‘Is there a cure for diabetes?’
So far concerted lifestyle changes such as diet and exercise are known to reverse diabetes while there are no known/approved medical cures.
In diabetes, either the pancreas makes insufficient levels of insulin so cells absorb glucose poorly or cells themselves become insulin resistant and thus unable to absorb glucose despite adequate insulin levels. Both types of change increase blood sugar levels above normal. Parsed this way, type I and type II diabetes overlap some but also differ.
In type I diabetes, insufficient levels of insulin result from the immune system itself attacking the pancreatic beta cells. On the other hand, while beta cell dysfunction varies widely between type II diabetes patients, insulin resistance is a major part of the disease. Restoring the beta cells of the pancreas to health is the treatment approach these two diseases share to some degree.
Clinical attempts to treat type I diabetes focus on either replacing the damaged pancreas with a healthy one through islet cell or pancreas transplant or targeting the in an effort to stave further damage to the pancreas. However, these efforts have several shortcomings.
- Donors are in very short supply.
- A systematic review finds transplant results themselves tend to vary a lot ( ).
- Treatments to target the immune system to halt its attack of pancreas remain blunt and non-specific.
- Anti- (mAb) indiscriminately targets and depletes CD4, , and CD8, , T lymphocytes, not just those that damage/destroy the pancreatic beta cells.
- While seeming somewhat safe, anti-CD3 mAb don’t seem quite effective, one follow-up study at 1 year found only 5% of patients insulin-independent ( ).
In the meantime, tremendous interest in using different types of , mesenchymal, bone-marrow or umbilical cord blood, to try to regenerate the pancreas motivated many clinical trials for both type I and type II diabetes in recent years with mixed results. A 2016 concluded (see below from ).
‘On the basis of our study, we conclude the following: (1) remission of DM [Diabetes mellitus] is possible following stem cell therapy; (2) stem cell transplantation can be a safe and effective approach for therapy of DM; (3) available data from these clinical trials indicate that the most promising therapeutic outcome was shown in mobilized marrow CD34+ HSCs; [hematopoietic stem cells] (4) patients with previously diagnosed diabetic ketoacidosis are not good candidates for the applied approaches stem cell therapy; (5) stem cell therapy at early stages after DM diagnosis is more effective than intervention at later stages; and (6) well-designed large scale randomized studies considering the stem cell type, cell number, and infusion method in DM patients are urgently needed.’
Recent global increase in diabetes, especially type II diabetes, is a product of the global obesity epidemic and attendant increase in . In turn this has fueled an increase in surgical intervention in the form of . Diabetes reversal often follows sustained weight loss and indeed a 2014 Cochrane review of such surgeries found diabetes improvement in 5 randomized clinical trials ( ). However, depending on the country and insurance plans, such weight loss surgery can be costly. They’re also not risk-free with risks varying greatly depending on the person’s overall health profile and age as well as skill and experience of the surgeon.
As research progresses apace, the future will likely include some form of microbiota intervention to help mediate both weight loss as well as diabetes reversal. However, it’s too soon to know exactly what such interventions might entail.
1. Hilling, Denise E., et al. “Effects of donor-, pancreas-, and isolation-related variables on human islet isolation outcome: a systematic review.” Cell transplantation 23.8 (2014): 921-928.
2. Sherry, Nicole, et al. “Teplizumab for treatment of type 1 diabetes (Protege study): 1-year results from a randomised, placebo-controlled trial.” The Lancet 378.9790 (2011): 487-497.
3. El-Badawy, Ahmed, and Nagwa El-Badri. “Clinical efficacy of stem cell therapy for diabetes mellitus: a meta-analysis.” PloS one 11.4 (2016): e0151938.
4. Colquitt, Jill L., et al. “Surgery for weight loss in adults.” The Cochrane Library (2014).
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