My daughter's endocrinologist has told me that there will be a cure for my daughter's diabetes and that she will not be on insulin for the rest of her life. Is he just telling me what I want to hear or is there real hope that someday a cure will be found?
This question was referred to several members of the Diabetes Team, who have each given an answer:
Answer from Dr. O'Brien:To begin with, I know of no drug or drugs that will "prevent" complications absolutely, and most of the work on both man and animals has been on the amelioration of existing complications. Broadly speaking, drug treatment has been sought along three main lines:
- The prevention of glycation, that is the attachment of sugar molecules to proteins. This of course is what happens in the formation of HBA1c; but in other proteins, it may change their shape and function. In this category you could put insulin, the diabetes pills, and in fact all the factors that lead to good control.
- The second approach includes the antioxidants or the drugs that scavenge "free radicals" (the oxygen derivatives that in excess amounts are thought to be the final damaging agents in Type 1 diabetes). One of the ones that have been tried is aspirin (not much good), and selenium and vitamin E (in man) and butylated hydroxytoluene (so far only in rats).
- The third group are the so-called aldose reductase inhibitors, chemicals that prevent the conversion of a sugar into its corresponding alcohol. Both sorbinil (man) and ponalrestat (rats) have been used with limited benefit, particularly in neuropathy.
Finally, there are some other drugs whose exact role is not understood. These include propionyl and acetyl-L-carnitine for neuropathy in rats, LY 290811 for renal function (rats) and enalapril, an angiotensin conversion enzyme inhibitor (used for blood pressure control) which really seems to help microalbuminuria in man.
Answer from Jeff Hitchcock, the Editor:From the perspective of a parent, this is an exciting time. The advances in understanding of the underlying genetic predisposition and subsequent immune assault clearly hold out the promise of preventing Type 1 diabetes. The various efforts at finding a bioartificial pancreas, or islet transplant, offer great hope for a cure for children like my daughter. And research into a drug that will prevent the complications of high blood sugar offer, in my mind, the best prospect for dramatic improvement in the managment of diabetes.
Answer from Dr. Lebinger:I agree that this in an exciting time. I find that every time there's an update on TV from a researcher about some new development or progress in an old development, I get calls from parents thinking the cure is here.
I tell my patients we could have a cure tomorrow, and it might not be anything we've heard about in the news. I certainly hope we will have a cure soon and tell my patients that, but I also warn them it may not be in the near future.
Original posting 16 Aug 96
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