Is there hope for a cure for diabetes?
In 1922 the first successful injection of insulin was given to a diabetes patient. One hundred years on, is insulin still the best option or are we any closer to a cure for diabetes?
Given the rapid pace of change over the last century, it would be a fair bet that some progress had been made. After all, 1922 was also the year in which the BBC was founded and the year in which it started broadcasting regular radio news reports. In the intervening years, we’ve seen the invention of television and mainstream computing and the rise of internet technology and smart devices. Medical breakthroughs in that time are many and varied from the first heart, lung, and kidney transplants to the unravelling of the mystery of DNA which opened up the possibility of gene therapy.
As our understanding has grown so too has the potential to find a cure for many conditions including diabetes. Certainly, we are far closer to understanding the condition than we were one hundred years ago. We now understand the difference between Type 1 and Type 2 diabetes and, as discussed in a recent article, are starting to explore the possibility of Alzheimer’s as Type 3 diabetes.
We are also far more aware of the potential causes of diabetes, with Type 2 diabetes, in particular, being triggered by lifestyle factors including obesity, excess drinking and lack of exercise.
And whilst this increased understanding of potential triggers hasn’t led to a cure, it has at least enabled physicians to suggest lifestyle changes which could lead to diabetes remission.
Diabetes UK is carrying out further work in this respect with a groundbreaking Diabetes Remission Clinical Trial, DiRECT for short . The trial is proving promising with 45.6% of those who took part being in remission after the first year and 36% still in remission after the second year. Interestingly, success seems to be linked to the amount of weight lost with 64% of those who lost more than 10kg being in remission after two years.
Admittedly we are talking about remission rather than a complete cure here. But the more that our understanding of the link between diabetes and lifestyle grows, the greater the chance we have of helping people to achieve permanent remission or prevent diabetes from developing in the first instance.
We also have to stress that this type of intervention only works for Type 2 diabetes as it looks to reverse the factors which caused diabetes in the first place.
As far as we know, lifestyle choices play no part in triggering Type 1 diabetes.
Type 1 diabetes arises in a completely different way; occurring when the body’s immune system attacks the pancreas and prevents it from making insulin in the first instance. This has led scientists to look towards immunotherapy or gene therapy as potential avenues for research.
A number of potential immunotherapy pathways are currently under review, with a prime goal of identifying ways to persuade the body to switch off the attack, thereby enabling the pancreas to resume its production of insulin.
One 2022 study commented that immunotherapy has been shown to be effective in relieving disease progression for Type 1 diabetes patients. 
However, it also highlighted ongoing challenges including unsustainable immune tolerance and the current need to start treatments early in the progression of the disease in order for immunotherapy to be effective. Nevertheless, this approach does seem to have potential, particularly as we are seeing rapid developments in this field.
Another approach under development is gene therapy. Essentially, this looks to manipulate the genes in our bodies in order to produce a different outcome. This can be done in one of three main ways with a view to either introducing a new gene into the body, substituting defective genes with ones that work, or deactivating faulty genes.
Gene therapy has the potential not only to reverse Type 1 diabetes but is also being investigated as a potential treatment for cancer and other life-limiting conditions. Research is at a comparatively early stage but results look promising. The early stage results of one limited trial reported in 2021 that one Type 1 diabetic individual who received stem cell treatment appears to have been cured.  However, researchers expect this trial to run for a total of five years before being able to announce more definitive results.
Meanwhile, in October 2022 Australian scientists announced the start of a trial to examine the impact of transplanting genetically engineered pancreatic islet cells as a means of treating or eradicating type 1 diabetes. It should be noted that this trial is currently in an early production phase with patients expected to be invited to take part in 2024 so here again it is a waiting game. 
Are we closer to finding a cure for diabetes? Since the first insulin injection, our understanding of the causes and triggers of diabetes has grown significantly.
Researchers believe that there is more to come but what they have learnt so far has enabled them to come up with a variety of potential treatment regimes. There is no cure yet, but as we celebrate Diabetes Awareness Month, there is hope that one day we may have a cure.
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