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Is There a Cure?

David Spero

October 17, 2012

Everyone wants a cure for diabetes. Or do they? Some people think so much money is made from “treating” diabetes that nobody in power really wants to “cure” it. Is there any truth to this? Could there be a cure?

I’m not sure it’s possible to find a cure for something without knowing what causes it or how it works. At least in the case of Type 1, we have a general idea. The immune system attacks the insulin-producing beta cells and destroys them.

For this reason, Type 1 is called an “autoimmune” disease, although nobody seems to know exactly what that means. We don’t know why beta cells come under attack, but environmental exposure to something — a food, a virus, a chemical — seems to set the process off.

According to JDRF (formerly the Juvenile Diabetes Research Foundation), to cure Type 1, we would have to turn off the immune system attack, or somehow protect beta cells from the immune system. Then we would need to find a way to restore new, functioning beta cells. These cells could perhaps be grown from other remaining healthy cells in the pancreas, or they could be manufactured in a lab or obtained from another animal and put into the body.

If this all sounds extremely difficult, it is. Until now, no autoimmune disease has been cured. But perhaps it is possible. University of Colorado researchers say they have cured the condition in mice. They created a peptide that stops the immune system’s T-cells from attacking the beta cells.

One researcher, Dr. David Wagner, said the effect could be huge, if it works in humans. The drug is effective at both preventing the mice from developing diabetes as well as reversing the effects of diabetes in mice that already have the condition. These effects “last for as long as we administer the drug,” Wagner noted.

JDRF is certainly looking for a Type 1 cure. They fund research on protecting the pancreas and also research on Type 1 prevention, which they call “the most cost-effective cure.” They have a sophisticated fundraising program.

Unfortunately, Type 2 is more complicated and less well understood. As with Type 1, the causes are probably genetic and environmental, but we don’t know exactly what they are.

The process of Type 2 is also poorly understood. There can be problems in the pancreas, the liver, or the intestines. Besides insulin defects, there may also be problems with glucagon, which tells the liver to pump glucose into the blood. Glucagon problems one of the issues the drug metformin is supposed to control, but it doesn’t always work.

Other hormones including amylin, ghrelin, leptin, and incretins also affect glucose and can go wrong. Glands that are supposed to tell the pancreas to produce insulin may not be working. Muscle cells may stop producing proteins needed for insulin to get glucose into cells.

With all these possible targets for treatment, it’s not surprising that drug companies are pursuing Type 2 with all they’ve got. In 2010, 25.6 million people age 20 or older had diabetes in the US alone, according to the National Diabetes Information Clearing House (NDIC). Roughly 95% of them had Type 2, so Type 2 drugs have a huge potential market.

New drugs and whole new categories of diabetes drugs are developed all the time. The incretin drugs seem to remedy the intestines’ failure to signal the pancreas to produce insulin. Metformin and others try to keep the liver and glucagon under control. Sulfonylureas and meglitinides tell the pancreas to produce more insulin.

Others like the thiazolidinediones work on the muscles and other cells to get them to cooperate with insulin and take in more glucose. And there are other categories of glucose-lowering drugs, over ten in all.

People with Type 2 often have problems with lipids (fats) and blood pressure as well, so there are a dozen ways to “treat” or “control” Type 2 with drugs, but none of them come close to a cure. The cost of these drugs is over $14 billion a year in the US, and rising.

In America, we have been raised to think there is a pharmacological cure for everything. But because Type 2 diabetes is so complex, damaging so many body processes, I think it’s highly unlikely such a medical cure will ever be found. If there is such a medicine, it would most likely cause other problems that could be even worse.

That doesn’t mean there’s no possible cure; just that it won’t be a drug. I wrote here in June about the thousands of people who have “reversed” their Type 2, getting off all medicines, mostly with self-management measures. We have read that bariatric surgery and very-low-calorie diets often seem to cure Type 2 in a matter of days or weeks, at least temporarily.

Unfortunately, the research looking for cures or treatments is contaminated by the larger goal of making money. Surgeons profit from bariatric surgery, drug companies from drugs, equipment makers from needles and glucose strips, but nobody except people with diabetes profits from effective self-management. And we don’t have a lot of money to fund studies or research better methods.

What do you think? Is there a cure? Why aren’t more people looking?



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