What is the future for diabetes treatment?
Could there be a future without diabetes? Dr Matthew Hobbs and Professor Roy Taylor discuss projects committed to improving the care and treatment of Type 1 and Type 2 diabetes, and ultimately finding a cure.
The future of treating Type 1 diabetes
There are few conditions that science has made such a fundamental impact on as Type 1 diabetes - the first use of insulin in the 1920s transformed it from a death sentence into something people can live with.
But even today, Type 1 diabetes typically involves a lifetime of daily injections and, on average, people with it die younger than the rest of the population. This is why we urgently need more research into the condition.
Diabetes: type 1 vs. type 2
- Diabetes is a condition where the body cannot regulate blood sugar levels, because of problems with the hormone insulin
- In type 1 diabetes, the body is unable to produce any insulin
- In type 2 diabetes, not enough insulin is produced or the insulin that is made by the body doesn't work properly
One of the most exciting areas of research is islet cell transplants. These involves taking the islet cells - the cells in the pancreas that produce insulin - from dead donors and putting them into people with Type 1 diabetes, whose own islet cells have stopped working.
Diabetes UK funded the UK's first 15 islet cell transplants. It is now available on the NHS and 34 people have benefited since 2005.
The treatment is very effective. However, there are still issues to solve. The transplanted cells only last for a few years; there is a very limited supply of cells; and it is difficult to stop the body rejecting them.
We are already funding research that will help to solve these issues. The results should make islet transplants more successful and available to more people in the next few years.Artificial pancreas
We are also funding research into the artificial pancreas, a combination of electronic devices that work together to monitor and adjust insulin levels, like the pancreas does in people without diabetes.
We have funded tests to see if this system works in a clinic. Those tests were successful, so the next stage is to test this system when people use it at home. If those small trials are successful, the final step before this can become a widespread treatment is to test it in large numbers of people.
There is also the real prospect of bringing an end to Type 1 diabetes altogether by using vaccine-type approaches to prevent it developing.
This is likely to take much longer, but is set to be a key focus for research over the next decade. If successful, it would be a landmark discovery of the same magnitude as the first use of insulin.
Dr. Matthew Hobbs is the Head of Research for Diabetes UK
The future of treating Type 2 diabetes
We now know that the problem in type 2 diabetes relates to high fat levels in the pancreas and the liver. When calorie intake is sharply decreased - either by a diet, or by weight loss surgery - the fat levels in these organs decreases and it has been shown that the function of the pancreas and liver returns to normal.
The diagnosis of type 2 diabetes may in future be regarded as a medical emergency. The body's metabolism is being "gummed up" by excess fat in important organs. The concept of emergency surgery is familiar to all. We should become accustomed to the concept of emergency medical therapy - a very low calorie diet to achieve a drop in body weight of 15% within weeks.
Given that such emergency action can restore normal metabolism, further research on the best way to keep weight steady after the short period of weight loss is urgently required.
This definitive treatment for type 2 diabetes will only be possible for those who recognise the importance of escaping from the shadow of diabetes, with its risks to eyesight, limb and life. However, there will always be a need for better medical treatment which can improve high blood glucose levels, and indeed be used in people with very long duration diabetes who may be more resistant to the beneficial effects of major weight loss.Developing new drugs
There are interesting possibilities amongst the new, and not so new, drugs on offer.
Some drugs increase the amount of glucose which is lost in the urine.
How about a single injection each week which could help the body respond more appropriately to food, and at the same time would help with weight control? This is what the so-called GLP-1 agonists do - drugs which mimic a naturally occurring gut hormone, that tell the body to produce more insulin and the brain to stop eating. These are already available, and a long-acting injection is well on its way.Curb your blood sugar
You can also improve blood sugar levels after meals without using drugs. There are two important approaches.
Firstly, if a small, protein rich snack is taken first thing in the morning, and breakfast is delayed for two hours, the rise in blood glucose after breakfast is reduced by about one half. This is called the second meal effect and although it has been recognised in non-diabetic individuals for almost a century, it has only recently been shown to work in people with type 2 diabetes.
Secondly, if you go out for a half hour walk after a meal (or do any physical activity) then the rise in blood glucose will be very much less compared to just sitting in a chair. This is because muscle tissue takes up glucose more rapidly during exercise, and the meal time rise in glucose is blunted.
Professor Roy Taylor was Professor of Medicine and Metabolism at Newcastle University, and is now Director of the Newcastle Magnetic Resonance Centre.