Promising Diabetes Treatment Not for Everyone

From the WebMD Archives

June 6, 2000 -- A new treatment that may prove to be a beacon of hope for people with type 1 diabetes may be little more than a glaring reminder for people with type 2 diabetes of how the diseases differ.

Both types of the disease are called diabetes, but they harm the body in different ways, and type 1, in the short term, is much more life threatening than type 2. "They're both problems with insulin -- that's their common denominator," Suzanne Gebhart, MD, professor of medicine at Emory University School of Medicine and endocrine section chief at the Emory Clinic, tells WebMD. The similarities just about end there.

Insulin is produced by islet cells in the pancreas and is necessary for maintaining proper levels of sugar in the blood. In type 1, the islet cells don't function properly, so the people don't get the insulin they need. Daily shots of insulin are needed to prevent life-threatening reactions. A new study to be released in TheNew England Journal of Medicine details successful transplantations of islet cells into the bodies of seven people suffering from advanced stages of type 1 diabetes. Because their bodies can now produce their own insulin, the people no longer need the shots, and hopefully, they may not face the side effects of their diabetes.

About 90% of people with diabetes have type 2. It generally begins later in life, and about 85% of the people affected by it are overweight. Whether that excess weight actually causes the diabetes is still open to debate.

One thing is for sure, though; the islet cells of type 2 diabetics do the job they're supposed to. The problem is the body doesn't use the insulin that's produced properly, so the cells keep producing more and more insulin to less and less effect. Eventually, the islet cells can't meet the demand, leaving the patient with constantly high levels of sugar in the blood and the complications that go along with it. Infusing new islet cells into a type 2 diabetic could possibly help, to a degree.

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"[It] probably would have some effect," says Gebhart. "Type 2 diabetes is also associated with islet abnormalities, so presumably getting more islets, some of which function a lot better than the individual has, would be an advantage."

But it wouldn't be a cure, which is a possibility for type 1 diabetics. It wouldn't correct the other aspect of type 2, which is insulin's inability to get the job done, "so it wouldn't be a full answer, and certainly at this experimental stage it would be questionably ethical, because it's too new, too complicated to take on that different disease," Gebhart tells WebMD.

Type 2 may be controlled by changing one's lifestyle, but type 1 can only be controlled by the insulin shots, and if that fails, an islet transplantation may be the person's final appeal. Conditions for many type 2 diabetics do not get that dire until late in the disease. Gebhart agrees islet transplantation would be a "radical" procedure for someone with type 2 diabetes.

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