A “Cure” for Type 2 Diabetes

In case you haven’t already heard, researchers are now reporting that Type 2 Diabetes may (possibly) be reversed by a restricted low-calorie diet:

Adhering to the strict 600 calorie-a-day diet causes fat levels in the pancreas to plummet, restoring normal function, found Prof Roy Taylor of Newcastle University.

The discovery, a “radical change” in understanding of the condition, holds out the possibility that sufferers could cure themselves – if they have the willpower.

Until recently received medical wisdom was that Type 2 diabetes was largely irreversible.

But this small-scale study indicates that defeating it could be easier than commonly thought.

Prof Taylor asked 11 volunteers, all recently diagnosed, to go on what he admitted was an “extreme diet” of specially formulated drinks and non-starchy vegetables, for eight weeks.

Hyscience comments:

As the article goes on to point out, the trial study involved only 11 patients that ate a “meal-replacement” milkshake of 150 calories three times a day. This was supplemented with three portions of non-starchy vegetables including cabbage, broccoli, peppers, tomatoes, cucumber and lettuce. After one week, their pre-breakfast blood sugar levels had returned to normal and an MRI scan revealed that the fat levels in the pancreas were also normal, down from around eight per cent to six per cent.

Notes to self:

  • Great news – perhaps (I think)
  • “small-scale study” –  The smaller the study the less likely the results will be supported over time, esp. considering all of the potential influential factors.  Something like 33% of all reported major medical studies is contradicted within five years.
  • Radical change in management – pharma and device companies may need to revisit their strategic roadmap if this research is supported by larger scale studies

 

Why do we continually hear that diabetes diagnoses and treatment are ineffective?

We continue to hear year after year that both diagnosis and treatment of diabetes is inadequaete.  For example:

Nearly 90 percent of U.S. adult diabetics — more than 16 million adults aged 35 and older — have ineffective treatment of blood sugar, blood pressure, and cholesterol. That percentage is 99 percent in Mexico, said the researchers at the Institute for Health Metrics and Evaluation at the University of Washington in Seattle.

Frankly, I don’t know why a problem that is this often researched, reported and editorialized is not acted upon in an effective manner.  Here are a few guesses regarding why our progress in this area has been slow:

  1. Diabetes is a challenging disease to identify because is exists in a continuum of states begining with insulin resistance and hyperinsulemia.
  2. Finding an alternate or suplimentary tool for diagnosis faces stiff resistance among the medical community if it is not fully vetted with a large, mult-center and internationally approved clinical study.  After all, “new” mean changing the practice of medicine which requires significant proof. 
  3. The cost of (2) may be an large impediment
  4. Our society tends to rely too heavily on doctors and/or medications to cure with a sliver bullet.  Effective treatment of diabetes requires change in one’s lifestyle, expectations and resource allocation.  The disease is not life threatening (generally) on a day-to-day basis which makes it difficult for many to “sacrifice” their present desires for the future.

These were off the top of my head … I’ll add more as I think of them.

Thanks for reading.

Islet Transplantation for Type 1 Diabetes

At one time I believed that islet translation would lead to a therapeutic treatment and cure for Type 1 diabetes. Presentations by noted surgeons and their endocrinologist partners were hopeful and suggested that short-term trials were highly successful.
However, long term observations seem to have revealed two key factors: (1) the effectiveness of the transplanted cells diminishes through time and (2) their are risk factors associated with the immunosuppression drugs.

Consider the summary from a recent British Medical Journal Commentary:

Summary points
Islet of Langerhans transplantation is used in a select group of patients with type 1 diabetes with severe glycaemic lability, recurrent hypoglycaemia, and hypoglycaemia unawareness
The procedure is minimally invasive, with few procedure related complications
Two to three islet infusions are usually needed to achieve insulin independence

Most patients need insulin by five years post-transplantation owing to declining graft function; beneficial effects on the frequency of hypoglycaemic episodes and hypoglycaemia awareness remain

Most long term complications are related to systemic immunosuppression

The risk-benefit ratio of islet transplantation should be carefully weighed by the treating physician and the potential recipient, who should be given adequate information

As I understand it, the target population as those individuals with Type 1 Diabetes who are unable to achieve satisfactory (safe) results with conventional therapy. So, islet transplantation is not (yet) the holy grail many of us had hope but it is never-the-less beneficial for some individuals.