Nov. 13, 2024 — During her preoperative appointment at University of Florida Health Shands Hospital in Gainesville in July, Nicole Lembo was shocked to hear her A1C level, which measures blood sugar, was 11.3% — far beyond the normal range of 5.7% to 6.7%.

Since elevated A1C levels can lead to an increased risk of complications following a procedure, Lembo’s oral surgery, scheduled for a few days later, had to be postponed indefinitely.

It was a wake-up call for the 55-year-old elementary school paraprofessional from Citrus County, Florida. She had been diagnosed with gestational diabetes during her pregnancy with her son 29 years before and was later diagnosed with Type 2 diabetes in her 40s.

“I was blown away,” she said of this summer’s blood glucose results. “I’m not the best at pricking my finger and checking my levels, but now here my care team is telling me we can’t do the surgery because they’re concerned about my body healing.”

About one in 10 Americans has diabetes, a chronic disease that occurs when the body doesn’t produce enough insulin or doesn’t use it properly. Though it can be managed, diabetes is not currently curable, and the biological mechanisms responsible for causing it are still being explored.

Clinicians and researchers at the UF College of Medicine are diabetes detectives, sleuthing for clues that will help them better understand what motivates cells and organs to function improperly, causing the disease. In time, they hope to uncover the key to a cure that would impact more than half a billion people globally. Through clinical and world-renowned research programs, as well as community outreach, Florida is making headway in improving the lives of people affected by diabetes at the local level and beyond.

The UF Diabetes Institute is a globally recognized incubator for some of the most promising researchers in diabetes, particularly Type 1.

Type 1 diabetes is thought to result from an autoimmune reaction in which the body interprets insulin-producing beta cells as foreign invaders and destroys them, leading to insufficient insulin production and unstable blood sugar levels. This differs from Type 2 diabetes, in which a person’s body doesn’t respond appropriately to insulin, causing glucose to remain in the bloodstream.

The university is widely considered to be among the top five in the nation for Type 1 diabetes research and is internationally recognized for its efforts in diabetes care and research. The UF Diabetes Institute is a leader in clinical trials seeking to prevent or reverse the disease and has been remarkably successful in acquiring competitive research grant funding from national agencies, including the National Institutes of Health, Breakthrough TD1, and the American Diabetes Association.

Florida researchers like Todd Brusko, Ph.D., director of the UF Diabetes Institute, have been pivotal in exploring immunotherapies and studying genetic variants that cause Type 1 diabetes.

His lab’s current research may be a game changer for diabetes patients, as he and his team explore specific genes linked to Type 1 susceptibility.

The institute benefits, Brusko said, from having a critical mass of clinicians, educators, and researchers in close proximity.

“When our physicians and scientists have been working together for decades, and our students and trainees are integrated, it raises the bar because everyone is operating at a very high level,” said Brusko, also a professor in the Department of Pathology, Immunology, and Laboratory Medicine.

Florida is also home to the largest diabetes organ and tissue sample and donation program, the Network for Pancreatic Organ donors with Diabetes, or nPOD. Tissue samples and blood samples from living study participants have been shared with more than 250 investigators worldwide, shipping from either Gainesville or an ancillary site in California. Investigators use these resources to drive further diabetes research and explore potential therapies.

Diabetes research at Florida expands beyond the College of Medicine. Graciela Lorca, Ph.D., a professor of microbiology and cell science at the UF Institute of Food and Agricultural Sciences, studies the role gut microbiota may play in the development of insulin production and predisposition to Type 1 and Type 2 diabetes.

Up to 95% of diabetes diagnoses are for Type 2, and until recently these diagnoses usually occurred in adulthood. In recent decades, the number of children and adolescents with Type 2 diabetes has soared.

“We have long understood that microorganisms play a role in human health,” said Lorca, who collaborates with researchers such as Michael Haller, M.D., a professor and chief of pediatric endocrinology at Florida. “When the sequencing era exploded in the 1990s, we gained access to sequencing whole bacterial genomes, as well as microbiomes present in different areas of our bodies. Our group used this technology to study animal models that develop diabetes or do not, and discovered that they have different biomes.

From there, we’re thinking, ‘Can we turn this into a therapy?’ I think it’s really rewarding that we have been able to move from that discovery phase early on into something we are already testing in the clinic.”

As scientists work in the lab to investigate new treatments for diabetes patients, Florida clinicians are busy meeting with populations affected by diabetes to find the best ways to manage care and provide updates on the latest information available.

On a hot summer day at Camp Winona outside the Ocala National Forest, 80 children ages 9-12 rotate between activities like yoga, arts and crafts, archery, and inflatable water obstacles, like at any other summer camp.

The difference for attendees of the Florida Diabetes Camp is that the children also get supplementary access to specialized physicians, mental health counselors, and other children their age who are going through the same challenges that come with living with Type 1 diabetes.

