Diabetes: Hope For the Future

During the month of November, I have joined with others at Blogcritics in "Blogging for a Cure" for diabetes. Millions of Americans are afflicted with diabetes. Each and every one of us is impacted in some way, either directly because we have the disease or know someone who does, or indirectly, because healthcare costs for everyone are higher due to the high cost of treating diabetes.

Each one of us is responsible for our own health. The most important thing I can do in the fight against diabetes is to take care of myself: eat properly, get enough exercise, keep my weight at an appropriate level for my build, and so on. If each of us did that, diabetes would still occur, but it wouldn't be nearly as prevalent as it is.

Reality intrudes, unfortunately. The typical American lifestyle is not particularly healthy. Obesity is a national epidemic. Diabetes, especially Type 2 diabetes, is likely to become much more prevalent, not less.

Thankfully, researchers are exploring ways to treat and prevent diabetes, despite our unhealthy lifestyles, and they are meeting with success. New drugs and other therapies designed to prevent or treat diabetes or its effects are being discovered or tested right now. In the following paragraphs, I'll point you to information on some of the experimental and current treatments I've learned about.

Islet Transplantation

The American Diabetes Association has a page on their web site describing this potential treatment for Type 1 diabetes. This form of diabetes (also known as childhood diabetes) is caused due to destruction of the islet cells in the pancreas which produce insulin. It has been recognized for many years that if the islet cells in the pancreas of a person with Type 1 diabetes could be replaced via transplantation, then perhaps the disease could be eliminated. Until recently, however, islet cell transplantation has not been very successful in humans. However, scientists at the University of Alberta in Edmonton, Canada developed what is known as the "Edmonton protocol," which allows islet cells to be successfully transplanted into a diabetic patient's liver. Once the islet cells start functioning, the patient often can stop daily injections of insulin.

This treatment is not perfect, as it requires the patient to take anti-rejection drugs, the supply of donor islet cells is limited, and it does require surgery. Research is continuing in this promising field. More on this later in this article.

Drug Therapies

There are a large number of drugs being tested for treatment of Type 1 and Type 2 diabetes, attacking the problems of these diseases from different angles.

•  Some drugs slow the rate in which blood sugar levels rise after meals.
•  Some drugs mimic the effects of naturally-occurring hormones that stimulate insulin production, increase the bodies' sensitivity to insulin, reduce appetite, and slow digestion.
•  On the other hand, some of the drugs in development block the action of other hormones that are known to raise blood sugar levels.
•  Since Type 1 disease is caused by destruction of the islet cells in the pancreas by the diabetic's own immune system (it is an "autoimmune" disease), some research has focused on drugs and vaccines that prevent the destruction of the islet cells. Scientific American reported on such a drug that appeared to be successful in a small trial last year (subscription might be required for the link to work).
•  Some drugs are known to increase the body's sensitivity to insulin, and at least two broad classes of drugs with this effect are in use; however, others are being researched.
•  There are also non-hormone drugs that stimulate production of insulin by islet cells. Since patients must have functioning islet cells for these drugs to work, they are only useful for patients with Type 2 diabetes.

Therapies for Complications of Diabetes

Diabetes causes a number of severe and debilitating problems, including nerve damage (neuropathy), eye problems (glaucoma, cataracts, retinopathy), heart disease, severe skin problems, gum disease and kidney disease. There are therapies and drugs to treat many of the complications of diabetes, but not all. Research is ongoing for drugs and therapies to treat nerve damage and retinopathy, for example. Diabetics have an increased risk for heart and kidney disease, so many of the therapies used to treat those problems are of interest for diabetics.

Future Treatments

Research continues on islet cell transplantation techniques, including research that uses stem cells derived from pancreatic ducts. Stem cells are immature cells that can be coerced to form mature pancreatic islet cells. Since stem cells can be grown in the laboratory indefinitely, they have the potential to be an unlimited source of islet cells for transplantation. There has been laboratory success with transplantation of islet cells derived from stem cells in mice, but not yet in humans.

Looking further into the future, researchers are studying the use of gene therapies to correct the genetic defects that are the original cause of diabetes. There are a number of hurdles to overcome before gene therapy will be used as a treatment for diabetes, the first being that the genetic factors that cause diabetes have not been completely identified. Some recent problems in trials of gene therapy for other diseases, including the death of some patients, have lead to some doubt whether these techniques can succeed. At the least, those problems have slowed trials of gene therapy, as researchers study what went wrong and attempt to devise solutions to the problems.

Because successful gene therapy will effect a true cure of the disease, it seems likely that researchers will continue to pursue its development, despite the many hurdles. At this point, however, gene therapy for treatment of diabetes appears to be many years in the future.

You Can Help

If you have diabetes, you can help develop these therapies by participating in clinical trials. The American Diabetes Association's web site has additional information on clinical trials in which you can participate. Visit the site to learn more about the trials and also about new and existing therapies for diabetes and its complications.

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