Diabetes is an overwhelming public health issue that continues to affect millions of people worldwide. In 2012, just over 29 million people in the U.S. had diabetes, with eight million of them undiagnosed. Type 1 diabetes is generally present at birth, and gestational diabetes is only seen in pregnant women (and is usually resolved when the pregnant mother gives birth), but Type 2 is developed over time due to a combination of factors that include genetics, diet, and lifestyle. Essentially, the body stops producing insulin and is then unable to correctly process sugar. Of the three types of diabetes, Type 2 is by far the most common and most dangerous. Almost 28 million of all cases of diabetes are Type 2, with these numbers predicted to double or even triple by 2050 if swift action isn’t taken.
Fortunately, researchers have responded to this urgency with a revolutionary discovery: a dimmer switch, of sorts, related to insulin levels.
This ground-breaking research from the University of Alberta has diagnosis and treatment implications that offer the potential to halt the progression of diabetes in its tracks.
Patrick MacDonald, senior author of the study and a Canada research chair in islet biology, associate professor in the University of Alberta’s Faculty of Medicine & Dentistry, and member of the Alberta Diabetes Institute, led the team that examined pancreatic islet cells from 99 human organ donors. The pancreas is the “lightbulb” of insulin production in the body, and just like an old incandescent, when it burns out, no more insulin is available to help the body metabolize sugar. Researchers found a new molecular pathway that functions as a dimmer switch to the pancreas. This switch regulates how much or how little insulin is produced in response to blood sugar in the body.
In Type 2 diabetes, this molecular pathway is generally no longer functional, but MacDonald and his team believe that it can be reactivated and turned on, essentially revitalizing the old lightbulb of the pancreas.
For Type 2 diabetics and those with pre-diabetes, this discovery can be a game changer. While treatments and medications are still a long way off, this discovery means that:
- Those with pre-diabetes may be able to reverse their course: If doctors can identify a malfunctioning molecular pathway that is causing symptoms of pre-diabetes, then they may be able to offer treatments to repair and restore function.
- Type 2 diabetics may be able to reduce supplemental insulin: While this research does not quite indicate a cure for Type 2 diabetes, restoring function to the pancreas may mean that Type 2 diabetics who rely on supplemental insulin may be able to reduce the number of shots they need daily.
Again, it is much too soon to fully extrapolate the potential benefits of this discovery, but its significance cannot be overstated. If researchers can use this discovery to develop a simple diagnostic test regarding this molecular pathway, then those people who are most at risk for developing Type 2 diabetes may be able to change course earlier.
The implications of the benefits of this research are enormous. A recent study published in JAMA, the Journal of the American Medical Association, found that the about half of the U.S. population either has diabetes or is pre-diabetic. Diabetes costs an estimated $245 billion a year in direct medical costs, lost wages and productivity, and indirect costs such as disability payments and lost income due to early death.
The emotional toll of diabetes is also high, especially with regard to Type 2 diabetes. Children watching the decline and disability of their parents may struggle, and parents themselves may find that the stress of dealing with a chronic illness becomes too much to bear.
There are some bright spots, including JAMA’s belief that diabetes and pre-diabetes numbers in the U.S. are at or near a plateau.
They credit a number of strategies for this:
- Acknowledging that obesity, a major risk factor for Type 2 diabetes, is a disease that needs to be addressed with comprehensive treatment strategies
- Addressing broad societal and environmental frameworks regarding food and nutrition to provide better food to those in need (i.e., looking at remediating food deserts and improving the quality of school breakfast and lunch)
- Concerted efforts to reach out to diagnose, treat, and educate formerly underserved, high-risk populations
- Providing better insurance coverage for comprehensive treatments that include behavioral therapy and counseling
These strategies, in combination with the new discovery of a switch to reactivate insulin production may just result in numbers of Type 2 diabetes shrinking rather than rising.
MacDonald acknowledges that this discovery is just one step on the long road ahead, but he credits the organ donors and their families for the opportunity to make this important discovery:
“Without access to this critical tissue through the Alberta Diabetes Institute IsletCore and the generosity of organ donors and their families, we would not have been able to carry out this study. If we want to learn about diabetes, and how to treat and prevent it, studying the insulin-producing cells from donors with diabetes is a powerful way to do it. We don’t know enough to stop Type 2 diabetes yet, but this is a large step towards understanding what’s going wrong in the first place.”
There are other incredible successes occurring in diabetes treatment. Check out this clinical trial involving one Type 1 diabetes patient who no longer needs insulin.