Hopes Held out for Diabetics – No More Insulin Injections?

a184e_shutterstock_110115209A person is diagnosed with diabetes when the body fails to transfer glucose from the blood into the cells of the body to release energy. Our body needs insulin to push glucose into cells, which in diabetics is either scarcely made by the beta cells of the pancreas (insulin deficiency-type 1) or the cells stop responding to it (insulin resistance-type 2). Type 1 diabetes is an autoimmune disease that permanently destroys the beta cells of the pancreas, consequently making little or no insulin. To control blood glucose,a diabetic needs regular shots of insulin 3 to 4 times a day or use of an insulin pump.

 

Hence also called insulin-dependent-diabetes mellitus (IDDM). Type 2 diabetes is a serious metabolic disorder in which body cells stop responding to insulin made by the body and a higher dose of insulin is required which the pancreas cannot compensate. Exercise and diet control are major efficient managements, oral anti-diabetics like the sulfonylureas, the meglitinides and the phenylalanine derivatives are often prescribed. These drugs work by causing the pancreas to secrete more insulin, by decreasing the liver’s glucose production or by helping  the muscle cells to respond to insulin and use glucose more effectively.

 

Disease progression can lead to insulin deficiency by destroying insulin producing cells, requiring insulin injections in addition to diet control, an active lifestyle, weight loss and medication. While researchers are keenly looking to cure diabetes, massive emphasis is given at making diabetes management easy and hassle free. Painful Insulin injections are sought after to be replaced, however bearable methods of administration have not become widespread as yet.

 

Inhaled insulin is an alternative, though rare, it is an option for people allergic to insulin injections and now cost effective as well[1]. Still at developmental and research level, oral insulin is a promising substitute as it can directly be delivered to the liver once a way has been dealt with, for it to survive the harsh stomach environment [2]. Islet cells comprising of beta cells are insulin producing cells of the pancreas. A revolutionary diabetes treatment in Scotland, “Islet Cell Infusion Operation” has improved lives of Insulin-dependent diabetic patients[3]. This treatment, wherein extracted islets cells from a deceased donor are injected into the liver of the recipient, replacing destroyed beta cells; significantly reduces insulin dependence, improving the quality of life of patients having inadequately controlled diabetes.

 

In some cases, islets cell transplants may be so effective they do not require any insulin at all. Out of 15 islet cell transplants, 9 have been successful. Scientists are working on successful inter-species islet cell transplants (xenotransplantation) to reduce the transplant waiting list, lessening the consequences of diabetes such as harrowing damages to kidney, eyes, nerves and heart and curbing the progression of disease in waiting patients. Researchers at Northwestern University in Illinois were triumphant at transplanting rat islet cells into mice without the long term use of immunosuppressive drugs and are now working on successfully transplanting pig islet cells into human since pig insulin can control blood glucose level in humans[4][5].

 

A ground-breaking advancement in the treatment of diabetes, though still at a very early stage, is showing potential to eradicate the use of insulin and even diabetic medication. The discovery was made when Douglas Melton, a co-director at Harvard Stem Cell Institute and his post doctorate fellow Peng Yi found a hormone, Betatrophin, which repopulated the beta cells by 30 folds and subsequently facilitated the pancreas to pump insulin, promising a natural blood glucose control and reducing risks of poor management [6][11].

 

Another colossal break-through mimics the natural pancreas; it’s a mini-organ, compatible with the human body, filled with re-generating or transplanted islet cells with oxygen and helper cells to ensure its long term efficacy. This quarter-sized man-made receptacle, called BioHub, implanted somewhere in the body will restore insulin production, like a healthy pancreas, totally reversing type 1 diabetes [7].

 

Finding ways for management of Type 2 diabetes enthusiastically has become an area of cautious interest for the researchers as its prevalence (currently 90-95% of diabetes worldwide) is dramatically increasing owing to the hike in unhealthy eating habits. Recent researches have proved that lowering the body’s peripheral lipid accumulation, by inhibiting vascular endothelial growth factor B (VEGF-B), increases insulin sensitization since fat build-up hinders the  ability of cells to respond to insulin[8]. VEGF-B blockers contro l the endothelial uptake and transport of fatty acids in the heart and skeletal muscles, thereby improving glucose tolerance, preserving pancreatic islet architecture and its insulin producing function.

 

Insulin-preserving drug is another exciting breakthrough in the management of diabetes . Studies have shown that two courses of the drug which is an anti-CD3 monoclonal antibody, Teplizumab, the first one starting soon after diagnosis of type 1 diabetes and the second course after a year’s break reduces the destruction of pancreatic beta cells [9]. In addition to this, 45% of the patients enrolled in the clinical trial had a three-fold better response to insulin. Professor Herold Kevan Herold, MD, PhD, a professor of immunobiology and deputy director for translational science at Yale University, said ,”If approved, this would be the first drug to change the natural course of type 1 diabetes since insulin “[10].

 

These exciting advancements have opened new doors to improving the quality of life in diabetic indivisuals. Though clinics are still relying on the traditional approach to cure diabetes, these technological advancements prove that there is a genuine reason for diabetics to be happy. Seeing the efficacy of these products it is inevitable that they will be found at the bedside table of every diabetic in the not too distant future.

 

References:

[1] http://www.diabetes.co.uk/news/2013/Aug/insulin-inhalers-could-be-back-as-a-treatment-option-for-diabetes-92115047.html

 

[2] http://www.diabetes.co.uk/insulin/insulin-pill.html

 

[3] http://www.diabetes.co.uk/news/2012/Sep/breakthrough-treatment-can-help-improve-lives-of-type-1-diabetes-patients-93430541.html

 

[4] http://www.diabetes.co.uk/islet-cell-transplants.html

 

[5] http://www.northwestern.edu/newscenter/stories/2013/07/interspecies-transplant-works-in-first-step-for-new-diabetes-therapy.html

 

[6] http://www.diabetesincontrol.com/articles/diabetes-news/14845-harvard-betatrophin-hormone-found-to-increase-production-of-beta-cells-in-mice-thirty-fold

 

[7] http://www.diabetesmine.com/2013/03/newsflash-dri-creating-mini-biohub-organ-to-mimic-pancreas.html

 

[8] http://www.ncbi.nlm.nih.gov/pubmed/23023133

 

[9] http://www.ucsf.edu/news/2013/08/107936/type-1-diabetes-drug-proves-effective-clinical-trial

 

[10] http://www.diabetes.co.uk/news/2013/Aug/drug-preserves-insulin-production-in-new-cases-of-type-1-diabetes-91343334.html

 

[11] http://www.diabetesresearch.org/document.doc?id=1159

 

About the Author: Sonia Siddiqui is a a second year MBBS students at Dow Medical College, Pakistan. She can be reached at [email protected]

 

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  • dr danish hasan

    Well done..an article like that which is well researched and well written with all the latest references(checked all the references) shows promise.