ScienceDaily (June 19, 2008) — Research findings and innovative approaches offer the promise of new therapies and the potential for cures for adults living with type 1 diabetes, according to researchers at the Juvenile Diabetes Research Foundation's (JDRF's) Global Research Forum in Washington D.C.
Type 1 diabetes is an autoimmune disease that results in the destruction of insulin-producing beta cells in the pancreas. It renders people insulin-dependent for life and carries the constant threat of debilitating and life-threatening complications. Half of those diagnosed each year with type 1 diabetes are adults. Overall, adults with diabetes may have lived with the disease for more than 90% of their lives.
Still Capable of Producing Insulin
Among the research presented at the JDRF conference were insights of the Medalist Study from the Joslin Diabetes Center in Boston. George King, MD, Senior Vice President, Director of Research at the Joslin Center and director of the study, said that individuals with established type 1 diabetes (even those who have lived with it for 50 years or more) are still capable of producing insulin. The Joslin Study also found that even after 50 years about 30% of the patients studied didn't experience common complications such as eye, kidney or nerve disease. These findings have potential implications for improved treatment for all type 1 diabetes sufferers.
Potential for Islet Cell Regeneration
Mark Atkinson, M.D., Director of The Diabetes Center of Excellence at the University of Florida, presented initial findings from nPOD; the Network for Pancreatic Organ Donors with Diabetes. Organized and funded by JDRF, the network was established last August to procure and characterize, in a collaborative manner, pancreatic and related tissues from organ donors with long-standing type 1 diabetes as well as those who are islet autoantibody positive. These tissues would be used to study how type 1 diabetes develops with the hope of finding a means to cure the disease.
Dr. Atkinson presented findings from nPOD, which have enabled researchers to assess the potential for islet cell regeneration. "Contrary to common dogma, what we've learned so far is that some pancreata from subjects with long-standing type 1 diabetes have insulin positive beta cells and some have many intact islets. This finding gives hope for islet cell regeneration or restoration," Atkinson noted. He pointed out another key finding: that some islets have beta cells that don't produce insulin. "If we know beta cells are there, then we can focus on finding ways to get them to produce insulin," Dr. Atkinson explained.
JDRF's Chief Medical Officer, Paul Strumph, MD, also presented findings that showed how beta cell mass expands in response to increased metabolic demands such as growth during the first decade of life, obesity, and pregnancy - leading to possible therapeutics that mimic the biological mechanisms that increase insulin-producing cells in this instances. "A little bit of insulin is not a cure, but it can be significant to reduce the complications of diabetes," Strumph noted.
A New Era of Diabetes Research Has Begun
All of the presenters agreed that researchers are on the cusp of a new era in diabetes research, one in which advanced technology and human clinical research should enhance the development of new therapeutics and an ultimate cure.
"Much of what we've known regarding the pathogenesis of type 1 diabetes has dated back to studies performed with the human pancreas' in the 1970s -- before microwaves, the internet and cell phones, and before modern day medical research technology. Now we're looking at this disease in whole new ways," explained Atkinson.
Strumph added that there is more of an emphasis on looking at the natural history of the disease to guide research opportunities for those with established type 1 diabetes. JDRF is currently devoting a significant portion of its $160 million in research funding to science involving people with established type 1 diabetes, with a particular emphasis on areas such as autoiummunity and regeneration; the organization and plans to fund as much as $195 million on research in the coming 12 months.
| Health & Medicine |
The revolution ahead
Work on artificial pancreas project nears historic end
Copyright 2008 Houston Chronicle
Researchers are edging closer to a high-tech system that would automatically regulate diabetics' blood sugar and rid them of their daily burden of pricking their fingers and injecting insulin.
The system, a so-called artificial pancreas, has been a Holy Grail of diabetes treatment for decades, a bridge to the day when a cure is finally found. It would mostly benefit Type 1 diabetics, those whose bodies have stopped making insulin, but also those Type 2 diabetics who require insulin shots.
"The artificial pancreas will revolutionize diabetes treatment," said Aaron Kowalski, a research director at the Juvenile Diabetes Research Foundation, the project's big sponsor "It will significantly lower or eliminate the risk of complications such as blindness, kidney failure, heart disease. And it will improve quality of life as people will no longer have to constantly monitor themselves."
