Where is the cure for diabetes?
It’s a simple question, yet the answers are anything but simple.
By PETER LIGHT
One in three people in Alberta has either diabetes, prediabetes or undiagnosed diabetes.
People with diabetes have high blood sugar, resulting in their bodies either not producing enough insulin or none at all, which can lead to a wide variety of health issues. Left untreated, diabetes leads to serious complications that include heart disease, stroke, blindness, nerve damage and amputation. They must constantly monitor their glucose levels to maintain quality of life and health. From a health-care perspective, the financial implications on the province are astronomical, with annual costs estimated to rise to $1.6 billion by 2020.
There has been, and continues to be, a great deal of research conducted on diabetes, including right here in Alberta. So why don’t we have a cure for diabetes yet? A simple enough question, yet the answers are anything but simple.
There are two types of diabetes, Type 1 and Type 2. Ninety per cent of diabetics suffer from Type 2 diabetes, the underlying causes of which are complex. Risk factors include diet, exercise, lifestyle, genetics and the environment. Due to the complexity of what precisely causes Type 2 diabetes, it is now thought that the existing “one size fits all approach” to treatment needs to be tailored to the individual’s needs based on what risk factors are causing the disease in the first place.
There are many “versions” of Type 2 diabetes, which is why there is no cure for it right now—and quite frankly, probably won’t be any time soon. However, when detected early, it can be effectively managed and even reversed through changes in lifestyle such as diet and exercise.
Our health-care efforts must be focused on optimizing monitoring and prevention strategies as well as developing more effective interventions and therapies through dedicated research efforts. This will make the biggest impact on the lives of Albertans living with Type 2 diabetes.
Type 1 diabetes is often first diagnosed in children and accounts for about 10 per cent of diabetes cases. In Alberta, that’s 25,000 people. To control blood sugar levels and maintain their health, people with Type 1 diabetes must constantly measure their sugar levels and inject precisely the right amount of insulin to lower blood sugars. Paradoxically, too much insulin is life-threatening. But insulin is only a long-term treatment, not a cure.
What is really required to ultimately cure people with Type 1 diabetes is the replacement of the insulin-secreting cells, found in clusters of cells known as islets, from the pancreas. Such an approach has already been developed here at the University of Alberta, with the first human islet transplantation in Canada in 1989 leading to the development of the Edmonton Protocol in 2000. Although a pioneering breakthrough, it is not a cure, as people with Type 1 diabetes often require multiple islet transplants and the use of potent immunosuppressant drugs for the rest of their life. As a result, this protocol is only suitable for a small number of people with Type 1 diabetes with very poor blood sugar control.
Further research will lead to novel ways to control blood sugar more effectively through cell-based therapies in many more people. In time, we may also be able prevent or slow down the immune destruction of the insulin-releasing cells after initial diagnosis.
It is our hope that we may one day ultimately cure Type 1 diabetes through cutting-edge research on islets and stem cells and alternative ways to reduce immune rejection, enabling many more people with Type 1 diabetes to receive these therapies.
Complex problems such as diabetes unfortunately do not have simple solutions. We require sophisticated and co-ordinated research strategies and efforts throughout Alberta and Canada if we are to effectively prevent, treat and ultimately cure some forms of diabetes. Moreover, we need strong long-term support from government entities, health organizations, funding agencies, research facilities and the public. Only through such efforts will we be able to fully understand diabetes and reduce the diabetes epidemic in Alberta. We must then take our newly learned lessons and share them with the world.
Peter Light is the Dr. Charles A. Allard Chair in Diabetes Research and the director of the Alberta Diabetes Institute at the University of Alberta.
This article originally appeared in the Edmonton Journal.