What If My Child Has Type 1
Search for answer reveals wonderland of research and hope.
Recently I was asked, "What looks most promising in diabetes cure research?" To be honest, I was stumped. For years I have advocated for better funding for diabetes research, but I never thought a cure was in my future, so I have always focused my personal attention on diabetes technology and lifestyle "cures" (e.g. artificial pancreas) that may make living with the disease easier.
But the question was not just about research. The question was about those who are most at risk for developing type 1 diabetes – the children of people with type 1 diabetes. What if my child had type 1 diabetes? What research would be most promising then? In no time, I felt a wave of embarrassment and terror come over me. To think that I couldn't answer such a seemingly simple question. Had I really not thought much about what would happen if little Ava were diagnosed with diabetes? I have thought about day-to-day living with both Mommy and baby sharing a physical battle, but not about curing the disease. In fact, last month Ava was entered into TrialNet (www.diabetestrialnet.org), her second diabetes research study. The aim is to find out if she has any of the four known antibodies that are linked to type 1 diabetes. (1) (I just learned she does not!) So, this question and topic came at the perfect time.
The State of Type 1 Research
I am sure you can imagine the next few moments…within minutes of being asked the question, I turned where we all turn to answer the unanswerable – Google. Here are a few highlights from those lists, starting with type 1 diabetes.
One of the first articles to pop up is a brief on research going to human clinical trials from the University of Pittsburgh:
"A study from Children's Hospital of Pittsburgh and the University of Pittsburgh Medical Center has shown that type 1 diabetes can be reversed in a mouse model. Scientists extracted the mouse's dendritic cells from the blood and enhanced them with specific molecule blockers. They then reinjected them into the mouse. This procedure stopped the process that kills beta cells, by blocking the T cells which attack them."
The next Google hit features research from Massachusetts General Hospital and Harvard Medical School by Denise Faustman, M.D. Her project is looking at a "simple solution that will control the immune system and cure type 1 diabetes."
According to her bio at Massachusetts General, "Dr. Faustman has spent the last decade researching the nature of the molecular defect in T-cells that results in the development of autoimmunity. Her work has led to the discovery of a novel way to treat diabetic mice, accomplishing for the first time ever the permanent reversal of established diabetes." Her research has just started recruiting for human clinical trials. In the animal studies conducted by Dr. Faustman, a commonly used vaccine that provides protection against tuberculosis, called Bacillus Calmette-Guerin (BCG) was used effectively to deplete the abnormal immune cells that attack and destroy the insulin producing cells of the pancreas.
The clinical trial will be using the same BCG vaccine. BCG is expected to cause a low-grade inflammatory reaction, which in the mouse model of autoimmune (type 1) diabetes lead to the destruction of the abnormal autoimmune cells.
I contacted the research coordinator and learned that to be eligible for these trials, one must be able to participate in a rather "intensive visit schedule" in Boston. (I was so disappointed that I don't live in Boston!)
George King, M.D., the Research Director at Joslin Diabetes Center, says that "Previously, research toward a cure was focused on transplantation of islet cells, which are insulin-producing cells found in the pancreas. In type 1 diabetes, the body's immune system turns on itself and destroys these islet cells. As a result, the body can't produce the insulin required to escort glucose from the food we eat to where it is needed—into the cells of the body's muscles and other organs. We are now focusing on understanding this immune attack in hopes of finding safe ways to block it. Several ongoing studies are using our knowledge of immunology in an effort to intervene and prevent type 1 diabetes."
He further notes that research is also looking at regenerating islet cells. This basically means figuring out ways to teach cells to produce insulin again. Fascinating! Recent research by Dr. King has shown that many people who have lived with diabetes for more than 50 years can still make insulin. These longtime survivors still have some innate islet cell function, although unfortunately not enough. Regeneration or an increase in the growth of islet cells could help them make more natural insulin.
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One of the online diabetes groups I belong to (but don't frequently post to) is geared towards "frum" (Orthodox or "observant") Jewish people with (mostly type 1) diabetes. Most of the chat on the mailing list centers around people needing last-minute supplies before Shabbat or a holiday, where to acquire supplies and get medical help when visiting Israel, and advice on which pump is best for one's type 1 child — in other words, the usual sort of diabetes chatter, but...