AskNadia: A Cure for Type 1 Diabetes?

Dear Nadia,

Is there any promising research for curing type 1 diabetes? Seven years in our family. Any hope?

Steve,

Twitter Follower

Dear Steve:

Yes, there is hope—a considerable amount of it, thanks to research focusing on ways to “tell” the body not to mistakenly attack insulin-producing beta cells. This means that at some point, although I can’t guess how soon, we will be able to use the body’s own resources to defeat type 1.

But as we’re looking to find a complete cure for type 1, there’s one “near-cure” approach that looks extremely promising:

A recent experiment by University of California and Yale University researchers on 14 type 1s showed that a simple manipulation of a certain kind of their own body cells allowed the group to go off insulin for a year. No shots, no insulin injection paraphernalia, no constant blood glucose measurements. In effect, a temporary cure.

What the researchers did was to extract several million T-reg cells from each of the diabetic patients. T-reg cells are like the body’s army—they destroy invaders and even cells from the body’s own autoimmune system that mistakenly attack pancreatic beta cells. But type 1s have way too few T-regs, which is why their own autoimmune systems’ attacks on beta cells wipe out their ability to make insulin.

The university researchers then placed the extracted T-regs into a growth medium that increased their number by a factor if 1,500, producing billions of T-reg cells. Each patient then received an injection of their own bulked-up T-regs. Result: Insulin production was restored and there were no type 1 symptoms for up to a whole year.

The drawback to the new procedure is that it has been tested on way too few subjects for researchers to declare that they’ve developed a wonderful tool for remission. But if it does turn out to be applicable to type 1s, this procedure, to quote one of the principal researchers, will be a game changer.

Other Roads to a Cure:

Improved Closed-Loop Systems, i.e., the Artificial Pancreas

The technology already exists to create a system that mimics a healthy pancreas. You attach a loaded insulin pump on a patient’s body that connects to a continuous glucose monitor. Ideally, the CGM detects when a blood glucose level is too low or too high and sends that data to the pump. The pump responds by injecting a dose of bolus insulin (or, in advanced concepts, glucagon).

It works on paper and for many diabetic patients who have tested it, it works extremely well. One problem accompanying this approach is the simple mechanics of having sophisticated machines attached to the body. No matter how robust they are, they can be damaged or stop functioning. Wearers have to regularly check the machines to make sure they’re working properly. In a way, it’s like trading one burden of diabetes—constantly checking BG levels—for another. But at least the daily task of bolus injections goes away.

A special concern is possible insulin overdose if the system cannot detect already existing insulin in the body. Another is that the algorithm the machine uses to determine whether an insulin dose is called for. Because every diabetic person can respond to insulin differently, the algorithm has to be adjusted for the individual.

Most of the people who are researching and testing artificial pancreas are confident that technological advances will solve current problems, even to the point of having the capability to deliver glucagon in the face of an insulin overdose.

3. Transplanted Beta Cells (Human or Animal)

Transplantation of a pancreas or part of a pancreas from a recently deceased person to a type 1 patient has been around for several years, with mixed results. Some patients enjoy full resumption of insulin production and are able to go off insulin injections for considerable lengths of time. Others enjoy limited benefits until their own immune systems successfully destroy the transplanted beta cells.

Drawbacks are considerable The procedure is expansive and requires taking drugs to ward off infection as well as suppress autoimmune system responses to the transplant.

Given the progress made in other areas, I think that pancreas transplants are unlikely to become the type 1-ending therapy of choice.

Some Sources:

http://www.telegraph.co.uk/news/science/science-news/12016532/End-of-daily-injections-for-diabetes-as-scientists-restore-insulin-production.html

“Home Use of an Artificial Beta Cell in Type 1 Diabetes.” N Engl J Med. 2015- http://www.nejm.org/doi/full/10.1056/NEJMoa1509351

https://clinicaltrials.gov/show/NCT01961622

http://www.cnbc.com/2014/06/13/diabetes-the-54-billion-battleground.html

Disclaimer:

Nadia’s feedback on your question is in no way intended to initiate or replace your healthcare professionals’ therapy or advice. Please check in with your medical team to discuss your diabetes management concerns.

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Email Nadia at AskNadia@DiabetesHealth.com.

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About Nadia:

Nadia was not only born into a family with diabetes but also married into one. She was propelled at a young age into “caretaker mode,” and with her knowledge of the scarcity of resources, support, and understanding for people with diabetes, co-founded Diabetes Interview now Diabetes Health magazine.

Nadia holds 11 nominations for her work as a diabetes advocate.

Her passion for working in the diabetes community stemmed from her personal loss. She has used her experience as a caretaker to forge a career in helping others.

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