Targeting a Cure for Type 1 Diabetes
by Lisa Rotenstein, Ben Kozak, Adam Brown, Michael Dougan, and Kelly Close, diaTribe
Copyright © 2011 by Close Concerns, Inc.
Excerpted with permission of the publisher, Close Concerns, Inc.
"Targeting a Cure for Type 1 Diabetes," can be downloaded for free at http://www.diatribe.us/cure.
NOTE: Excerpts are provided on dLife.com for informational purposes only. The information contained within will not be updated by dLife and may be outdated. Please consult your doctor before acting on anything described here.
"Targeting a Cure for Type 1 Diabetes is a valuable and thought-provoking overview of research efforts underway to cure type 1 diabetes. Education about the progress being made — and the hurdles to be faced — is crucial if we're to achieve our ultimate goal of ridding type 1 diabetes from the lives of our loved ones. I thank the diaTribe team for their ongoing efforts to inform and enlighten all those who care about type 1 diabetes."
— Jeffrey Brewer (President and CEO, Juvenile Diabetes Research Foundation, New York, NY)
Since we founded diaTribe in 2006, its focus has always been on providing helpful, practical information to people with diabetes. Our new book, "Targeting a Cure for Type 1 Diabetes," aims to continue that focus by providing a detailed update on progress toward curing type 1 diabetes. We hope that you will enjoy and learn from it whether you are a person living with type 1 diabetes, a parent or caregiver, a researcher or clinician, or anyone else looking for clear information on an issue that inspires strong opinions and stirring hopes. In writing this book, we have assumed that our readers are interested in details, but not that they have deep experience in science or medicine. Though no one knows exactly when a cure will come or what it will look like, we hope that this book will give you a better idea of the possibilities and the promises of the search for it. We are not blind optimists. We know the hurdles are high. But we also know that the gains made have been substantial, and we believe that a cure will arrive in our children's lifetimes.
Where Are We Today?
The discovery of insulin in 1922 was one of modern medicine's greatest breakthroughs, and has saved millions of lives. With insulin's discovery, people with diabetes could hope to live long, productive lives as long as they continued to receive injections of this "miracle" drug. Today, nearly 90 years later, insulin remains the most important drug for people with type 1 diabetes and many with type 2 diabetes, but as the t-shirt that some of you may have says — insulin is not a cure.
Some inroads into the search for a cure have been made in recent years. Our understanding of what causes type 1 diabetes has improved. We have successfully reversed diabetes in some animal models of the disease. We have devised methods to keep transplanted islets alive for longer periods of time. Blood glucose monitors, insulin pumps, continuous glucose monitors, Symlin, and other therapies and technologies have enabled better daily management of glucose levels. These advances could eventually lead to preventing, reversing, or overcoming diabetes. But for now, the cure for human type 1 diabetes remains painfully elusive. In "Targeting a Cure for Type 1 Diabetes: How Long Will We Have to Wait?" we present what we believe are the four most promising categories of therapies that target a cure: immune therapeutics, islet transplantation, regeneration of beta cells, and the artificial pancreas. While all have the same goal, each has its unique advantages and disadvantages, which are introduced below.
What Happens in Type 1 Diabetes
To understand what a treatment would need to do to "cure" type 1 diabetes, we must first understand the changes that occur in the body that lead to this condition. Type 1 diabetes is caused by the destruction of beta cells, cells housed in structures within the pancreas called islets that are responsible for producing insulin. This drastically reduces the production of insulin.
As many readers will know, insulin is a hormone that allows glucose produced from the carbohydrates we eat to enter the cells of our body that use glucose for nutrition. The beta cells in a healthy person secrete enough insulin to admit the right amount of glucose into cells, but that process breaks down in people with type 1 diabetes because of insulin deficiency.
In people with type 1 diabetes, the destruction of insulin-producing beta cells is caused by the immune system, the part of the body normally charged with protecting us from bacteria and viruses. The immune system is thought to destroy beta cells in type 1 diabetes, because the beta cells have been misidentified as "foreign" invaders. Why the immune system misidentifies beta cells as "foreign" (akin to thinking the cells are infected with a virus) is not yet know, but is an active area of research. The general theory is that some kind of environmental trigger (a toxin or infection) may inappropriately initiate an immune response in certain genetically susceptible people.
Swordfish with a Hoisin Sauce Wine Baked Fillet of Sole Light Pumpkin Bread Arugula, Fig, and Blue Cheese Salad Grilled Chicken Salad with Raspberry Vinaigrette Salisbury Steak with Green Pepper Sauce Fresh Spinach Salad Italian Roasted Pork Chops Panko Crusted Dijon Chicken Tuna-Cabbage Sandwiches
Well maybe not so much a furor as a controversy. The question, bluntly put, is whether or not a single HbA1c reading should be sufficient and adequate to diagnose diabetes — and whether the conditions under which the test was conducted should have any bearing on the diagnostic or non-diagnostic value of the test. The lede from