Medalist Program & Study

In 2003, George King, MD and Hillary Keenan, PhD, initiated the Joslin 50-Year Medalist Study, which is now known as "The Medalist Study." The Joslin Medalist Study was initiated in order to determine whether protective factors exist to prevent the development of severe complications such as retinopathy, nephropathy, and cardiovascular diseases in people with diabetes.

Protective factors against these terrible complications may exist in diabetic patients since previous anecdotal reports have indicated that in rare individuals who have had type 1 diabetes for more than 50 years, eye or kidney complications may not occur even with hyperglycemia.

This idea is very exciting since the findings of these protective factors can benefit millions of people with diabetes to prevent or stop the development of devastating eye and kidney complications. In order to determine and characterize these protective factors, The Medalist Study recruited over 1,000 people with type 1 diabetes and still living in the United States. Each Medalist's medical history and records were reviewed in order to make sure that the individual had been insulin dependent for 50 years or longer.

Once the 50-, 75-, or 80-year medals had been awarded, each medalist was invited to join the Medalist Study. This involved:

• A medical history questionnaire and clinical evaluation. The evaluation took pace at the Joslin Diabetes Center's Clinical Research Center, and included physical exams, an EKG, mixed meal tolerance test (MMTT), and complete eye examination.
• Laboratory tests, including plasma serum, urine, and circulation cells; including a DNA analysis.

The Medalists responded with a high level of enthusiasm to this study with more than 80 percent participation. Further, over 50 percent of the medalists agreed to donate their organs upon their passing.

The results from the initial studies provide exciting information. About 35 percent of the Medalists in the Medalist Study do not have significant eye, kidney, or nerve diseases; even in the presence of hyperglycemia for 50 years. These studies, reported in several highly cited articles in important journals, Diabetes Care (2007,2011) strongly support the idea that protective factors exist endogenously in the Medalists, which can neutralize the adverse effect of hyperglycemia in the eye, kidney, and possibly nerves.

In addition, these studies also show exciting new findings that a large number of Medalists still can produce insulin as measured by plasma level of C-peptide. This new finding has raised a possibility that factors may exist in people with T1DM, which can rejuvenate insulin producing beta cells, and can be therapeutically important for both type 1 and type 2 diabetic patients.

In 2010, Drs. King and Keenan began the longitudinal component of The Medalist Study, which invites each of the original 1,020 participants to return to Boston for a second set of studies to confirm the original findings and determine whether aging can affect the course of T1DM. Recent studies using the bio specimen obtained in circulating blood and targeted organs, such as the eye and kidney have identified a profile of proteins that have the capability to prevent damages to the kidney.

Through a long and complex study, Dr. King's laboratory has potentially identified a set of proteins that could protect the various parts of the kidney from being damaged by high blood glucose levels. This was published in one of the most prestigious scientific journals in the world, Nature Medicine, in 2017. Further reports will be coming soon regarding the protective factors against the development of eye disease in individuals with diabetes.

At this time, we have started multiple new projects involving the Medalists. These other studies include the characterization of Medalists' beta cell functions to produce and secrete insulin. The studies also looked at the existence or lack of cognitive dysfunction and osteoporosis, which are two of the major complications of aging diabetic patients. Another new study will be on the role of the gut bacteria to preserve the beta cell's ability to make insulin.

In addition, our newest endeavor is to characterize how the potential protective factors in the cardiovascular tissues that could be protecting the Medalists from heart disease with a seed grant from The Thomas J. Beatson, Jr. Foundation. These studies have and will provide a wealth of information regarding patients with long duration type 1 diabetes and will have a huge impact on the development of new treatments, even a cure for diabetes and its complications.

We want to thank all the Medalists who have been awarded the medal and those who have participated in our study. We greatly appreciate their enthusiasm in participating in the study, their generous donations of bio specimens, and all of the other assistance they have provided since 2003.

Have you or a loved one lived with insulin-dependent diabetes for 25, 50, 75 years or more? If so, Joslin would like to recognize this achievement.

This program is open to everyone. You do not have to be a Joslin patient to participate. There are no physical restrictions for these awards, however, some form of documentation is required. Records of the date of your diagnosis and the date you began insulin treatment are helpful.

• Medalist Application
• Release of Protected Health Information form to request records from external institutions
• Authorization for the Release of PHI

If you would like more information about Joslin’s Medalist Program, please call 617-309-3421, 617-309-4538, or email us.

R01 Application

The 50-Year Medalist Study welcomes investigators for ideas and collaboration. If you have any inquiries, email us.

Review Committee

The committee will consider all requests for a two-month deliberation period and respond within three months of receipt. Each request should include a short proposal (no more than two pages) about your idea, specific aims, background, and research plan. Please attach a biosketch with all collaboration requests.

Data Sharing

Once the project is approved, we will provide the principal investigator with all of the data necessary to finish the project.