Over 425 million people live with diabetes worldwide (according to the International Diabetes Federation). Of those 425 million, approximately 42.5 million (10%) have type-1 diabetes and 382.5 million (90%) have type-2 diabetes.
In the UK alone there are currently 400,000 people living with type-1 diabetes, 29,000 of whom are children.
For some of these people their diabetes can be managed with diet, exercise and medicine, but for the rest, for whom the diabetes has caused further complications, their lives are even more miserable.
Complications from diabetes that can arise include kidney failure, nerve damage, blindness and heart disease.
What is diabetes
Diabetes is essentially abnormally high blood glucose levels.
The three most common types of diabetes:
- Type-1 diabetes. This can develop at any age meaning your body produces little or no insulin. You need daily insulin injections to maintain your blood glucose levels.
- Type-2 diabetes. This is most common in adults and means your body does not make good use of the insulin that is produced. This type of diabetes is most often caused by poor lifestyle, little exercise and an unhealthy diet. Type-2 diabetes is reversible.
- Gestational diabetes. This is a result of high blood glucose during pregnancy; whilst it tends to disappear after birth, it leaves both mother and child at risk of developing type-2 diabetes later in life.
What would a cure for type-1 diabetes involve?
Because type-1 diabetes can’t be prevented, unlike type-2 diabetes, a cure for type-1 diabetes must do two things (according to JDRF):
- Prevent the immune system from destroying the insulin producing beta cells in the pancreas.
- Replace the destroyed insulin producing cells.
There is a treatment presently that can help people with type-1 diabetes, it involves giving new insulin producing cells (islets) to sufferers. It means transplanting healthy, functioning islets from the pancreas of an organ donor into the pancreas of the patient with type-1 diabetes.
However this is not a common solution as the risks involved in transplantation far outweigh the potential benefits of not having to inject yourself with insulin each day. Because with the transplant, the patient then has to inject themselves with strong drugs that will prevent their body from rejecting the new cells.
Plus, research has shown that people who have had the islet transplant have had to resume insulin injections after a few years anyway, because the immunosuppressant drugs they were taking did not stop the immune system from attacking the new beta cells.
The other problem is even if the transplants were successful, there simply aren’t enough human donors to go around.
Which brings stem cell research nicely into the picture.
How stem cell treatment could treat diabetes
Induced pluripotent stem (iPS) derived beta cells could be the cells that work for beta cell replacement therapy, meaning that the current islet transplant therapy could become more successful.
As iPS cells are made in the lab, they could be made from the patient’s own cells, so there is no requirement to use donor cells, reducing the risk of rejection. A recent study by Harvard has improved the laboratory process of converting stem cells into insulin producing beta cells, improving control over the beta cell production process.
However, whilst that is good news for replacing the destroyed cells part of the equation, it doesn’t prevent the ongoing autoimmune attack on the beta cells.
Which leads us neatly onto ongoing research.
Ongoing research into cures for type-1 diabetes
Research is being carried out to try to find a way to protect beta cells from being attacked by the immune system. One such method being tested is cellular engineering (or encapsulation), where the beta cells are coated in a semi-porous membrane which would protect them from the onslaught by the immune system, but still allow glucose and insulin to pass through them.
As the largest part of the problem is the immune system attacking the insulin producing cells, research into retraining the immune system to not do that is key. It doesn’t matter how many beta cells are replaced if the immune system doesn’t stop targeting them, it is futile.
There are a number of experimental approaches being explored currently, including testing whether blood stem cells from bone marrow could reset the immune system to stop it attacking the beta cells.
Another avenue of research involves cell regeneration. Because preventing the immune system from destroying the cells is one thing, replacing the destroyed cells is another.
But what if there was a way to get the body itself to grow new insulin producing beta cells? Thus negating the need for a transplant and all the complications that go alongside it.
Might we find a cure for type-1 diabetes?
At the moment, there are high hopes that a cure is just around the corner. We know that induced pluripotent stem derived beta cells can reverse diabetes in experimental animals, with recent experiments revealing that alongside the diabetes reversal, the cells also continue to produce insulin even after six months.
So, who knows what the future holds, but it is definitely looking rosy for type-1 diabetes sufferers.