NEW DEVELOPMENTS IN THE WAR ON DIABETES

By Adam Brochert, M.D.
PersonalMD.com, Medical Contributor

	Prologue
	Understanding the Basics of Diabetes Mellitus:- Diabetes is a condition characterized by abnormal glucose (sugar) levels in the blood. In the United States, more than 10 million people are affected. Diabetes can begin at almost any age, from childhood to late adulthood, and its consequences can be devastating...More

Diabetes mellitus is a disease that affects 10 million people in the United States. Researchers and drug manufacturers have been working around the clock to help unravel the mystery of diabetes and devise new and more effective treatments. Their efforts have already given us new weapons in the war on diabetes, and more are on the way.

New insulin preparations and delivery systems are being actively developed. A new form of insulin, called lispro insulin, has been on the market for a few years. This is a short acting insulin which can be taken just before a meal to prevent glucose levels from getting too high after eating.

Because its peak effect is within one hour, lispro insulin is less likely to cause hypoglycemia in between meals. Insulin pumps are also on the market and are being improved and updated. With a pump, no more self-injections are needed and a smaller amount of insulin can be delivered on a continuous basis.

Researchers are also close to developing an inhalable form of insulin. This form of insulin could be inhaled into the lungs through the nose or mouth, and would eliminate the need for insulin injections, which are painful and cumbersome. These may be available within a few years.

New oral medications are also becoming available for type II diabetes. Repaglanide is a new oral medication that is short acting and can be taken just before a meal to prevent high glucose levels after eating. This short acting medication can help prevent episodes of hypoglycemia that sometimes occur with longer acting agents.

A new class of medications, the thiazolidinediones, are already available. Rezulin was the first agent in this class, and though it has caused some cases of liver damage, the newer agents in this class are becoming available and seem to lack this side effect.

Further away are transplants of pancreas tissue and even development of an artificial pancreas. As you may know, the pancreas is the organ that secrets insulin. Researchers have been able to transplant the insulin secreting cells of the pancreas into animals and eliminate their diabetes.

Human trials are not too far away. The other possibility is the development of an artificial pancreas, which could ideally sense when the blood glucose is too high and secrete an appropriate amount of insulin.

Click here to view human pancreas.

Some of the complications of diabetes have been shown to be decreased or delayed by use of medications without affecting glucose levels. ACE Inhibitors, a common class of medication used for hypertension (which commonly coexists in diabetes), have been shown to decrease progression of kidney disease and peripheral nerve damage in diabetics. Remember that diabetes is the number one cause of kidney failure and limb amputations (which are often caused by diabetics having numb feet), so this is an exciting finding.

While these new treatments are exciting, they unfortunately are going to be up against an alarming new trend in diabetes. This trend is an increase in new cases of diabetes in children in the U.S., and it has been noticed by clinicians around the country. The increase is in cases of type II diabetes, which is usually seen in adults.

The increase can be directly attributed to the increased number of obese children. As children become less active and continue to eat a Western diet, they naturally gain weight, which is the number one risk factor for type II diabetes.

It is estimated that up to 4 out 5 children the the U.S. are overweight.The groups most at risk for progression to diabetes are African Americans, Hispanics and American Indians.

So while the trend of diabetes in our youth is discouraging, the war on diabetes is being won on other fronts. The new medications and other methods of treatment being developed make this an exciting time for diabetes research and offer hope to those afflicted with the disease. Hopefully, one day we will be able to look back on diabetes as a thing of the past.

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