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DIABETES AND
OBESITY

the treatment of diabetes exists and has well-known, affordable by asking subjects to walk as fast as they can for 10m and taking
medications in the market. Could this possibly also be the solu- the fastest speed of 3 trials. low physical activity is measured by
tion for frailty? the “Minnesota leisure Questionnaire” (MlQ) which calculates
The diabetes meds in the market today have multifactorial ef- the calories burned through different physical activities conducted
fects within the body with mechanisms that are not 100% under- in one year and the calories are compared to a nationally studied
stood by the medical community. but the most important known database. Weight loss is assessed if there was a 10lb or more un-
effect is the increase in glucose uptake within the cells through in- intentional weight loss or loss of >5 percent body weight in the
sulin. This “insulin sensitizing effect” is mediated via a highly span of one year and finally exhaustion is recorded via self-re-
complex AMPK signaling pathway which has hundreds of cascade ported questionnaires. Within these parameters it’s possible to
effects within the body. One of the most important and relevant quantify the extent of “frailty” progression throughout the study
cascade effects is the overall decrease in inflammatory markers using a score of 0-5. Within the course of two years I will help
such as CRP, Il-6, and TNF-a. These are the key inflammatory assess patients and see whether diabetes medications may revolu-
markers that exacerbate frailty. tionize the treatment for frailty.
So perhaps there can be a way to treat patients that are afflicted being involved in the MSTAR (Medical Student Training in
with frailty. This hypothesis is built from two premises. One, an Aging Research) program as a first- and second-year medical stu-
increase in inflammatory markers can cause or exacerbate frailty. dent equipped me with the tools to be involved with the diabetic
Two, diabetes medications work by decreasing inflammation via patient population. My favorite aspect of this research opportunity
AMPK signaling pathway and insulin sensitization. So, the re- is that I have the opportunity to work in the veterans hospital and
search question is formulated: can diabetes medications be used interact with the geriatric patients that are within the vA system.
to ameliorate and even treat frailty? To learn more information about the MSTAR program or vA
This was the research question that I worked with in the health system visit:
MSTAR (Medical Student Training in Aging Research) program https://www.afar.org/research/funding/mstar/
as a first- and second-year medical student with dr. Sara Espinoza. https://www.va.gov/health/vAhealthnews
dr. Espinoza is one of the pioneers for frailty and diabetes re-
search here at UT Heath San Antonio School of Medicine. She Patricia S. Machado, is a medical student at University of Texas Health
works with the vA hospital and is currently conducting a double- San Antonio, Long School of Medicine and MSTAR program participant.
blinded randomized controlled trial involving
200 participants within a two-year period to
test whether diabetes can be used as a phar-
macological treatment for frailty. The inclusion
criteria are patients over the age 65 that are af-
flicted with pre-diabetes with OGTT between
140-199 mg/dl that also show signs of
“frailty.” The term frailty that is used by her
team is described by 5 categories that include
weakness, slowness, low physical activity, ex-
haustion, and weight loss (Fried et al. 2001).
Weakness is assessed via grip strength, where
subjects squeeze into a device called a dy-
namometer that measures force (N) of the
dominant hand and the highest number of
two trials is recorded. Slowness is calculated

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