Dan Hurley, award-winning journalist and author of the new book Diabetes Rising is turning out to have some controversial views. He certainly thinks about Type 1 diabetes — which he's lived with himself for 34 years — in different terms than I do; he's very focused on causes and prevention, while I'm just trying to work out how to live with this thing. When I approached Dan to write a piece here at the 'Mine on "something hot" that came out of his book research, I wasn't sure what to expect. He prefaces the following by saying he's not intending to upset anyone, but rather to focus on the chicken's health before the egg's, or something along those lines.
A Guest Post by Dan Hurley
Within months of the discovery of insulin back in 1922, newspapers around the world were proclaiming it a "cure" for diabetes. Doctors and patients were quick to realize it was only a lifelong treatment, not a cure.
Since then, claims of a cure for type 1 have come and gone. In the late 1960s and early 1970s, much was made of pancreas transplants. When I was diagnosed with the disease in 1975, during my freshman semester at college, doctors promised me that a transplant would one day cure my disease. Then researchers realized that the anti-rejection drugs necessary for the transplant's success made this "cure" sensible only for diabetics already needing another organ transplant.
More recently, the buzz was about the Edmonton Protocol, a method for transplanting the insulin-producing beta cells in the pancreas. It looked for a few years like a true cure — until most of the transplanted cells, in most of the recipients, stopped producing insulin, and the patients had to resume taking injections.
These days, leading researchers continue to work hard toward a cure. But nearly all the researchers I spoke to while researching my book, Diabetes Rising, told me that they are skeptical about the short-term prospects for a biological cure. To be sure, they think it will happen some day... and some remain convinced that a cure could come any day. For many others, however, the optimism that once pervaded the field has been replaced by a hard-earned respect for the enemy.
Meanwhile, while everyone has been focused on searching for a cure, few have noticed a disturbing trend: type 1 is now far more widespread than it used to be, and continues increasing. The latest results from SEARCH, the largest-ever national surveillance of diabetes in youth, reported last year that the rate of new diagnoses was about twice as high as seen in the 1980s and 1990s. Likewise, the EURODIAB study of type 1 in 17 European countries reported last year that between 1989 and 2003, the incidence of type 1 jumped by 3.9% per year. If those trends continue, the researchers predicted, children's risk of developing type 1 will double by the year 2020. Similar trends have been reported around the world.
Why is that? A growing body of evidence suggests that insufficient levels of vitamin D might play a role. Another possible factor being studied in an international randomized trial is the exposure of infants in their first six months of life to cow's milk-based formula. The growing weight of children may also be increasing their risk of developing type 1; so too might exposure to pollutants, and lack of exposure to once-common bacteria and intestinal parasites. None of these theories has been proved beyond doubt, but the first three theories, in particular, have a great deal of peer-reviewed scientific research behind them.
These clues suggest that we might be able to prevent a great many cases of type 1 diabetes, without the need for any elaborate medical treatment.
For now, the Juvenile Diabetes Research Foundation has shifted much of its attention from searching for a biological cure, to working out the remaining technical and legal obstacles to bringing to market an "artificial pancreas" — a device that continuously senses exactly how much insulin a diabetic needs, and then delivers exactly that much with a computer-controlled pump. I participated in a clinical trial of such a device last year, and I know they already work pretty darn well.
It won't be a cure. But if we can get the rate of type 1 back down to where it used to be, and find practical treatments that actually work for those cases that do develop, the lack of a cure will have lost much of its sting.
Not sure I can get on board with that last statement, Dan, but I do agree that better prevention — and especially better treatments for those already effected — can take some of the 'sting' out of suckish disease.