The Reality of Diabetes Reversal
The conversation around diabetes reversal has increased, and when researching diabetes there are numerous states to this claim, but how realistic is it?
Sadly, diabetes affects a huge number of people worldwide and is responsible for blindness, kidney disease, limb amputation and death. WHO estimates that diabetes was the seventh leading cause of death in 2016[1] and 422 million adults currently live with diabetes (1 out of every 11 people). There is no cure for the disease currently, however research teams across the globe work tirelessly to better understand, treat and one day cure the various types of diabetes that are responsible for these shocking statistics.
The conversation around diabetes reversal has increased, and when researching diabetes there are countless articles stating this claim, but how realistic is it? To address this we need to look at the various types of diabetes and also how we’re defining the term “reversal” to better understand the reality of the current situation.
A QUICK LOOK AT TYPE 1 & TYPE 2 DIABETES
Type 1
People with type 1 diabetes can’t make insulin as the cells responsible for producing these cells (beta cells) are destroyed in the pancreas by their body’s immune system. Killer T-Cells are responsible for destroying bacteria and viruses in healthy people, but for those with type 1 diabetes they attack beta cells. Tregs (regulatory T-Cells) usually keep the killer T-Cells at bay by “turning them off”, but become outnumbered for people with type 1.
People with type 1 need daily insulin injections to make sure that blood glucose levels are maintained.
Type 2
Most typically linked to old age, a family history of the disease or being overweight, type 2 diabetes occurs due to fatty accumulation in the liver (limiting its responsiveness to insulin which means that more glucose is then produced) and the pancreas (causing metabolic stress which stops ß cells from functioning).
Individuals with type 2 diabetes are encouraged to manage their weight and may also be prescribed medications like metformin which actively reduces the amount of sugar in the blood by limiting how much is produced in the liver. It also increases insulin sensitivity in muscle cells.
TYPE 1 TREATMENT
Islet Transplants
For those with type 1 diabetes, the amount of severe hypos (those which require the sufferer to receive help from another person) can be reduced by islet transplants. This involves extracting islet cells from the pancreas (of a deceased donor) and then implanting them into the liver.
One issue with this treatment is the widespread potential for “immune rejection” where the body sees the islets as foreign and tries to destroy them. Patients take immunosuppressant medication which (although widely available now) when islet transplants were first carried out in the 1990s, weren’t so well developed. At that time, just 8% of islet transplants were successful.
Improvements to islet transplants have been further developed within the last year: Placing islets inside microcapsules makes them less likely to be targeted by the body’s immune system. Microencapsulation requires large quantities to be administered, with the result of lots of empty caps, so researchers at the University of the Basque Country in Spain developed a system whereby empty microcaps are separated by a magnetic purification system.
Magnetic nanoparticles are added to islets and then purified, meaning that a volume reduction of 80% could be achieved, addressing the problem of a shortage of islet donors and subsequent risk of immune response[2].
Although islet transplants have the potential to be widely successful in the treatment of type 1 diabetes and their limitations are being addressed by current research, they are still not necessarily suitable for all type 1 diabetics (for example those requiring larger quantities of insulin each day or those who are overweight[3]) and the lack of donors prevents this type of treatment from positively impacting as many type 1 sufferers as it could.
Future Treatment: Immunotherapies
Immunotherapies have been adopted as an approach to treating autoimmune conditions such as type 1 diabetes. They work by interrupting the process whereby the immune system wrongly reacts to pancreatic cells producing insulin as dangerous. It’s been suggested that immunotherapy could eventually replace insulin as the primary treatment for type 1 diabetes.
Forms of immunotherapy have different actions but each aim to stop the immune system from attacking the pancreas. Approaches include changing what killer T or B cells do, or helping to protect the pancreas when attacked.
An example treatment developed by Imcyse works by injecting a molecule which encourages the system to produce a new type of immune cell which has been engineered to kill those cells that ruin the pancreas[4].
Stem Cell Therapy
An increasing number of scientists are suggesting that diabetes could one day be cured using stem cell therapy. Stem cells are implanted into the patient and over the course of a few months they mature into insulin producing stem cells.
Stem cells can help both type 1 and type 2 diabetics, cases have shown individuals with type 1 diabetes who have successfully received stem cell treatment to have gone for years without the need for an injection of insulin, so with further refinement a cure may be possible at some point soon.
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