Richard A. Jackson, M.D.
Dr. Jackson is an Investigator in the Section on Immunobiology, a Senior Physician and the Director of the Hood Center for the Prevention of Childhood Diabetes at Joslin, and an Assistant Professor of Medicine at Harvard Medical School. He received his medical degree from Ohio State University School of Medicine and completed residency training at Worcester Memorial Hospital as well as fellowship training in Endocrinology at Duke. He is a former Mary K. Iacocca Fellow and recipient of the Cookie Pierce Research Award from the Juvenile Diabetes Research Foundation.
To prevent type 1 diabetes, one must first know who is at risk. For 50 years, Joslin researchers have been at the forefront of efforts to improve the methods for identifying people likely to develop diabetes, starting with metabolic screening of the family members of diabetes patients in the 1950s. Through the 1980s and 1990s, Dr. Jackson and his collaborators broke new ground in the use of markers called autoantibodies as powerful tools for risk assessment. His efforts led to the launch of the Diabetes Prevention Trial - Type 1 (DPT-1), the first National Institutes of Health-sponsored clinical study of the effectiveness of preventive strategies in first- and second-degree relatives of patients with type 1 diabetes.
Such studies are complicated by the fact that the pancreas is difficult to biopsy and is not easily visualized using imaging technologies. During DPT-1, Dr. Jackson, who was Principal Investigator for Joslin in the study, and his collaborators Diane Mathis, Ph.D., and Christophe Benoist, M.D., Ph.D., noted that the time required to draw conclusions in interventional studies could be greatly reduced if they could obtain a clearer picture of precisely what was going on in the pancreas.
This insight has fueled an ongoing collaboration with radiologists at the Massachusetts General Hospital centered on adapting magnetic resonance imaging (MRI) for “viewing” the state of the pancreas. Cancer researchers pioneered the use of biodegradable iron nanoparticles to make tumors more visible by MRI. Tumor blood vessels leak, encouraging accumulation of the nanoparticles within tumor tissues. The same principle applies in the prediabetic and diabetic pancreas, which also tend to have leaky blood vessels. This research is giving Dr. Jackson and his colleagues a fresh look at what happens within islets as diabetes develops, and could also help accelerate clinical trials by opening a window into the effects of new interventions or medications.
As an offshoot of his prevention work, Dr. Jackson is interested in understanding how to better disseminate information on diabetes control to the community. Many people with diabetes are unsure of the precise steps needed to properly control their condition, particularly if they are unaware of areas of concern. Together with the U.S. Department of Agriculture’s Cooperative State, Research, Education and Extension Service, Dr. Jackson has set up a series of community-based programs, mostly in underserved rural locations, to provide self-care information, blood pressure screenings and blood tests.
In addition to these programs based in underserved areas, Dr. Jackson launched an in-house Diabetes Outpatient Intensive Treatment (DO IT) program. This three-and-a-half-day program—offered at Joslin Clinic by Dr. Jackson and a team of diabetes educators, dietitians, exercise physiologists and social workers—consists of a thorough set of physical assessments and educational workshops aimed at providing patients with up-to-date, personalized information on how well they are controlling their diabetes and what steps they can take to control it better. Randomized controlled studies have shown the effectiveness of this program, and it continues as a testing area for new approaches to diabetes care.
Polonsky WH, Fisher L, Earles J, Dudl RJ, Lees J, Mullan J, Jackson RA. Assessing psychosocial distress in diabetes: development of the diabetes distress scale. Diabetes Care 28:626-631, 2005.
Polonsky WH, Earles J, Smith S, Pease DJ, Macmillan M, Christensen R, Taylor T, Dickert J, Jackson RA. Integrating medical management with diabetes self-management training: a randomized control trial of the Diabetes Outpatient Intensive Treatment program. Diabetes Care 26:3048-3053, 2003.
Krischer JP, Cuthbertson DD, Yu L, Orban T, Maclaren N, Jackson R, Winter WE, Schatz DA, Palmer JP, Eisenbarth GS. Screening strategies for the identification of multiple antibody-positive relatives of individuals with type 1 diabetes. J Clin Endocrinol Metab 88:103-108, 2003.
Diabetes Prevention Trial–Type 1 Diabetes Study Group. Effects of insulin in relatives of patients with type 1 diabetes mellitus. N Engl J Med 346:1685-1691, 2002.