For LADA Patients, New Drug Holds Promise
Some secretion of insulin key to success
Eight years ago at the age of 23, Mike Lawson, Head of Experience at the Diabetes Hands Foundation was diagnosed with type 2 diabetes. His diagnosis for type 2 diabetes was made based on his elevated glucose levels and the fact that he was overweight. He was prescribed metformin, a common oral therapy for the treatment of type 2 diabetes. He then spent a year struggling to control his blood sugar. No matter how strict his diet, no matter how closely he followed the doctor's instructions, his blood sugar level was always high.
Mike's story is not unique. Estimates suggest that as many as 10% of people diagnosed with type 2 diabetes actually have a form of diabetes called LADA. LADA, short for Latent Autoimmune Diabetes in Adults, is generally considered a slow-progressing form of type 1 diabetes. LADA is usually diagnosed in people over the age of 30 and can be distinguished from type 2 diabetes by several tests. One test looks for antibodies against the insulin-producing beta cells of the pancreas. A second test examines the level of c-peptide in the patient's blood, which indicates how much insulin a patient is producing. "Patients who at first glance look like type 2 patients but are positive for antibodies (usually GAD) and show low levels of c-peptide," says Dr. Mariela Glandt, an endocrinologist at Bronx Lebanon Hospital, "are likely to have a diagnosis of LADA."
Often, but not always, LADA patients will require insulin therapy within six months. "I eventually found a healthcare provider who sent me to get a c-peptide test," says Mike. "After the results came back I was immediately put on insulin." While this is typically the treatment for LADA patients, they can sometimes be treated with oral medications for years before they require treatment with insulin," says Dr. Glandt.
"The slow progression of beta cell destruction seen in LADA can make it easier to treat than classic type 1 diabetes, as patients who still secrete some of their own insulin have more stable blood sugar levels, and may for many years require less artificial insulin," says Dr. Glandt. And, the ability to secrete some insulin seems to be a key criteria in the success of a new drug, Diapep277, currently in clinical trials.
What is Diapep277?
Diapep277, which appears to prolong a patient's ability to produce insulin, was discovered in 1990 by Professor Irun Cohen and his team at the Weizmann Institute's Department of Immunology as they were studying the mechanism by which the immune system attacks and destroys the insulin producing beta cells in the pancreas. Diapep277 works like a signal that guides the immune system to make desirable decisions in how it should relate to the body. In other words, it tells the body to stop the immune attack on the beta cells, and this prevents the progression of diabetes.
A recent study investigated whether Diapep 277 was helpful with patients who have autoimmune positive diabetes. In children, the beta cell attack is usually more aggressive (typical type 1 diabetes) and treatment with Diapep277 over time did not change the expected decline in insulin production. However, in patients who were older and had LADA (scientifically known as lower risk HLA class II genotypes), the study results showed that after 12 months of treatment, Diapep 277 caused the patient's beta cells to secrete more insulin than they had at baseline (when they began the Diapep277 treatment).
Someone who has been living with LADA as long as Mike may not benefit from Diapep277 treatment. "But for the newly diagnosed who still secrete some of their own insulin," says Dr. Glandt, "this new medication, which is still under investigation, might be able to preserve, and even increase, that production."
Diapep277 is certainly not the cure people with diabetes are waiting for, but its promise is still very significant because the longer a patient can secrete some insulin, the easier living with diabetes will be.
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