease Control (CDC), which fund translational research in diabetes.

JDRF

The Juvenile Diabetes Research Foundation (JDRF) has funded more than $1.4 billion in diabetes research since its founding in 1970. In fiscal year 2009, it paid out close to $101 million to support research projects in 22 countries and fund 40 clinical trials.

$33 million went to research on immune therapies - attempting to stop the body's autoimmune response from attacking and destroying beta cells.

$39.8 million went to research on beta cell therapies - promoting either the regeneration of beta cells or their replacement.

$5.9 million was spent on glucose control research - improving glucose control through the development of novel insulins, and especially the development of a closed loop artificial pancreas.

$22.1 million went to research on complications therapies - blocking complications affecting the eyes, kidneys, and nerves.

ADA Research Foundation

The ADA Research Foundation has funded over 4,000 research projects since its inception in 1953 and has invested over $500 million in diabetes research since 1980. Its mission is "to ensure the availability of funds necessary for the full exploration of all the scientific possibilities that diabetes research is generating."

Significant ADA discoveries include the invention of the first glucose meter and first insulin pump, the development of oral diabetes medicines to help control blood sugar in patients with type 2 diabetes, and mapping the genetics of both type 1 and type 2 diabetes.

During the last 10 years, the ADA has funded over 1300 grants, including such projects as the development of programmable implantable insulin pumps, the replacement of beta cells for the treatment of type 1 diabetes, and the regeneration of islet cells to prevent type 2 diabetes, currently underway.

Other non-federal funding agencies include the following (adapted from UNC http://research.unc.edu/grantsource/diabetes.php):

• Allen Foundation emphasizes the connections between diet and health, and funds projects that benefit nutritional programs.
• American Association of Diabetes Educators supports research in the profession of diabetes education.
• American Federation for Aging Research supports basic and clinical research in gerontology.
• American Geriatrics Society and its spin-off, the AGS Foundation for Health in Aging, support research in areas related to gerontology and senior healthcare issues, including diabetes.
• American Health Assistance Foundation is interested in the health concerns of seniors, focusing on Alzheimer's, macular degeneration, glaucoma, and heart disease, including diabetes as an associated factor.
• American Heart Association supports research into heart disease.
• American Society of Health System Pharmacists supports research in the safe and effective use of medication, especially for chronic conditions.
• American Society of Nephrology funds clinical and basic science research in the field of nephrology through a variety of grants.
• Bugher Foundation is dedicated to cardiovascular disease research, including hypertension related to diabetes.
• Johnson & Johnson offers basic research grants and partnerships in various areas of interest, including diabetes.
• Joslin Diabetes Center brings individuals with unique and interesting perspectives to study broad areas of type 1 and type 2 diabetes and related complications in collaboration with Joslin faculty.
• National Kidney Foundation seeks to further the understanding of kidney disease, offering a clinical scientist award, young investigator grant, and research grants from the Council on Renal Nutrition.
• Oral and Maxillofacial Surgery Foundation supports new research on oral and maxillofacial surgery (including oral diseases associated with diabetes).
• Orentreich Foundation for the Advancement of Science occasionally makes limited grants to support collaborative biomedical research on topics including aging and endocrinology.
• Polycystic Kidney Disease Foundation awards grants and fellowships for basic or clinical research on autosomal dominant polycystic kidney disease (ADPKD) and autosomal recessive polycystic kidney disease (ARPKD).
• Prader-Willi Syndrome Association (USA) funds research on Prader-Willi Syndrome.
• Prevent Blindness America focuses on public health issues and clinical research relating to eye diseases.
• Retina Research Foundation is dedicated to reducing blindness caused by retinal disease and provides basic research grants, research project awards offered in conjunction with other organizations, and career development awards.
• Robert Wood Johnson Foundation funds research and programs on topics such as childhood obesity, health disparities, and quality healthcare.
• Roche Organ Transplantation Research Foundation seeks to advance the science of solid organ transplantation and offers conventional and clinical research grants.

International

A program initiated by the International Diabetes Federation (IDF), called BRIDGES (Bringing Research in Diabetes to Global Environments and Systems), is supported by Eli Lilly and Company. The program's goal is "to help communities around the globe to identify special needs related to intervention and prevention."  It focuses on "translational" research, in which currently available knowledge is translated into useful practices for public health.

BRIDGES is supporting 20 translational research projects around the globe, including the "Effectiveness of a group diabetic education programme using motivational interviewing in underserved communities in South Africa," "Improving Diabetes Care in Cap Haitien, Haiti," and "Prevention of type 2 diabetes in women with gestational diabetes in urban India - a feasibility study."