Twenty-three years ago, the cure to diabetes was just around the corner. My mother subscribed to Diabetes Forecast so that we could keep tabs on developments in treatment and research. I remember feeling excited each time I read about some new step closer to that cure.
Today, I'm a bit more realistic about things. Perhaps even cynical. But I honestly do not believe there will be a cure to diabetes in my lifetime. And, since I plan to live to the ripe old age of at least eighty, we're talking close to fifty years. Maybe I'll be proven wrong. We'll see.
In twenty-three years, however, there have been amazing advancements in the treatment of diabetes, and I only see that continuing...eventually the point where the need for a "cure" won't be so significant. And, I think we'll soon see the vaccination against Type 1 diabetes, which will mean future generations will never have to face the disease.
So, what's in store for us? And what do I see as obstacles?
First is the next generation of blood glucose monitoring. We have already seen a couple of methods for continuously monitoring BGLs. I think this technology will continue to advance to the point where we have a continuous and real-time update on our BGLs. This will, of course, lead to interactions with insulin pumps that auto-regulate your BGLs. This is not far-fetched, as there are a few companies already developing this and I believe at least one already undergoing FDA trials.
But I don't see this technology as perfect. I don't think we'll just be able to eat without counting carbs, and have the closed-loop system (as they call it) function without interaction. The trouble is insulin technology, and inherant delays in BG monitoring. Insulins, currently, take ten to fifteen minutes before getting into the bloodstream enough to do anything. Add in the delay that it takes for the food you eat to enter your system, and you will end up with a lag in insulin delivery. Furthermore, you have a delay in the actual BGL compared to what is monitored in a continuous fashion.
Still, even if we still need to bolus for food, a closed-loop system will be able to immediately compensate for error plus otherwise unknown causes in highs and lows...even, potentially, preventing them altogether.
There is, of course, the possibility of avoiding these delays by having an implantable system. Yet, I'd be leery of such a solution, with a greater risk of infection, not to mention the ongoing problem of the body "clogging up" the delivery and sensors for monitoring. Despite the pain and annoyance in having to insert a new infusion set every few days, I think it is a safer solution all around.
Second, as I already mentioned, there is the vaccination, which is already undergoing trials (although, I don't recall if they are animal trials or human trials at this point). I know those with diabetes (or parents of those with diabetes) are wishing for a cure...I honestly think the vaccination is a far better solution. Prevent anyone else from developing diabetes, and in a couple generations, the need for a cure is rather moot. With improving treatments, I'd personally rather see research monies put towards preventing diabetes and treating diabetes.
But, third, there is the future of a cure. As I said...not something I expect in my lifetime, but certainly a possibility. Of course, the most promising at this point is the use of adult stem cells. And I do qualify stem cells with "adult" because I don't see embryonic stem cells as a viable source of a cure. Not just due to the ethical/moral implications. But for scientific reasons. To date, embryonic stell cells have proven to be pretty much worthless in the treatment of anything. There is a lot of "hope" in them, but thus far, nothing more than that.
Adult stem cells, however, have been successfully used in a variety of treatments of various ailments, and there has been success even in the area of diabetes. Money needs to be directed there rather than the unproven "technology" of embryonic stem cells because we already know it has potential and can work.
And there is another reason: Rejection. There is a huge issue with rejection when you deal with any source of tissue that are not from the person they came from. Much as with organ transplants, stem cells taken from another source other than the person to be cured will require anti-rejection medications, which have health risks of their own. But adult stem cells don't face this hurdle. Stem cells can be taken from a person's own body, cultured into new beta cells, and used by the body without fear of rejection.
But if we're so close to that, where is the problem? Well, the fact is, we still have the problem of what caused the killing of the beta cells to begin with. They body of the diabetic killed off his or her own beta cells already. Even if the new cells are implanted, there is a great risk that the body will react to the new cells the same way they reacted to the original beta cells. The question becomes, can any form of beta cell implantation work successfully for those who are already diabetic? We've already seen cases of transplants where this has been an issue. For the first year or so, the body appears to produce insulin again...but that soon fails. That might be due to rejection, but it might be due to the body's autoimmune response.
We have a long way to go. But there is a future for diabetics. I've lived twenty-three years with the disease, and have a wonderfully prosperous life. I expect to continue living a prosperous life with the disease for another fifty. And I look forward to what the future holds.
Today, I'm thankful for the treatments available. For insulin pumps, analog insulins, BG meters that are almost instantaneous. I'm thankful for the medical companies that develop this. A grand example of capitalism at work. Competition among medical companies has benefited the lives...and will continue to benefit the lives...of diabetics everywhere.
