Type 2 Diabetes
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What Does the Future Hold for Diabetes?
I recently read a blog on the homepage of a site developed by the parents of a child
with Type 1 diabetes. In it the parent sent out a plea for healthcare
professionals not to “promise cures with a time goal.” I believe they are
correct in asking for this restraint; forty or more years ago an organization set
out to “cure” Type 1 in a short interval with lots of money and great
scientists. What we have learned is that science is progressive and that one
discovery leads to 10 new avenues, especially as technology progresses at the
same time. On the other hand, the imperative has lead to a better understanding
of the condition and how to improve quality of life for diabetics. This includes
preventing complications and allowing more normal pregnancies. So we have new
insulins, new meters, new glucose sensors, new pumps, and better
educational programs around the U.S. and elsewhere.
On the other hand, I do think we are coming to a resolution of Type 1 diabetes. First, the possibility of prevention through efficient identification of newborns at risk and a suitable vaccine. When I speak of a “cure” to patients and their families I define it is as restoration or preservation of intact, normal functioning islets without invoking a separate disease such as immune compromise. I believe it will be medical rather than surgical and, given the progress in research, will probably occur sometime in the next two decades and it must be available to everyone. The best bet is through immunologic pathways to block the immune reaction that results in beta cell destruction, similar to a vaccine. Progress on this front has been remarkable.
Finally, as opposed to the rigidity of Grover Norquist and his no increased taxes pledge, biology is infinitely variable, so there is always built-in flexibility. For a young person who develops Type 1 diabetes today it means that at least 2/3 of their lives will be completely normal.