Has anyone else noted the recent influx of “A Cure for Diabetes” stories around at the moment?  I know you have because you’ve been bashing my door down trying to get a Reality Check on it all.  Here it is:

First a wee bit of background: 
Type 1 Diabetes is caused by our immune systems destroying the cells which produce insulin in our pancreases.  A lot of research happening at the moment is focusing on transplanting new insulin-producing cells into our bodies and ensuring that our immune system does not or cannot destroy them again.
More: http://www.diabetes.org/diabetesforecast/00March/page54.asp

The most recent story on the news was from Edmonton, Canada.  Insulin-producing islet cells were taken from young healthy people who had died, and injected into the hepatic vein near the liver.  Seven people with Type 1 Diabetes underwent this procedure and have now been “insulin INdependent” for more than a year.  There are a few catches though, as always!

Here’s a checklist of a few things to look out for to see whether the cure stories we hear are just media beat ups or real breakthroughs.

Immune suppressants.
All current transplants involve patients taking immune suppressants for the rest of their lives. This means your immune system is significantly suppressed so that a simple cold could kill you. 
    There are also increased risks of cancer.  The only people who qualify for transplants on an ethical basis are those whose diabetes is considered more life-threatening than immune suppression would be.  Mainly these people are suffering severely and repeatedly from hypoglycaemia unawareness ie. no early symptoms of hypos just blacking out straight away.  This is very rare. (Thank goodness!).
     A real breakthrough would involve no immune suppression.   Instead, attempts are being made to prevent rejection of insulin-producing cells by encapsulating them in membranes which have pores of a size sufficient to allow nutrients in and insulin out, but too small to allow entry of antibodies or cells of the immune system to destroy the cells. 

Are the insulin-producing cells readily available? 
The number of pancreases required per person for the Edmonton study was 2-3.  Only 156 people in Australia donated organs last year. 
    The insulin-producing cells also have to be separated from the pancreas.  The cost of setting up a facility to do this is considerable (a million to establish and half a million a year to maintain). It is for this reason that there is no such facility in Australia.  At the very best, the Edmonton procedure could only benefit 40 of the 100,000 Australians with insulin-dependant diabetes each year. 
    For this reason, scientists are currently pursuing transplanting insulin-producing cells from animals into humans and also engineering other cells from our bodies to produce, store and secrete insulin.

Simple technology
A “cure” needs to be not so labour intensive that only a few clinics could perform it.  Similarly, it needs to be relatively affordable.  The Edmonton trial cost approximately US$100,000 per patient.  (Even if you’d pay that, plenty couldn’t!)

Does the technique work in humans? 
If so, are people able to cease insulin injections? For how long? How many people have remained off insulin for 1 year? 
    Beware that some stories reported in the media refer only to trials on mice or the like.  It’s worth asking the above questions before taking much notice.