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Hope for Diabetics

Health, December 2005
Hope for Diabetics
by Peter Jaret

A groundbreaking transplant of insulin-producing islet cells, and the first-ever inhaled insulin.

Type 1 diabetes: Keys to a diabetes cure
Last January, a Japanese woman gave her 27-year-old daughter a new lease on life, thanks to an operation that offers hope to millions with type 1 diabetes. Doctors at Japan’s Kyoto University Hospital transplanted insulin-producing islet cells from the healthy 56-year-old mom to her diabetic daughter—the first successful living-donor transplant. The new cells immediately began producing insulin.

The breakthrough is an important next step toward finding a cure for diabetes. Before, doctors had successfully transplanted pancreatic cells from cadavers. But the cells are in short supply, and people with the disease often have to wait for years. “The living-donor technique may prove to offer an important advantage,” says transplant surgeon James Shapiro, MD, PhD, a diabetes specialist at the University of Alberta in Canada who worked with the Japanese surgeons on the transplant. “Unlike islet cells from cadavers, which are often damaged, cells from living donors are in near-perfect condition, which may allow them to function better.”

In another important diabetes advance, University of Minnesota researchers announced that they had successfully transplanted islet cells from a single cadaver pancreas into eight patients with diabetes—and that all of the patients were able to stop insulin injections after the transplant. Five of the patients were still diabetes-free after 1 year. New approaches to treating type 1 diabetes are badly needed. “Most patients with the disease currently try to maintain blood-sugar levels by monitoring blood glucose and taking shots of insulin several times a day,” says Bernhard J. Hering, MD, director of the islet-transplant program at the University of Minnesota. “But they still ultimately run the risk of blindness, kidney failure, and circulatory problems that lead to amputations. And life expectancy is still lower.” Advances in islet-transplant techniques will make replacing islet cells, which remains the only cure for type 1 diabetes, available to more people.

Diabetes: an alternative to injections
For people with diabetes who require insulin injections, keeping blood sugar steady could soon become a lot easier. In September, an FDA advisory committee recommended approval of the first-ever inhaled insulin. To develop it, researchers at California’s Nektar Therapeutics created insulin particles small enough to be inhaled and absorbed through your lungs. So far, more than 3,000 patients have tested the mouth-inhaler system, which could replace the fast-acting insulin shots some diabetics take before meals. Final FDA approval is pending, but experts expect the handheld inhaler to reach pharmacy shelves sometime this year.

This is good news. Type 1 generally hits the young and injected insulin usually causes problems over the years.