Cure: Deal or no Deal?
When I saw the headline in JAMA pictured to the left I thought two things: 1.) Right on! And 2.)What do you mean by soon? The second thought came to mind because, like many people with diabetes, I have been told a million times that we will be “cured” within this lifetime. In fact, I can remember clear as day sitting in the Mayo Clinic, a few days into my diagnosis, hearing my pediatric Endo say “I truly believe in 10-15 years, we’ll see a cure for this…,” while my grandpa nodded in agreement.
Its been 16.5 years folks; Cure, where you at???
I am half-kidding, because in those 16+ years I have had with diabetes, there have been leaps and bounds in treatment options. Remember NPH and RPH? That’s a far cry from my wireless insulin pump that suggests bolus doses based on carb count and BG reading, while at the same time doubling as a meter. Not to mention I have the option of using a variety of long-acting insulins, should I choose to take a pump break. I also now carry Symlin in my tool kit of ‘betes management, a drug that didn’t exist 5 years ago.
But as any person who lives with Type 1 diabetes, in our hearts and minds we ultimately hope for a cure. We fundraise at walks and bike rides across the country to fuel the expensive clinical trials investigating potential solutions. We blog about the latest stem cell treatment and start discussion threads on the Edmonton protocol, hoping, waiting, and speculating. Though we know we are years away from a cure, we all know that is the ultimate goal, right?
Uuuuhmm, maybe not, according to some of the latest research. In a lengthy article in this month’s JAMA (I know I keep referring to it, but the ENTIRE issue is devoted to diabetes and there is a goldmine of topics covered – seriously pick up this issue if you can or if you have doctor friends like me – thanks Elyce!) Dr. Guiseppe Remuzzi, MD, of the Mario Negri Institute for Pharmacological Research in Bergamo, Italy noted that he and his colleagues have discontinued performing islet cell transplantations as a result of their concerns about its safety.
“In order to not use insulin, we are giving them much more toxic drugs with major side effects” he said in an interview. He is of course referring to immunosuppressive drugs that keep the body from rejecting the transplanted Islet cells.
Great. So a leading doctor has already given up on our most viable cure. As if that was not disturbing enough, Remuzzi went on to say that existing treatments for diabetes have improved so much that it would be difficult for islet transplants to deliver better results, at least in terms of survival. He noted that in a retrospective study of 10,000 patients at 124 transplant centers waiting for a pancreas transplant, they found better survival rates for patients on the waiting list than for those who subsequently received a pancreas transplant! So the people who received a “cure” ended up worse off than those who were simply managing the disease….yikes. This is not good news.
Ok, so maybe the transplant route just isn’t the right route for a cure. That’s fine, we all know its going to take a fair amount of exploration and trial and error before we find a cure. But what is most disturbing about Remuzzi’s statements is the endorsement of managing diabetes with existing therapies rather than continuing to explore the transplant issues. It’s hard not to look at his statements as a white flag of defeat. Sure, we have major improvements in the tools available for management, but is it too much to ask that we continue to drive towards a cure AND continue to develop those management tools? I don’t think so. In fact, I think that’s what people with diabetes deserve. Insulin is not a cure. People with diabetes have never looked at their medications as a cure, but rather as innovative tools that help them manage in the interim (I know it’s been a long-ass interim, but you get the point). It would be a tragedy to abandon that hope for a cure in favor of simply treating the symptoms. But in the meantime, I do want those innovative tools available. I would like to have my (sugar free) cake and eat it to, so to speak. I think the 170 million people with diabetes worldwide would agree: that’s not asking too much.
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Comments
Elizabeth - thanks so much for your comment - I would love to hear your diagnosis story - sounds like an interesting one! Email any time.
I am indeed familiar with Dr. Faustmans work, but I believe her work focuses on restoring function in newly diagnosed diabetics who still retain a little beta cell function, so folks like you and I who have had it for a lenght of time would not be eligible for her treatment. Of course, if widely used, this would basically eliminate all new cases of diabetes -awesome for the future, not so awesome for us. Is that correct? Or did I misunderstand the research?
Thanks for stopping by and checking out the blog! Keep reading!
Hi, first of all thank you so much for the blog. I have been meaning to write you an email to introduce myself and tell my (DRAMATIC!) diagnosis story for a few months, I promise I will get around to it soon…
But in the meantime, I was sort of confused by this post because ever since I was diagnosed (Oct 2007 at 20 yrs old)I considered the best hope for a cure to be Dr Denise Faustman’s work using existing drugs to restore beta cell function, rather than transplants. I believe human trials recently started, and Dr Faustman is very confident in her research.
Personally, I would never want to have a transplant! It seems so drastic when the disease has become so manageable, and is becoming more so year after year.
Have you heard anything about Faustman’s research?