Diabetes Research

Now that stem cell research has been changed in the United States we can perhaps look forward to major therapeutic interventions for the newly diagnosed some time in the future. An article in the BBC spoke of a joint US-Brazilian project with 23 patients found that most were able to produce their own insulin after a transplant of stem cells from their own bone marrow. Even those who relapsed needed less insulin than before. But writing in JAMA, the team warned that treatment may only work in those recently diagnosed. To measure its effectiveness the team from Northwestern University in the US and the Regional Blood Center in Brazil, looked at levels of C-Peptides, which show how well the body is producing insulin. Twenty of the 23 patients who received the treatment became insulin-free—one for as long as four years. Eight had to return to insulin injections, but at reduced levels. The treatment did not work in three patients and it was unlikely to work in patients with more than three months after a diagnosis of type 1 diabetes. It does not have therapeutic benefits for those with type 2 diabetes. This is one of those studies that may raise the hopes of those with diabetes but there is still research needed on why some people benefits and others didn’t and why the stems cells could not continue to benefit the production of insulin over time.

Still looking at the newest research topics in diabetes, April 14 th we noted the following article. This will help you see the scope of this research and what we still need to help actually cure this disease we live with 24.7. Pancreatic islets which produce hormone-producing cells are becoming more prominent in diabetes research according to John S. Kaddis of the City of hope medical Center in Duarte California and his colleagues in the April 15 issue JAMA which was a themed issue on diabetes. “Perhaps the most prominent clinical application of this research is currently in the form of replacement therapy.” With the exception of one report in a type 2 diabetes cohort, islet transplantation has been used exclusively for a subset of people with type 1 diabetes and was shown to have some temporary value. Several obstacles remain including limited engrafement acceptance of the islets within the recipient, chronic immunosuppression and inconsistent supply of human islets. To meet the increasing demand for human islets for transplantation and research, islet-sharing networks have been established. Between September 2001 and August 2008, 297.6 million islets were produced by 14 laboratories in the Islet Cell Resource (ICR) consortium, with 67 percent of the islets used for basic science research and 31 percent for clinical purposes, “Data available through the ICR as of August 2008 indicates that a total of 151 national and international scientists received human islets for use in both intramural research performed by the consortium as well as 182 clinical and basic science projects submitted to the consortium for support.” The writers conclude that “Human pancreatic islets will be critical for the restoration of beta-cell function in patients with diabetes”. “Even given adequate funding levels, the ongoing challenges to supplying human islets must be addressed for the successful exploration of therapeutic options for this chronic debilitating disease.”

Let’s get back to the revisions for the 2009 Clinical Practice Recommendations. Here you get what your medical care should be based on so please pay attention and ask questions of your medical team to make sure you are receiving the best of medical care.

We start with Prevention and Management of Diabetes Complications.

• Glomerular filtration rate (GFR) cut points for use of thiazide or loop diuretics have been revised. Ask if this affects you.
• Pharmacologic therapy for patients with hypertension should be with a regime that included an ACE inhibitor or an angiotensin receptor blocker. If needed to achieve blood pressure targets, a thiazide diuretic should be added.
• Several dyslipidemia recommendations have been revised. Ask you physician if you are meeting these criteria. If targets are not reached on doses of statins, combination therapy using statins and other lipid-lowering agents may be considered.
• Several antiplatlet agent recommendations have been revised. Use aspirin therapy (75-162 mg/day) as primary prevention strategy in diabetics at increased cardiovascular strategy who are >40 YEARS OF AGE. For patients with CVD and documented ASA allergy, clopidogrel should be used.
• Combination therapy with aspirin and clopidogrel is reasonable for up to a year after an acute coronary syndrome.
• Coronary heart disease recommendations have been revised and the level of evidence has been changed. In patients with known CVD, Ace inhibitor(C), aspirin (A), and statin therapy (A) (if not contraindication) should be used to reduce the risk of cardiovascular events. In patients with congestive heart failure (DHF) thiazolidenedione use is contraindicated. Metformin may be used in patients with stable CHF if renal function is normal. It should be avoided in unstable or hospitalized patients with CHF.
• The recommendation in the “Retinopathy screening and treatment” screening has been revised to include adults and children aged 10 years and older with type 1 diabetes should have an initial dilated and comprehensive eye exam by an ophthalmologist with 5 years after the onset of diabetes. The Foot care section has been extensively revised including the recommendations comprehensive foot examinations fir pulse pulses and testing for loss of protective sensations.

• Treatment of high-normal blood pressure between the 90-95th % for ages, sex, and height should include dietary intervention and exercise aimed at weight control and increased physical activity, if appropriate.
• Recommendations on celiac screening in children with type 1 diabetes by measuring tissue transglutaminase or anti-endomysial antibodies, with documentation of normal serum IgA levels, soon after the diagnosis of diabetes. The recommendation on preconception care has been revised starting at puberty including counseling for routines diabetes clinic visits for all women of child-bearing potential.

Diabetes care in the school and day care setting have been revised so that Individualized Diabetes medical Management Plan (DMMP ) should be developed by the parent/guardian and student’s personal diabetes health care team with input from parent/guardian.

• All school staff members who have responsibility for a student with diabetes should receive training.
• School training may be led by the nurse, but a small number of other personal may be included to help monitor blood glucose levels and administration of glucagon as needed.
• As specified in the DMMP and as developmentally appropriate, the student with diabetes should have immediate access to supplies at all times and should be allowed to self-manage diabetes in the classroom or anywhere in student may be in conjunction with a school activity.

BSP