A century ago, before the discovery of insulin, a diagnosis of type 1 diabetes meant an early death. Now people with the disease can plan on living long lives. Yet it's still a challenging condition to manage well. New research promises more effective and easier control, and even the hope of prevention:
New drugs. For more than 80 years the only treatment for type 1 diabetes was insulin. A second injected drug, synthetic amylin, became available in 2005. Doctors are studying many other potential drug therapies, including human trials of rituximab and otelixizumab, monoclonal antibodies (synthetic proteins that attack foreign substances) which may help preserve insulin-making cells in the pancreas and reduce a patient's need for insulin therapy. And although the first inhaled insulin flopped in 2007, once-daily injections are available, and researchers are working on other methods of insulin administration, including patches, pills and sprays.
Vaccines. Some scientists think that the increasing incidence of type 1 diabetes and some other diseases may be partly due to … good hygiene. According to this theory, the decrease in minor childhood infections, though beneficial in many ways, deprives our body's immune system of opportunities to "practice" and strengthen itself against attack. A potential solution is a preventive vaccine that bolsters the immune system. Other researchers are working on vaccines to protect the pancreas of a type 1 diabetic patient from a hyperactive immune system.
Cell studies. Much of the research on type 1 diabetes focuses on ways to create insulin-making cells that the immune system won't attack. Scientists already have made insulin-releasing cells from human stem cells and even from human skin cells. They've also found stem cells in the pancreas and hope they can one day turn these into insulin producers in the lab or the body.
Nutrition. Type 1 diabetes and certain other autoimmune diseases, such as multiple sclerosis, are more common in regions farther from the equator. A suspected culprit may be lack of vitamin D, which the body can make from exposure to the sun. Several studies suggest vitamin D supplements might help prevent type 1 diabetes and other ills. Researchers are also studying whether other nutritional interventions, such as omega-3 fats, can help prevent or control type 1 diabetes.
Technology. Glucose meters have come a long way. Now there's continuous glucose monitoring, a wearable device that measures blood sugar around the clock and may improve control of the disease. Another innovation, already available in some places, is the surgically implanted insulin pump. But both of these technologies still require input from the patient, such as checking glucose levels regularly and administering supplemental insulin as needed. The long-term goal is an artificial pancreas that automatically assesses glucose and releases the right dose of insulin in response.
Transplants. Pancreas transplants have been used for decades to treat some cases of type 1 diabetes. There's also a newer, less invasive but experimental procedure called an islet cell transplant, which involves injecting pancreatic cells into a patient's body. Sometimes these procedures have had disappointing results, but in other cases they have indefinitely freed the recipient from insulin therapy. Improvements in tissue harvesting and immunosuppressive drugs could increase the availability and success rate of transplants.
With so many new developments, management of type 1 diabetes is easier and quicker than ever. "I am walking, talking proof that there are cures out there for people with established diabetes. And I don't mind saying, it's great to be cured," James Tyree, chairman of the Juvenile Diabetes Research Foundation International, said in his 2008 State of the Foundation Address, a year and a half after receiving a pancreas transplant.
Tyree acknowledged that the treatment wasn't an option for many patients. "But it's certainly a proof of concept. This disease can be reversed," he said. "And every day, we're funding science to advance less drastic, more universally available cures for people who have lived with type 1 diabetes for years and years."
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