Some consider islet cell transplantation a cure, and other advances made over the last 5 to 10 years have vastly improved living with type 1 diabetes. I acquired type 1 diabetes thirty-seven years ago and every few years I heard, "In 10 years there'll be considered a cure," as well as the first two decades of my diabetes-life, nothing much appeared to happen.
Today, however, advances in research and technology have resulted in watershed developments. On the biological front, some physicians and patients consider islet cell transplantation a cure, and regeneration, the replenishing of insulin-producing beta cells, is a hotbed of dynamic and aggressive research.
The arrival of recent technologies has yielded revolutionary devices such as the continuous glucose monitor, smart and tubeless insulin pumps, small feature-packed meters, even a digital lancing device. And one of the very highly anticipated breakthroughs, a man-made pancreas, is now in clinical trials. More has changed in the last several years than in the past thirty years combined.
The Diabetes Research Institute (DRI), an accepted world leader in cure-focused diabetes research, performed its first islet cell transplant in 1990. Nine years later, in Edmonton, Canada, scientists performed islet transplants on seven patients, proving towards the medical community that islet transplantation can function. The procedure is known as the Edmonton Protocol.
As reported by the Mayo Clinic in research published in 2006, more than 40 percent of thirty-six islet cell transplant recipients were off insulin within one year of the transplant. 2 yrs later, however, less than 14 percent of recipients remained insulin-free. Even so, scientists remain enormously hopeful that islet cell transplantation works.
"Not since the polio vaccine was developed in the 1950s have medical scientists been as enthusiastic about the possible cure of some other of the world's most devastating diseases as is also now," wrote Jaron Terry in Ohio State University Medical Center's 2007 article, "Islet Cell Transplant: Is This the Cure for Type 1 Diabetes?" OSUMC is one of the select group of medical centers across North America approved to process pancreatic islet cells for human transplant.
"Islet cell transplantation is a wonderful experiment but not a clinical solution for many patients," says Dr. Fred Levine, adjunct professor in the Burnham Institute for Scientific research in California. However, it provides a perfect platform for regeneration research. Regeneration is the growth, replication, and replenishment of insulin-producing beta cells. The important thing (and also the trick) gets the cells to work in the body and never be rejected.
The fantasy, says Dr. Levine, is that we can hand people two pills: one causes beta cells to form, and also the other causes the body to not reject them. The fantasy might not be all that far-off: Scientists at Edinburgh University recently took the first step toward purifying new pancreas cells, and also the DRI has already established early success getting liver cells to function as islet cells. Clinical human trials are growing beta cells both outside and inside of the human body, and researchers are currently trying to turn off the immune system so it won't destroy new pancreatic cells, plus they are studying Byetta (a glucoselowering injectable for people with type 2 diabetes) just as one regenerator of beta cells.
More than a dozen different programs to preserve and regenerate pancreatic islet cells are occurring internationally, and regeneration is the Juvenile Diabetes Research Foundation's (JDRF) fastestgrowing area of supported research. (The JDRF may be the leading funder of type 1 diabetes research worldwide.) In addition, technology provides new breakthroughs in regeneration research, just like magnetic resonance imaging (MRI), which now enables scientists to noninvasively locate, count, and track beta cells.
The ultimate technological breakthrough is the artificial pancreas, and researchers believe they are several short years away from patients using this device. The artificial pancreas, also called a mechanical pancreas, has three components: a continuing glucose monitor to provide a continuing accurate reading of blood sugar levels, an insulin pump to automatically dispense the appropriate quantity of insulin, along with a control system to make sure that the exact way of measuring insulin is dispensed when needed. All three works in concert to imitate the way the pancreas works.
Dr. Roman Hovorka at the University of Cambridge continues to be testing devices in patients, as has the DRI, that is now addressing issues of safety to prevent malfunctions and operator failures. Dr. Aaron Kowalski of the JDRF is working closely with Dr. Hovorka and the team to speed funds to artificial pancreas study teams. U.S. Fda regulators are also working to design studies that will lead to quicker review. Anticipation is that the first generation of devices will be out by the spring of 2009. Additional advances in management products are already available. They include
Delivering insulin in a pill was long just a dream, because digestive juices in the mouth degrade insulin, destroying its efficacy. Today, however, Oramed, an Israeli biotechnology company, is conducting clinical trials for oral insulin. Even though current trials are with people who have type 2 diabetes, researchers believe their findings will ultimately benefit those with type 1 diabetes as well.
Dr. Miriam Kidron, chief medical officer of Oramed, says the company has technologically overcome the problem of insulin being destroyed by the gastrointestinal tract, and also the results of the trial thus far show a reduction in blood glucose levels as well as an increase in insulin levels.
Dr. Gerald Bernstein, vice president of Medical Affairs with Generex Biotechnology, is enthusiastic about a product that Generex is developing. Insulin will be absorbed with the lining from the inner mouth, leaving no deposit in the lungs. Because I take multiple daily injections, needless to say I share Dr. Bernstein's enthusiasm. Insulin patch technology and, strange since it sounds, an insulin suppository are also being explored.
Although I may not see a remedy in my lifetime, I am genuinely excited about the recent advances in diabetes research, procedures, tools, and medicines. One from the latest may be the development of a "smart insulin," a part of an operating system whereby when the body detects a spike in glucose, it'll release an appropriate quantity of insulin from the reservoir of once-daily-injected insulin, to keep blood sugar levels level. Each one of these advances give me hope that my life can be about the same time, productive, and satisfying as anyone else's. And that I might even live long enough to consume my words and actually see a cure.
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