Founded in the 1960s and later incorporated as a nonprofit, the Florida Diabetes Camp offers a fun, safe, and educational space for children with Type 1 diabetes to gain confidence, skills, knowledge, and community.

Nearly 1,200 children from the Southeast U.S. annually attend the camp. Children ages 5-18 attend weekend and sleepaway camps for up to a week at a time at a low cost, with scholarships available for families in need.

“A big area of focus is building confidence because a lot of times, especially if they’re newly diagnosed, seeing a community going through the same things and having supportive, encouraging counselors and doctors there gets them out of their comfort zone and more willing to try new things,” said Prescott Cowles, the executive director for the Florida Diabetes Camp. “It’s a transformative week. And I think as a result, it also builds community among the campers and the staff. A lot of our volunteers have medical backgrounds, from the University of Florida and across the state.”

Paul Hiers, M.D. ’14, a clinical assistant professor in the Department of Pediatrics, serves as the camp’s medical director and ensures the counselors and campers have access to all the diabetes tools they require while at camp.

Hiers, who was diagnosed with Type 1 diabetes at age 18, said the camps are a safe space for children with diabetes to enjoy being kids, without parents and guardians needing to worry for their safety and well-being. Campers always have access to snacks if their blood sugar begins to run low; the amount of carbohydrates are calculated ahead of time for each component of every meal, which the campers and counselors — many of whom also have diabetes — use to determine how much insulin each camper needs after eating. And everyone take time to celebrate special achievements, like when someone administers an insulin injection on themselves for the first time.

During afternoon activities, Hiers also leads an education session, in which he and a mental health counselor allow the campers to anonymously submit questions and have open discussions about living and growing up with diabetes. During one camp this summer, preteen campers were curious about the impact of puberty on diabetes, what it’s like to live alone with diabetes, and struggles with feeling different from their peers.

“Don’t let it stop you from playing sports, being with your friends — you can do anything,” Hiers told the campers.

A pipeline of campers often return as counselors. Florida biology senior Shannon Brady, who was first diagnosed with Type 1 diabetes at age 12, attended the 2024 summer camps as a counselor for the first time, after enjoying the experience of being a camper.

“Diabetes is one of the things where you have an instant connection,” said Brady, whose goal is to become a pediatric endocrinologist. “It’s been great to feel like I can be an example for these kids that you grow with it and become more comfortable with it over time.”

Twelve-year-old Jack Garton, who attended camp for the second time this summer, said it’s a fun experience to make friends from around the state, whom he wouldn’t have otherwise met.

“You don’t feel weird, like when people ask about the insulin pump on your arm,” said the Palm Beach, Florida, resident. “You don’t really have to explain yourself because everyone already gets it.”

While children are receiving top-rate support for their diabetes through their participation in the camps, programs for UF Health’s adult population are also making a difference in the lives of diabetes patients.

After Lembo’s surgery was postponed, she was referred to UF Health to see endocrinologist Juan Pablo Perdomo Rodriguez, M.D., a clinical assistant professor in the Department of Medicine. Lembo said Rodriguez took the time to clarify any areas she had questions or concerns about, such as taking insulin for diabetes management.

“He was so patient and kind and just explained things to me,” she said. “I’ve had diabetes for over 10 years and was never truly educated about the details of diabetes that he shared. Not that my primary doctor didn’t help, but I don’t think they realized I just didn’t know some of this.”

Under her new care plan, Lembo receives insulin regularly and uses a real-time glucose monitor, allowing her to track her blood sugar levels as they fluctuate throughout the day.

She and her husband also met with Courtney Puentes, BSN, RN, the program manager for UF Health Diabetes Education and Nutrition, who counseled them on the best ways to incorporate foods higher in protein and fat into her diet to minimize blood sugar spikes caused by foods rich in carbohydrates.

Lembo has since started making many changes to her diet, such as incorporating a cheese stick in her work bag to eat alongside a snack of no sugar added applesauce. And when her sweetened morning iced coffee caused her blood sugar to skyrocket, she decided to swap her usual sweetener for a sugar-free alternative.

Between July and October, Lembo lost 20 pounds and said she feels healthier. At a three-month follow-up appointment with Rodriguez in October, she learned her A1C level had decreased to 6.6%, within a healthy range for those with Type 2 diabetes. She was cleared to undergo her oral surgery in November, three to six months earlier than her doctors originally thought she might be eligible.

“I probably wouldn’t have had my surgery until sometime next year, but everyone at UF Health really helped me. I thank God for their intervention,” Lembo said. “They opened my eyes, and I’ve been working hard with the new information I’ve received. I have 10 grandbabies, and I want to be healthier and live a longer life for them and my family.”