Cure Research for Type 1 diabetes


Research discussion: Implantable insulin pumps are surgically implanted, usually on the left side of the abdomen. The pump is disk shaped and weighs about 6 to 8 ounces. It delivers a basal dose of insulin continuously. Users deliver bolus insulin doses with a remote control unit that prompts the pump to give the specified amount of insulin.

An advantage of this method is that, like insulin produced naturally from the pancreas, the insulin from the pump goes directly to the liver to prevent excess sugar production there.

The insulin patch, placed on the skin, gives a continuous low dose of insulin. To adjust insulin doses before meals, users can pull off a tab on the patch to release insulin. The problem with the patch is that insulin does not get through the skin easily.

The inhaled insulin delivery system, provides insulin as a dry powder inhaled through the mouth directly into the lungs where it passes into the bloodstream. This aerosol delivery system is about the size of a flashlight and uses rapid-acting insulin.1

The DCCT is a clinical study conducted from 1983 to 1993 by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). The study showed that keeping blood glucose levels as close to normal as possible slows the onset and progression of eye, kidney, and nerve diseases caused by diabetes. In fact, it demonstrated that any sustained lowering of blood glucose helps, even if the person has a history of poor control.

The largest, most comprehensive diabetes study ever conducted, the DCCT involved 1,441 volunteers with type 1 diabetes and 29 medical centers in the United States and Canada. Volunteers had diabetes for at least 1 year but no longer than 15 years. They also were required to have no, or only early signs of, diabetic eye disease.

The study compared the effects of two treatment regimens--standard therapy and intensive control--on the complications of diabetes. Volunteers were randomly assigned to each treatment group.2

Over the years, scientists have been trying to find noninvasive ways for people with diabetes to measure their blood glucose. Most methods of monitoring blood glucose require a blood sample, usually obtained by using an automatic lancing device on a finger. Some meters use a blood sample from a less sensitive area, such as the upper arm, forearm, or thigh. Some devices use a beam of light instead of a lancet to pierce the skin. 3

In pancreatic islet transplantation, cells are taken from a donor pancreas and transferred into another person. Once implanted, the new islets begin to make and release insulin. Researchers hope that islet transplantation will help people with type 1 diabetes live without daily injections of insulin. 4

Scientists have made many advances in islet transplantation over the past 25 years. Dr. James Shapiro and colleagues at the University of Alberta in Edmonton, Canada, have used a new procedure called the Edmonton Protocol to treat eight patients with type 1 diabetes. These patients have been completely freed from insulin injections since the first transplant in mid-1999.

On July 13, 2000, the National Institutes of Health (NIH) and the Juvenile Diabetes Research Foundation International announced that they would fund a clinical trial to test Dr. Shapiro's promising new technique for transplanting islet cells into the large vein in the liver. The trial will test the procedure in 40 people around the world. The NIH-funded Immune Tolerance Network (ITN) is leading the 7-year study and will be in charge of recruiting patients. To be considered for the trial, people must meet the following criteria:

  • Be between the ages of 18 and 65

  • Have had type 1 diabetes for at least 5 years

  • Be unable to control their blood sugar even with intensive therapy

  • Be unable to adequately sense the onset of hypoglycemia (low blood sugar)

  • Have had at least one hypoglycemic reaction in the past 1.6 years that cannot be otherwise explained and required medical attention

  • Have diabetes complications--such as blurred vision or kidney, nerve, or blood vessel problems--despite efforts to control blood sugar

In recent years, advances in diabetes research have led to better ways to manage diabetes and treat its complications. For example, the insulin pump, new oral medications, and better ways of monitoring blood glucose have become available. In the future, it may be possible to administer insulin through inhalers, a pill, or a patch. Devices are also being developed that can monitor blood glucose levels without having to prick a finger to get a blood sample. Researchers continue to search for the cause or causes of diabetes and ways to prevent and cure the disorder. 5

Medical research for Type 1 diabetes: medical news summaries: The following medical news items are relevant to medical research for Type 1 diabetes:

1. excerpt from Devices for Taking Insulin: NIDDK
2. excerpt from Diabetes Control and Complications Trial (DCCT): NIDDK
3. excerpt from Noninvasive Blood Glucose Monitors: NIDDK
4. excerpt from Pancreatic Islet Transplantation: NIDDK
5. excerpt from Diabetes: NWHIC

Last revision: April 10, 2003

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