The system already is in trials at centers in the United States and internationally. But researchers say it'll likely be another five or so years, as component parts are improved and consolidated into a single package, before the realized vision is ready to hit the market.
It wouldn't be a traditional replacement organ. Rather than physically resemble a pancreas and fit near it, it would mostly rest outside the body and strive only to duplicate function. It would build upon two existing devices — insulin pumps and continuous blood glucose monitors — that marked big steps forward in diabetes treatment in 1978 and 2005, respectively.
In the finished product, the monitor will not only measure a diabetic's blood sugar level, but signal the pump to release an appropriate amount of insulin to adjust the level into the normal range, in effect mimicking a real pancreas. A computer program, developed based on the changes in levels caused by human diet and behavior, will calculate the particular need at any given time.
The result would be the elimination of the highs and lows diabetics now experience.
Some 21 million Americans have diabetes, which is characterized by the body's inability to produce or properly use insulin, a hormone that maintains normal levels of blood sugar, or glucose, and helps convert sugar, starches and other food into energy. About 5 million diabetics take it, including as many as 3 million with Type 1.
In an effort to maintain optimal glucose control of their glucose — high levels damage blood vessels and nerves and lead to complications — conscientious diabetics will prick their fingers four to 10 times a day to test their levels. But even frequent testers don't know if their glucose skyrockets or crashes between tests — most ominously, when they're asleep.
Studies have found that even patients who measure their glucose as much as nine times a day spent less than 30 percent of the day in the normal range. Their levels were either too high or too low the rest of the time.
In that context, the Food and Drug Administration's recent approval of continuous monitors was a breakthrough. The monitor, worn like a pager and connected to a sensor placed just under the skin, tells the patient whether levels are trending up or down. If levels reach dangerously high or low levels, it sounds an alarm.
"The monitor's made things a lot easier for me," says Rob Loar, a Kingwood native and medical student diagnosed with Type 1 diabetes in 1992, when he was 6. "Because of the additional information it provides I'm able to use my pump more effectively and avoid the peaks and valleys I used to experience."
But the monitors have limitations. Their readings are usually 15 to 30 minutes behind real time. They require users to be educated and committed to the task, a requirement that's resulted in short-term studies showing mixed results. And because adoption of the device has been limited so far, insurance only sporadically covers its high cost — $1,000 plus at least $350 a month for supplies.
The fully realized artificial pancreas should change all that. Researchers predict it would be universally adopted by diabetics on insulin — and thus covered by insurance — because it'd work automatically, rendering patient involvement unnecessary.
In the first pediatric trial of a prototype of the artificial pancreas earlier this year, Yale University researchers tested it on 18 teenagers who stayed in a hospital for 36 hours and found it effectively kept glucose levels in the normal range throughout. New series of trials testing the system in less controlled settings are in the works.
But researchers acknowledge there is still much work to be done. At the moment, they say, the biggest challenge is developing a sensor that delivers accurate measurements of glucose levels to the pump in real time. Algorithms that calculate just how much insulin should be delivered at different times and in different circumstances need to be improved, though researchers say that shouldn't be an easy problem to solve.
Still, there are skeptics aplenty, some of whom complain that they have been hearing about an artificial pancreas since the 1970s, when prototypes were refrigerator-sized and hospital-based. More than 30 years later, hoping instead for a biological cure, they argue it's still just a lot of hype.
More specifically, they warn about the inevitability of mechanical failure, which could cause catastrophe if it occurred at particularly inopportune times; the burden of carrying around even more technology; and price tags double the amount of today's pumps.
Researchers respond that they are working on back-up systems in case of mechanical failure, that later-generation models of the artificial pancreas likely would be wholly under the skin and that insurers will ultimately rush to embrace it because it will dramatically reduce the $100 billion the United States now spends annually on diabetes-related medical care.
"It's important to remember that an artificial pancreas won't be a cure," said Dr. Philip Orlander, head of endocrinology at the University of Texas Medical School at Houston. "It'll still require doctor's visits and monitoring. But it would be a major improvement over current treatment, one that I'm sure all Type 1 diabetics in our clinic would be on."
