Diabetes Research: Advancing Toward a Cure
Diabetes Research: Advancing Toward a Cure
George L. King, M.D.
Research Director and Head of the Section on Vascular Cell Biology, Joslin Diabetes Center; Professor of Medicine, Harvard Medical School
This is an incredibly exciting time in diabetes research. In the past, we only had one promising approach to a cure for type 1 diabetes. Now we have several possibilities related to a cure, and even prevention, for both type 1 and type 2 diabetes.
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 bodys immune system turns on itself and destroys these islet cells. As a result, the body cant produce the insulin required to escort glucose from the food we eat to where it is neededinto the cells of the bodys 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.
Another important effort is directed at regenerating islet cellsto produce insulin againeither through the use of stem cells (embryonic or adult) or by other methods. We are hopeful that a large number of people with type 1 diabetes may have some surviving islet cells to regrow. This optimism has been raised by the recent finding that many type 1 diabetes patients may have remaining islets that have retained some function to make insulin. A recent Joslin study of people who have lived more than 50 years with type 1 diabetes indicated that even some of these patients can still make insulin.
Much attention is also being aimed at the causes of type 2 diabetes. The main theory involves inflammation. Joslin researchers have pursued this idea from the basic science level, now resulting in a multicenter clinical trial of humans taking anti-inflammatory drugs to see if these drugs will decrease the incidence of type 2 diabetes.
In addition, diabetes investigators are working on understanding how islet cells malfunction in type 2 diabetes. What is the genetic basis for this? Why can islets in some people continue to compensate by making more and more insulin for many years without getting diabetes, whereas others cant keep up with the increased demand? Our goal is to improve the compensation mechanism to prevent type 2 diabetes, and Joslin investigators are now clinically testing ways to do this.
Progress in Preventing Complications
There have also been breakthroughs in understanding and preventing diabetes complications. Over many years, high glucose levels can damage blood vessels and nerves in the eyes, kidneys and other organs throughout the body.
Research that I have pursued for 25 years, for example, has led to the development of a potential new drug. The new drug called ruboxistaurin (RBX) appears to reduce the occurrence of moderate vision loss due to diabetes. This drug evolved from a discovery: Joslin scientists uncovered a major signaling pathway by which high amounts of glucose damage blood vessels. RBX blocks a form of an enzyme that is activated in blood vessels in the eyes, kidney and heart.
Diabetes affects so many different parts of the body. To find solutions, we must bring together different types of experts so problems can be attacked from various angles. For example, cardiovascular disease is a significant diabetes-related complication that has to be tackled from several perspectives. Genetics researchers concentrate on the genetic changes of people with diabetes that make them vulnerable to cardiovascular problems, such as heart attacks and stroke. Other scientists focus on the impact of insulin on the blood vessels. Finally, researchers who specialize in metabolism study the significance of exercise on improving the use of glucose through the body, which might also have an effect in preventing cardiovascular disease.
Many research findings have already moved us toward new treatments. And for every new strategy that succeeds, millions of people will benefit.
This article first appeared in the Nov. 13, 2006 issue of TIME.
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