The Healing Handbook for Persons with Diabetes
Chapter 15: Research
The Implantable Insulin Pump
Hope for the Future
At the present time, there is no cure for diabetes. In the past ten years, however, researchers have undertaken promising and exciting studies into possible means of preventing, treating, and curing diabetes.
Prevention of diabetes would be the ultimate achievement. Researchers can now identify diabetes in its earliest stages and even predict who may be susceptible.
Immunosuppression-type drugs have been tried to prevent the body from destroying its own beta cells. Although the drugs do halt beta cell destruction, their long-term use is impossible because of severe side effects. Once the drugs are stopped, beta cell destruction resumes. Researchers are now working to understand the mechanisms that produce diabetes. Once all the pieces of this puzzle are identified, it may be possible to develop strategies for preventing diabetes.
One major study now underway is the Diabetes Prevention Trial - Type 1. The online information we have linked to regarding this trial is provided by the American Diabetes Association's Texas Affiliate.
Researchers have developed an implantable insulin pump that can measure blood glucose levels and then deliver the exact amount of insulin required by the body. This "closed-loop" system thus mimics the action of natural beta cells. Unfortunately, in prototypes, the blood glucose sensor may become clogged, or may react to the presence of other body chemicals. Until these bugs can be worked out, the implantable closed-loop pump will remain an experimental device.
Home Glucose Monitors without the Fingerstick
Many companies are now working hard to develop a method that will let persons with diabetes check their blood sugar without having to prick their skin to get a drop of blood. Most methods rely on shining a special kind of light though the skin. Research in this area has been going on for many years, but the problem is a difficult one.
No one wants to put out a meter that gives wrong information that would lead to the wrong dose of insulin. At the moment there is no alternative to the kinds or meters we now have, but the new devices are currently being tested in volunteers.
Pancreas transplants have received considerable attention. This difficult procedure is most often done in conjunction with a necessary kidney transplant. Following the transplant, the patient receives powerful immunosuppression drugs to prevent rejection, the process by which the body destroys foreign materials -- such as the new kidney and pancreas.
Doctors are now also transplanting beta cells. Some approaches involve injecting beta cells so that they lodge in the liver. Other researchers have attempted to encase beta cells in a porous tube or bubble to protect them from rejection. The goal is to design a tube or bubble that does not allow white blood cells to enter and destroy the beta cells, but does allow insulin produced by the beta cells to pass out.
In other ongoing experiments, researchers are attempting to alter the code on the outside of beta cells so that the immune system will not recognize them as foreign material. If this work is successful, immunosuppression drugs will no longer be necessary when transplanting beta cells from one person to another.
Genetic manipulation is part of the RNA and DNA research you may have read about. Simply put, genetic manipulation involves reprogramming a body cell to become a beta cell and produce insulin. Every single cell in the body contains the genetic information of all cells. If this information could be used to reprogram individual cells, it might be possible to "train" a skin cell or other tissue to be a beta cell. This way, a person's own cells could be used to produce insulin, eliminating the rejection problems associated with beta cell transplants. This research is still in its early phases, however.
One of the first things researchers must do is learn what the genetic codes are that determine whether or not a person will have diabetes. An example of such a study that is underway is the GENNID study. It is described in the online pages of the American Diabetes Association's Texas Affiliate.
Much work is being done in the areas of prevention and treatment of diabetic complications. Research has demonstrated clearly that excellent control of blood sugar greatly reduces the risk of diabetic complications. This important research was obtained through the Diabetes Control and Complications Trial. Online information on this study is available through the American Diabetes Association's Texas Affiliate.
Other research has demonstrated that a low-fat diet greatly reduces the risks of heart and large blood vessel diseases. The kind of diet that helps reduce complications is explained in our chapter on diet.
New treatments for retinopathy and new procedures for clearing vitreous hemorrhages are being studied. New drugs for treatment of neuropathy are now available. New medications that prevent the progression of kidney disease are being researched.
Laboratories throughout the world are attempting to develop methods to control blood sugar without insulin injections. Agents that can act like insulin may be taken orally in the future. Other areas of research include techniques to reverse the severe atherosclerosis associated with diabetes, which eventually could prevent heart attacks, strokes, and blockage of blood vessels in the legs.
Preliminary studies have been conducted to identify people at risk of becoming diabetic. The next step will be to develop treatments to prevent diabetes.
While some of the ideas in this chapter may seem remote or improbable, a diabetes cure is certainly not impossible. No one knows what the future may bring. Research offers hope.
REMEMBER: The care of diabetes is a team effort involving you, your physician, and the diabetes education staff where you receive your medical care. This handbook cannot-and was not meant to-replace this team effort.
This handbook embodies the approach of the diabetes care team at the University of Massachusetts Medical Center. Different diabetes care teams may approach some aspects of diabetes care in ways that differ from those in this handbook. While most teams are in close agreement regarding the GENERAL PRINCIPLES of diabetes care, they may differ in the DETAILS. There can be more that one "right" way to approach a specific issue in diabetes management.
Always remain in touch with your diabetes care team, and bring any questions you may have about the materials in this handbook to their attention!
Copyright 1995-1999 Ruth E. Lundstrom, R.N. and Aldo A. Rossini, M.D. All rights reserved.
Feedback: send e-mail to Dr. Aldo Rossini