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Dr. Rodica Pop-Busui — Making Strides Against Diabetes Complications

Rodica Pop-Busui, MD, PhD
According to the American Diabetes Association, diabetes was the seventh leading cause of death listed on U.S. death certificates in 2006 and was a contributing factor in three times more additional deaths. Diabetes-related deaths are due to the serious complications that arise from the disease. For example, heart disease and/or stroke were noted on 84% of diabetes-related death certificates among people aged 65 years or older in 2004. Diabetic neuropathy occurs in more than 50% of patients with diabetes as a result of the nerve damage, and is associated with high risk for amputations and mortality.

Diabetes complications can also have disastrous effects on a person’s quality of life, as well as taking a huge economic toll on the healthcare system and patients’ budgets. All of these factors have motivated Dr. Rodica Pop-Busui, M.D., Ph.D., to specialize in the field of diabetes.

“There was no doubt in my mind, ever since I started doing clinical rotations in medical school, that I wanted to do this,” Dr. Pop-Busui says. “I was seeing many patients with diabetes who were experiencing devastating complications, and I wanted to prevent these things from happening in the future.”

Dr. Pop-Busui also always wanted to go into medicine: “Since the fourth or fifth grade, I wanted to help people by becoming a doctor. Later I realized the importance of understanding the complexity of the human body, how to mend pain and restore functioning.”

Dr. Pop-Busui graduated college in her native country of Romania at the top of her class, with a B.S. in mathematics-physics, summa cum laude. She went on to study at the University of Timisoara School of Medicine. She was the number two applicant chosen in a competitive testing system from a field of 3,000 vying for 100 slots. She also excelled there, earning her M.D. summa cum laude with perfect scores, as well as earning her Ph.D. in molecular biology, again graduating summa cum laude. She concurrently held an assistant professorship at the Division of Diabetes, Nutrition and Metabolic Disorders, University of Timisoara, while doing residency in internal medicine.

Dr. Pop-Busui credits Dr. Gheorghe S. Bacanu, one of her professors of internal medicine at the University of Timisoara, for being an important influence on her career choice. He created the first diabetes center in Romania in the 1950s with his vision that diabetes patients should receive comprehensive care. He also had a large database of over 4,000 diabetes patients who were being followed and studied, which was Dr. Pop-Busui’s first exposure to doing research.

As a result, Dr. Pop-Busui decided that she wanted to do clinical research, as well as treat patients. “I realized how complex and devastating a disease that diabetes can be, as far as complications. And I realized that you can actually make a step forward if you can better understand how to prevent the complications from happening in the first place.”

Romania was still a poor country, without access to state-of-the-art equipment to do the best research. To further her research, Dr. Pop-Busui applied for and received a Fulbright Scholarship to study in the United States. She had read a lot of medical literature about diabetes research here at the University of Michigan, so she chose to come to the Ann Arbor. Despite the fact that it meant she would have to re-take her medical board exams and do additional fellowships before she could apply to practice medicine in the U.S., Dr. Pop-Busui was undaunted. By then, she had determined that she would dedicate her efforts to fight diabetes complications. The diabetes complication she was most interested in was neuropathy — damage to the nerves in various parts of the body, including the heart.

Dr. Pop-Busui served as a research fellow in the then-called Division of Endocrinology and Metabolism at the University of Michigan for three years and then was a clinical fellow for another three years. After a stint on the faculty of the Medical College of Ohio, Toledo, in 2005 she returned to the University of Michigan as an assistant professor of medicine in what is now the Division of Metabolism, Endocrinology and Diabetes (MEND), promoted to associate professor in 2011. Dr. Pop-Busui also currently serves as the Associate Director of the U-M Peripheral Neuropathy Center under Director Eva Feldman, M.D., Ph.D.

In her relatively short tenure in the MEND Division (especially compared to the lengthy road she took to get here!), Dr. Pop-Busui has already made her mark. Not only has she authored or co-authored numerous papers, but she is also the head researcher for the U-M branch of several important multicenter studies funded by the prestigious National Institutes of Health (NIH).

One of the groups that Dr. Pop-Busui led worked with data from a large, important trial called the “Action to Control Cardiovascular Risk in Diabetes” (ACCORD). She is also a co-investigator for the U-M branch of the well-respected “Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications” (DCCT/EDIC). William Herman, M.D., M.P.H. is the lead investigator for the U-M site.

Several of the trial results that Dr. Pop-Busui took part in publishing relate to the proven importance of an early "intensive glucose control" in preventing serious diabetic complications. "Intensive glucose control" is defined as keeping hemoglobin A1c readings as close to normal as possible (seven percent or less), with at least three insulin injections a day or an insulin pump, guided by self-monitoring of blood glucose five to six times daily.

While Dr. Pop-Busui is involved in numerous research projects on a variety of neuropathy complications, in both type 1 and type 2 diabetes, her main focus now is on a type of heart nerve damage called cardiovascular autonomic neuropathy (CAN). CAN often manifests as heart rhythm problems that lead to ischemia (blocked blood flow) and cardiac death.

Dr. Pop-Busui states, “Trials that study neuropathy [nerve damage] — and, specifically, CAN — are lacking, especially compared with the wealth and quality of trials exploring other diabetes complications, such as nephropathy [kidney damage] and retinopathy [damage to the retina in the eye].”

Because of this, Dr. Pop-Busui sought, and was awarded in fall 2010, a prestigious $2.3 million R01 grant from the National Institutes of Health to fund a novel study of how heart disease develops in patients with type 1 diabetes. The aim of the study is to identify sensitive biomarkers that characterize the earliest problems with heart function and predict their progression, allowing effective therapies to be developed to prevent and treat this dangerous condition at an early stage. Patients at least 18 years old who have been diagnosed with type 1 diabetes for no more than 5 years are being sought for this important, ground-breaking study.

Part of the problem with studying the heart is how to observe it! To avoid extreme procedures such as heart biopsies to gather the data, Dr. Pop-Busui devised an original, comprehensive, minimally-invasive approach to measure the effects of diabetes on heart and other organs by integrating state-of-the-art imaging scans and molecular techniques, continuous glucose monitoring, and sophisticated mathematical modeling.

The blood glucose data is being captured from study subjects with a new-generation continuous glucose monitoring sensor, which is inserted under the skin and worn by patients for several days at various time intervals. Dr. Pop-Busui, who does not have diabetes, wore the same continuous glucose monitor for one week while planning the project, in order to understand what her study subjects would experience.

Positron emission tomography, or PET scans, using specific tracers specially developed by the U-M Division of Nuclear Medicine, will be used to study the heart’s use of oxygen and sympathetic function. A revolutionary cardiac magnetic resonance imaging (MRI) technique called “myocardial tagging,” which offers three-dimensional studies of the left ventricle’s contraction, will be employed to identify abnormalities of heart function before they can be detected clinically by the patient’s doctor.

Clinicians wishing to refer patients to the study or who would like more information may contact Dr. Pop-Busui at 734-763-3056 or rpbusui@med.umich.edu.