Advancements in Diabetes Research: We've Come A Long Way
My family and I just finished participating in local JDRF Walk To Cure Diabetes. As I walked, wearing our team's orange shirt that said: "Insulin Is Not A Cure," I realized yet again that I am not an unusual participating parent: I want nothing more than a cure for my Type 1 son.
Type 1 Diabetes is one of the neediest of all chronic conditions in terms of attention, commandeering our immediate attention day in and day out. So much so that we look it all aspects of the disease from a two-foot level all of the time.
When the time to Walk To Cure Diabetes circled back again this year, I admit, I felt a little down, a little out, a little overwhelmed. Hadn't we (my husband, three boys and me) just walked twelve months ago? Wasn't that effort added in to all of the other contributions enough to speed research along to find a cure for Type 1 Diabetes?
Apparently not. Because there I found myself again, preparing for the Walk.
It wasn't until fellow HealthCentral blogger Ann Bartlett forwarded on to me an interview with Lee Ducat, one of the key founders of the JDRF, that I stopped looking at our progress with finding a cure for juvenile diabetes up close and personal. Instead, I backed up, way, way up, and observed instead our progress in finding advances in treating, managing and someday curing juvenile diabetes from a twenty thousand foot level. Then I truly began to appreciate just how far we've come.
Where Have We Been?
Before 1922, no one lived long after displaying signs of Type 1 diabetes. When Frederick Banting and his assistant Charles Best discovered insulin, everyone assumed that diabetes had been cured.
No doubt, the discovery of insulin is one of the greatest medical discoveries of the twentieth century. Insulin makes life with diabetes possible - furthermore, insulin offers the promise of a fairly normal life. However, it is not a cure.
Forward time about half a century to the late 1960s. Lee Ducat's nine-year-old son just has been handed the devastating diagnosis of Type 1 diabetes. After hiding her tear-swollen eyes behind dark glasses for nearly a year, the Philadelphian decided to step up and figure out a way to find monies to fund research for a cure for diabetes. In May 1970, Ducat held a cocktail party in her Penn Valley home outside of Phildalephia with parents of other area Type 1 children attending. This get-together served as the first meeting of the JDRF (which celebrated its 40th birthday last month). At that point in time, the amount of money spent on diabetes research was about $1 million (which included the monies spent by the National Institutes of Health (NIH)).
In the first year of fund raising, the JDRF collected $10,000 in donations. Impressive considering that nearly everyone thought that insulin was a cure for diabetes.
Diabetes management was much different in the ‘60s and early ‘70s. These were the days before people could test their blood. All testing was done on the urine and indicated readings that were often hours old, therefore people were making corrections off of old information. Too this information didn't test for low blood sugars, which can cause immediate danger.
Here We Are Today
The prognosis for those managing Type 1 diabetes has improved substantially in the past 40 years. Consider that the outlook for those born in the 1950s and then developing juvenile diabetes wasn't as good as it is now: the death rate 25 years after diagnosis was 30%. Compare that to someone born in the late ‘70s who developed Type 1 whose death rate is decreased significantly to 7%. Not perfect, but it's a vast improvement.
Significant gains have come also in the decreased incidence and severity of long-term health issues. Again, looking at those born in the ‘50s and then developing Type 1, nearly 90% would face retinopathy, and this rate has plummeted by 90%, particularly with the help of laser eye surgery. The incidence of kidney disease has fallen from 25% to 10%.
Motherhood for someone with juvenile diabetes is not as daunting. The likelihood of birth defects for babies born to those with Type 1 had been triple that of the normal population. Now, this rate is in keeping with the rate of defects of the general population.
These improvements can be attributed to several things. A better understanding of the disease, a deeper knowledge of the role of nutrition and exercise in managing diabetes and advances in technology and pharmaceuticals all play a part.
To this last point, I marvel daily at what medical technology has given my son. He can test his blood for near instant results - not his urine. His next step on this front is a CGM (continuous glucose monitor), which will allow him even tighter control. Administering insulin has come a long way from a steel needle, to insulin pump therapy. Even insulin itself has made great advances, with new formulations for better management.
What Does Tomorrow Promise?
And now we come to what is on the horizon. For this, I tapped Ann Bartlett, who I mentioned above and who serves on the Board of the National Capitol Chapter of the JDRF, for insights on some of the most promising advances for juvenile diabetes. The following was my Q&A with Ann:
Q: In terms of a future for finding a cure - and even superior management - where does stem cell research stand? What kind of promise does this offer?
A: Stem Cell research is still in infancy as there is so much still to learn about it. In regard to type 1 diabetes, I feel that stem cells will be one method for a cure, but not the only one. As we have read, many therapies have potential to cure Type 1 diabetes, but the big picture, with stem cell, may be its unique opportunity to affect the auto immune system, which could affect a vast number of auto immune diseases!
Q: Where are we with the artificial pancreas? How soon will it become a viable option for management?
A: The APP, Artificial Pancreas Project, is in Phase 2 human trials. When phase 3 happens usually this is the trial that works out the last kinks and provides the data the FDA needs to approve it for the marketplace. If all goes according to plan, it should be ready in 3-5 years. One of the interesting point to be made regarding the APP is that many therapies that are in clinical process, need to have the blood sugar very stable in order to succeed. At the moment we have pump, CGM technology, but the blood glucose level can still wobble. In the case of a transplant that could deter the success. With the artificial pancreas in place, it could mean more viability for some therapies that require a flatline in blood glucose control to succeed.
Q: What is the now and future of SmartInsulin?
A: SmartInsulin is one project many people are extremely excited about! This type of therapy is actually referred to as Glucose-responsive insulin. JDRF feels this is a very promising area of research, but still in it's early stages of clinical trials and is some years away from being available for people with type1. There could be other glucose-responsive insulin in the future as this is not an exclusive relationship.
These are projects that the JDRF is focusing on; other research organizations are focusing on other efforts. And maybe none of these will be a cure. But we're getting closer. More importantly, day by day and step by step, our kids have a better and better chance at a fairly normal and healthy future and long life.