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Dr. Jesse Roth. Image via Shmulik Shalish

In the world of diabetes research, there are superstar names you just know.

For example, Banting and Best, who discovered insulin. Elliot Joslin, who pioneered modern treatment and care. Kamen, Tamborlane, and others who led technology development.

And then there are the names that may not be as familiar: researchers who spent years in labs studying and testing, who broke down barriers to reveal a better understanding of diabetes and, yes, better outcomes.

Dr. Jesse Roth of the Feinstein Institutes for Medical Research in Manhasset, New York, is one of those quiet heroes.

After 5 decades of lab work that have changed the diabetes treatment landscape, he was recently named one of the “Giants in Medicine” by the renowned Journal of Clinical Investigation.

“His work hastened the discovery of insulin receptors and their molecular interactions within the body. New research by Dr. Roth and his colleagues around hormone-like molecules released within the intestine show promise for preventing pathological inflammation that is closely associated with diabetes and other illnesses,” writes the Feinstein Institutes in an earlier press statement.

“His lifetime contributions to understanding diabetes continues to lay the groundwork for future advancements.”

Turns out none of this may have been the case were it not for a lost job opportunity, a war in Vietnam, and Roth’s then-bosses going overseas for a bit.

“I felt like there was a divine finger pointing me in the right direction,” Roth said of his career, still ongoing 50-plus years later.

As a freshly minted graduate from his medical residency program, Roth was at a loss for where to land next. After a well-known prestigious institute turned him down (they weren’t hiring at the time), a seasoned physician became a mentor and guided him along.

“He took me for a drink in a fancy hotel in St. Louis,” Roth told DiabetesMine. “I’d never had such a fancy drink before.”

While the drink was sublime, it was the advice that resonated.

“He looked me in the eye and said, ‘The guy you want to work with is Rosalyn Yalow.’ She was at a small but avant-garde place in the Bronx (the Bronx Veteran’s Administration). Ends up, it was the perfect place for me.”

There, Roth had a chance to hone his skills in research and in partnering on studies, he said, especially when the big guns there traveled to Europe on an extended trip.

That time to explore and expand helped him grow as a researcher, he said. And it was noticed.

“When they came back, they saw us — and me — as future stars,” he said.

Indeed, Yalow later won a Nobel Prize for her work with Dr. Solomon Berson proving that type 2 diabetes is caused by the body’s inefficient use of insulin, rather than a complete lack of insulin as was previously thought.

When the Vietnam War began, Roth, not wanting to be drafted, asked his boss for help. That boss landed him a job at the National Institutes of Health (NIH). “He basically called the NIH and said, ‘I’ve got this kid for you!’” Roth remembered.

And that is where his diabetes-world-changing discoveries took root.

“My boss there said to me, ‘These are exciting times. Instead of doing what you were doing before, think of what the most exciting thing you could do would be,’” he said.

Roth settled on a question to answer: How does a cell know that insulin is there?

At that time, nearly 50 years ago, it was thought that insulin receptors were found in muscles and fat, and nowhere else in the body, Roth said. It was also thought that insulin worked pretty much on its own.

A younger Dr. Jesse Roth

What Roth and his team discovered was groundbreaking in every way: First, insulin receptors exist not just in pockets of muscle and fat, but throughout the entire body (even in the brain).

Second — and this opened the door to researchers digging even deeper into the cause and effect of diabetes — “insulin itself does nothing,” Roth said. “It’s the receptor that drives what the diabetes does.”

“It was definitely an aha moment,” he said. “It took us several years to convince people why this was important, which meant we had to stick to it and go several years with no applause. People were not ready for it. They yawned at us.”

But Roth and his NIH team knew they’d revealed crucial and useful information.

And they were right. Their discovery led to not just understanding how insulin and receptors work in tandem in a body, but also that insulin works differently in different people.

This finding led to the now common understanding that there aren’t just one or even two types of diabetes: There are many, and each requires its own research, understanding, and treatment.

“It used to be seen as one or two diseases,” Roth said. “Now, it turns out diabetes is a portfolio of diseases.”

That discovery, along with more research looking at how receptors act in each type of diabetes, he said, led to better treatments, since physicians could now look at each type of disease with a unique set of eyes.

Roth said that is what “jazzes up” a researcher such as himself.

“The lab is driven by what’s going on in the clinic,” he said. “Any time there is an improvement clinically, we’re extremely excited as well as motivated.”

For people with diabetes of any type, this knowledge led to more discoveries and, better yet, more precise treatments.

Being able to zero in on things like helping urine flush glucose is one example, Roth said, referring to SGLT2 drugs that leverage that pathway. This treatment has proven highly beneficial to people with type 2 diabetes, and is now sometimes introduced into treatment for those with type 1 as well.

Roth’s discovery of different forms of diabetes also helped practitioners explore things like exercise, stress, growth, and other factors that can come into play with insulin and receptors.

This has allowed people with diabetes and their medical teams to strive for better management and understand more when things go wonky.

While this may seem simple to anyone newer to diabetes, it’s important to remember that before this discovery, most people with type 1 diabetes took one injection a day and made few other changes in their dosing or daily activities around diabetes. This led to very imprecise diabetes management.

Today, all that has changed, thanks in large part to the work of Roth and his team.

Roth’s work over the years helped land him in some challenging and exciting roles.

He served as assistant surgeon general to the U.S. Public Health Service from 1985 to 1991 and as a fellow of the American College of Physicians, and has held leadership positions at the NIH and Johns Hopkins before joining Northwell Health and the Feinstein Institutes in 2000.

Today, Roth is still working hard and has more questions to answer in the lab.

Among them, he said, is further exploring the information he learned early on about the brain.

“One area I’m excited by is knowing we have insulin receptors all over the brain,” he said.

“We couldn’t figure out what to do there, but there are groups working on this now in Munich and Cologne (Germany), and in the United States. It’s exciting to think what could come of that,” he said.

Roth would also like to see more investigation into insulin and the nervous system. “We started it years ago but could not get people excited about it… Now, it’s getting worked on.”

Roth also has another dream that he believes can be reality: “I am very optimistic that we can cure type 1 and type 2 diabetes,” he said.

There’s no timeline attached to that, but not for lack of effort, he said.

“The body is just much more complicated than we think,” Roth said.

One more goal has less to do with the lab than the rest of the world, but it’s one Roth is passionate about: combating racial disparities in treatment.

“There is a marked unevenness in care in the United States,” Roth said. “We don’t see this in other places where healthcare is more accessible. We need to change that.”