Cure Research for Diabetes

Research discussion: In recent years, advances in diabetes research have led to better ways to manage diabetes and treat its complications. Major advances include

The development of a quick-acting insulin analog.
Better ways to monitor blood glucose and for people with diabetes to check their own blood glucose levels.
Development of external insulin pumps that deliver insulin, replacing daily injections.
Laser treatment for diabetic eye disease, reducing the risk of blindness.
Successful transplantation of kidneys and pancreas in people whose own kidneys fail because of diabetes.
Better ways of managing diabetes in pregnant women, improving chances of successful outcomes.
New drugs to treat type 2 diabetes and better ways to manage this form of diabetes through weight control.
Evidence that intensive management of blood glucose reduces and may prevent development of diabetes complications.
Demonstration that antihypertensive drugs called ACE (angiotensin-converting enzyme) inhibitors prevent or delay kidney failure in people with diabetes.
Promising results with islet transplantation for type 1 diabetes reported by the University of Alberta in Canada. A nationwide clinical trial funded by the NIH and the Juvenile Diabetes Foundation is currently trying to replicate the Canadian advance.

What Will the Future Bring?

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. Scientists are looking for genes that may be involved in type 1 or type 2 diabetes. Some genetic markers for type 1 diabetes have been identified, and it is now possible to screen relatives of people with type 1 diabetes to see if they are at risk.

The Diabetes Prevention Trial--Type 1, sponsored by NIDDK, identifies relatives at risk for developing type 1 diabetes and treats them with low doses of insulin or with oral insulin-like agents in the hope of preventing type 1 diabetes. Similar research is under way at other medical centers throughout the world. For more information about this trial, call 1-800-HALT-DM1 (1-800-425-8361).

Transplantation of the pancreas or insulin-producing beta cells offers the best hope of cure for people with type 1 diabetes. Some pancreas transplants have been successful. However, people who have transplants must take powerful drugs to prevent rejection of the transplanted organ. These drugs are costly and may eventually cause other health problems.

Scientists are working to develop less harmful drugs and better methods of transplanting beta cells to prevent rejection by the body. Using techniques of bioengineering, researchers are also trying to create artificial beta cells that secrete insulin in response to increased glucose levels in the blood.

Recently, researchers at the University of Alberta in Edmonton, Canada, announced promising results with islet transplantation in seven patients with type 1 diabetes. At the time of the report in the New England Journal of Medicine, all seven patients who had received the transplant remained free of insulin injections up to 14 months after the procedure.

A clinical trial funded by the NIH and the Juvenile Diabetes Foundation will try to replicate the Edmonton advance. With the insights gained from this trial and other studies, scientists hope to further refine methods of islet harvesting and transplantation and learn more about the immune processes that affect rejection and acceptance of transplanted islets.

For type 2 diabetes, the focus is on ways to prevent diabetes. Preventive approaches include identifying people at high risk for the disorder and encouraging them to lose weight, be more physically active, and follow a healthy eating plan. The Diabetes Prevention Program, another NIDDK project, focuses on preventing the disorder in high-risk populations, such as people with impaired fasting glucose, African Americans, Alaska Natives, American Indians, Asian and Pacific Islander Americans, Hispanic Americans, or women who have had gestational diabetes.

Several new drugs were recently developed to treat type 2 diabetes. By using the oral diabetes medications now available, many people can control blood glucose levels without insulin injections. Studies are under way to determine how best to use these drugs to manage type 2 diabetes. Scientists also are investigating strategies for weight loss in people with type 2 diabetes. 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

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 Diabetes: medical news summaries: The following medical news items are relevant to medical research for Diabetes:

Footnotes:
1. excerpt from Diabetes Overview: 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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