Diabetes treatment is now reaching a major turning point.
Until now, diabetes care has evolved primarily around “lowering blood glucose levels.”
Insulin therapy, oral hypoglycemic agents, SGLT2 inhibitors, and GLP-1 receptor agonists.
Diabetes medications have advanced dramatically over the past decade or two, enabling many patients to maintain better glycemic control than ever before.
However, despite these advancements, the prevalence of diabetes continues to rise globally.
Today, at the forefront of medical research, the perspective is beginning to shift from merely focusing on the outcome of “blood glucose levels” to a more fundamental question: “Why do cells lose their normal metabolic control?”
At the center of this shift is a tiny RNA molecule called “microRNA (miRNA).”
microRNA is a crucial regulatory factor that modulates gene expression within cells. In recent years, research into its connections to diabetes, obesity, arteriosclerosis, neurodegenerative diseases, and even aging has been accelerating worldwide.
Particularly since the late 2010s, microRNA research in the field of diabetes has progressed rapidly.
In Western countries, the core concept is undergoing a major paradigm shift from “treatments that lower blood glucose” to “treatments that regulate cellular information.”
Furthermore, microscopic cell-derived capsules known as “exosomes” have garnered significant attention in recent years.
Exosomes contain various types of information, including microRNA and proteins, and may function as “messengers” that transmit information between cells.
In other words, diabetes is no longer viewed simply as an abnormality in blood glucose levels, but rather as a condition where:
- Intercellular communication
- Chronic inflammation
- Mitochondrial function
- Immune regulation
- Aging signals
and other factors are intricately intertwined, leading to a reinterpretation of the disease as a “systemic information network disorder.”
On the other hand, this field remains a very new domain of medicine.
When implementing regenerative medicine or cell-derived therapies in Japan, a strict management system based on the “Act on the Safety of Regenerative Medicine” is required.
In particular, for treatments involving advanced cell processing or high-risk domains, safety reviews and cell management frameworks aligned with the “Class I Regenerative Medicine Provision Plan” are highly emphasized.
Ultimately, this field is not merely “advanced medicine,” but a highly sophisticated medical domain that relies on the comprehensive integration of:
- Scientific evidence
- Quality control
- Cell processing technology
- Safety evaluation
- Regulatory design
to be successfully established.
Dr. Masato Odawara is a physician who has spearheaded this “research to understand diabetes at the cellular level” for many years.
Dr. Odawara is widely recognized as a leading authority in Japan within the fields of diabetes, metabolism, and endocrinology.
In 1989, he published his research findings on insulin receptor gene abnormalities in the journal Science.
This was an extremely advanced study for its time and stood as one of the pioneering works that opened the door to “analyzing diabetes at the genetic level,” a path that directly connects to contemporary medicine.
Since then, he has continued his research across a broad spectrum of fields, including:
- Insulin resistance
- Mitochondrial gene abnormalities
- Diabetic arteriosclerosis
- Metabolic disorders
- Endocrine regulation
and has supported diabetes care in Japan for many years.
Currently, Dr. Odawara is focusing his attention on the new frontier of “metabolic regulation by microRNA.”
Dr. Masato Odawara Profile
Specializes in the clinical practice of arteriosclerotic complications (Diabetology, Endocrinology and Metabolism, Atherosclerosis, Molecular Biology). His primary research themes include genetic predisposition to diabetes and its complications, risk factors for diabetic macroangiopathy, and molecular mechanisms of insulin resistance. In 1989, he published research on insulin receptor gene abnormalities in the journal Science. Currently, he continues to work on elucidating mitochondrial gene abnormalities, the causes of diabetes, and the genes involved in the onset of diabetic complications. After serving as Professor and Chairman of the Department of Diabetes, Metabolism, Endocrinology, Rheumatology and Collagen Diseases at Tokyo Medical University, he is currently a Visiting Professor at the same university.
【Areas of Expertise】Diabetes, arteriosclerosis, metabolic disorders (hyperlipidemia, hyperuricemia)
【Board Certifications & Credentials】
Certified Instructor and Board-Certified Diabetologist by The Japan Diabetes Society
Board-Certified Endocrinologist by The Japan Endocrine Society
【Academic Societies】
The Japanese Society of Internal Medicine (Councilor, Certified Physician, Board-Certified Instructor)
The Japan Diabetes Society (Councilor, Certified Physician, Board-Certified Instructor)
The Japan Endocrine Society (Delegate)
Japan Society of Diabetic Complications (Councilor)
Japan Society for Adult Diseases (Councilor)
Japanese Society of Clinical Molecular Medicine (Councilor)
Japan Society of Metabolism and Clinical Nutrition (Councilor)
Japan Society of Clinical Nutrition
【Biography】
Graduate of the University of Tokyo, M.D., Ph.D. Former Professor and Chairman of the Department of Diabetes, Metabolism, Endocrinology, Rheumatology and Collagen Diseases at Tokyo Medical University. Former Vice Director of Tokyo Medical University Hospital. Former Director of the Department of Endocrinology and Metabolism at Toranomon Hospital. Former Clinical Lecturer at the Faculty of Clinical Medicine, University of Oxford.
“Diabetes = Lifestyle Disease” Alone Cannot Explain It
— First, what is your perspective on current diabetes care?
Dr. Odawara:
Of course, diabetes is a disease closely related to lifestyle habits such as diet and exercise. However, in actual clinical practice, there are very many cases that cannot be explained by lifestyle factors alone.
Some people develop diabetes while others do not, even when maintaining similar lifestyles.
Some individuals develop severe diabetes despite being lean.
Conversely, some people do not develop the disease despite being obese.
