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The Long Road to a Cure
Finding a cure for type 1 diabetes has been a roller-coaster of high hopes and deep disappointments. At the time of the great discovery of insulin, people thought that surely a permanent cure couldn’t be far off? Decade by decade we learned more about this complex disease and how to control it, so that diabetics could live long and productively. Yet close to a century after that great breakthrough, living with type 1 is still a formidable challenge, and the promise of a real cure seems to retreat into the indefinite future.
Diabetes is unlike other diseases where the cause is unknown and a cure might not be easily recognized. We know what conditions cause diabetes and we know how to recognize a cure, but still none has been found. In diabetes, the parameters are clearly defined: a therapy that results in normal blood sugars all the time is a cure. This makes it all the more frustrating when the available therapies are so imperfect.
What Is a Cure?
People define a “cure” for type 1 in different ways. Some insist that the only true cure would be to eliminate the cause—to somehow turn off the immune system malfunction that attacks the insulin-producing beta cells. Much effort is being devoted researching this possibility. But because we still know little about the specific mechanisms involved, it’s generally acknowledged that such a solution is far in the future.
Hanuman Medical Foundation, and the projects we support, define a cure in terms that are more realistic and achievable in a shorter term. To us, a “cure” equals a therapy that produces euglycemia without risk of hypoglycemia. It means being able to live a healthy life, free of dependence on injected insulin—and without using powerful drugs that suppress the body’s immune response. (As we’ve said elsewhere, immune suppression is the big stumbling block on the road to a cure through transplantation.)
Possible Paths to a Cure
Here are the general approaches currently being pursued toward a cure for type 1:
- Pancreas and Islet Transplantation Several hundred such transplants have taken place. The success rate of the islet procedure has been improving and may soon rival the success rate of kidney transplantation, better than 80 percent. However, all such transplants depend on immune suppression to prevent rejection of the implant—and current immune suppression methods have side effects that rival the morbidity of diabetes. We see little likelihood of complication-free immune suppression in the near future.
- Biomechanical Devices An artificial pancreas is being developed, which combines a glucose sensor, an insulin pump with a reservoir, and a computer to determine the pump speed. A version incorporating the first two is already being used by many diabetics, and this field is progressing fast. The main difficulty has been that no glucose sensor is sufficiently sensitive, accurate, and stable. Moreover, research strongly suggests that a sensor alone cannot control the insulin pump in the absence of information about caloric intake. Most clinical experimentation so far is limited to overnight periods, when no food is consumed.
- Medications and Stem Cell Therapy Some researchers are trying to develop drugs to control the immune malfunction that attacks islets and beta cells. Others are working on drugs that could regenerate beta cells or keep them alive and functioning. In one study, injecting patients with their own stem cells, to replace malfunctioning immune cells, allowed the regrowth of insulin-producing beta cells for a limited time.
- Genetic and Cellular Engineering In this approach, beta cells are engineered to evade the host immune system. This may be accompanied by specific immunosuppression. While promising, the rate of progress thus far indicates that complete immune evasion by bioengineered cells (in the absence of a physical barrier) will not be possible for many years.
- Bioartificial Pancreas The bioartificial pancreas contains living, functional islets or cells in an artificial matrix. The matrix can in principle be many different polymers; a common one is alginate. The cellular component can be primary islets of Langerhans (harvested from living donors or animals), cultured cell lines, or cultured genetically engineered cells. This is the approach taken by the Islet Sheet Project.
You’ll find more on the various research approaches under Type 1 Diabetes Research and the Islet Sheet Project.
Without a definitive cure, for now effective management of diabetes becomes the key to leading a life that you—rather than the disease—control.
- While type 1 diabetes can be controlled, decades of research still have not produced a permanent cure.
- People define such a cure in different ways. An ideal cure would be to eliminate the cause, but a more realistic prospect is to achieve normal blood sugars without the need for injected insulin.
- Among several promising approaches, we believe the bioartifical pancreas is the closest to success. Meanwhile, good control is the key to living with type 1.