In other words, it is not just a matter of “what you ate,” but rather how an individual’s cells react that is critical.
Recently, the concept of a “cellular state susceptible to diabetes” has begun to be highly emphasized.
This represents a significant shift.
In the past, the general understanding was simply that “high blood glucose equals diabetes.”
Today, however, we understand that underlying factors such as:
- Chronic inflammation
- Cellular senescence
- Decline in mitochondrial function
- Abnormal signal transduction
are deeply involved.
microRNA May Be the “Command Center of the Cell”
— Is microRNA at the center of this mechanism?
Dr. Odawara:
Yes, it is. microRNA is a highly fascinating entity.
Simply put, it potentially functions like a “command center within the cell.”
The human body contains tens of thousands of genes.
However, not all of them are active at all times.
They turn ON only when necessary.
They turn OFF when they are not needed.
Managing that coordination is thought to be one of the primary roles of microRNA.
For instance, in diabetes, there are cases where genes such as:
- Genes that intensify inflammation
- Genes that worsen insulin resistance
- Genes that promote fat accumulation
are abnormally activated.
microRNA possesses the potential to regulate these entire genetic networks collectively.
That is precisely why researchers around the world are focusing heavily on it right now.
There are Limits to Merely “Lowering Blood Glucose”
— What are the limitations of current diabetes treatments?
Dr. Odawara:
Current medications are exceptional.
In fact, they are helping a great number of patients.
However, the true threat of diabetes does not lie solely in “blood glucose levels.”
The real dangers are:
- Vascular damage
- Arteriosclerosis
- Neuropathy
- Nephropathy
- Cognitive decline
- Acceleration of systemic aging
In other words, diabetes is also a “systemic chronic inflammatory disease.”
Therefore, simply lowering blood glucose levels cannot completely halt certain aspects of the disease.
For example, “inflammatory signals” often persist over long periods in patients with diabetes.
This chronic inflammation:
- Damages blood vessels
- Damages nerves
- Damages mitochondria
And ultimately, it accelerates “aging itself.”
Recently, an increasing number of researchers have come to consider “diabetes as a type of accelerated aging disease.”
microRNA Has the Potential to Address the “Root Cause of Diabetes”
— Does microRNA have the potential to change that fundamental part?
Dr. Odawara:
I believe there is massive potential there.
Conventional medications have been, in a sense, a form of medicine that controls “outcomes.”
Blood glucose is high.
Therefore, we lower it.
Of course, that is vital.
However, microRNA research operates much further upstream.
“Why does that inflammation occur?”
“Why did the cells lose their normal response?”
It opens up the possibility of intervening directly in that informational control mechanism.
This is a groundbreaking shift.
If, in the future, we become able to normalize aspects such as:
- Inflammatory control
- Insulin sensitivity
- Mitochondrial function
- Cellular senescence
at the microRNA level, the very concept of diabetes treatment could be completely redefined.
Exosomes Become the “Couriers”
— Exosome research is also critical, isn’t it?
Dr. Odawara:
Extremely critical.
With microRNA alone, there are challenges in making it function stably within the body.
That is where exosomes enter the spotlight.
Exosomes are tiny information capsules released by cells.
They carry microRNA inside them to transport it.
In essence, they are “information couriers.”
This is highly intriguing.
For example, in the future, research could progress toward addressing metabolic disorders in a format like:
“Exosomes loaded with microRNA that suppresses inflammation”
This is a completely different concept from conventional pharmaceuticals.
It is not medicine, but a form of healthcare that delivers “cellular information.”
Diabetes Treatment May Evolve into “Predictive Medicine”
— Will pre-onset diagnosis become possible in the future?
Dr. Odawara:
That is highly probable.
Even now, at the research level, discoveries are being reported regarding:
- microRNA patterns indicative of a predisposition to diabetes
- microRNAs indicating arteriosclerosis risk
- microRNAs suggesting the progression of aging
Ultimately, this means that in the future, we may be able to identify a stage where:
“Blood glucose levels are still normal, but it will become dangerous if left unchecked.”
This would be a monumental achievement for medicine.
Until now, the timeline has been:
Becoming ill
↓
Abnormalities in medical tests
↓
Initiation of treatment
However, the future is likely to move in the direction of:
Detecting abnormalities in cellular information
↓
Intervening before the illness develops
This is what we call “predictive medicine.”
Connecting to “Aging-Control Medicine”
— Does diabetes research also tie into anti-aging?
Dr. Odawara:
They are very deeply connected.
In patients with diabetes, aspects like:
- Vascular aging
- Nerve aging
- Chronic inflammation
- Oxidative stress
tend to accelerate easily.
Hence, diabetes can be described as an “aging-accelerating disease.”
Conversely, if we can improve cellular information regulation, we can expect positive impacts on:
- The rate of aging
- Chronic inflammation
- Vascular damage
As a result, microRNA research is now expanding beyond mere diabetes studies and is beginning to connect with the broader theme of:
“What is aging?”
─
“Future Medicine” Has Already Begun
— In closing, how do you view the future of medicine?
Dr. Odawara:
I believe that medicine will transition from “material-based medicine” to “information-based medicine” going forward.
Historically, we have looked at “numerical values” such as:
- Blood glucose levels
- Blood pressure
- Cholesterol
However, we may be entering an era where we look at:
“How cells are exchanging information.”
The human body is not merely physical matter.
It is a system controlled by information.
microRNA research is striving to bring us closer to that core essence.
I sense an incredibly profound future in that pursuit.
Reprint source：WEB MAGAZINE AGELESS
https://ageless-medical.com/en/preventive-medicine/1969/
