One of the most common questions from patients is 'Can diabetes be cured?' This is a question to which, unfortunately, the answer is not the one that people want to hear.
Many people living with type 1 diabetes tell the story of being told the cure is 5 years away, every 5 years. For those with type 2 diabetes, we used to tell them that if they lost 50 pounds and lived a healthy lifestyle, they could “cure” their diabetes. We no longer tell them that.
What is happening in research regarding this much sought after cure? Let’s talk first about type 1 diabetes. Much work has been done to attempt to identify who is at risk of developing type 1 diabetes as well as factors that might prevent the disease from occurring. It is important to understand that while we can identify the “genes” that make someone more susceptible to developing type 1 diabetes, not everyone who has the gene gets the disease. In fact most do not.
Current research tells us that someone with a first degree relative (mother, father, or sibling) with type 1 diabetes, has a 50% chance of being born with the gene for type 1 diabetes. Yet out of the 50%, less than 10% actually develop diabetes. It is the second process that is the mystery. The body will mount an attack against the beta cells of the pancreas – we call this an autoimmune response. The “trigger” for this response can be illness, infection, stress or the unknown. Research in the area of type 1 diabetes is working diligently to attempt to understand how to block this response to prevent beta cell death.
In recent years we have also come to understand other factors for increased risk of type 1 diabetes. These include lack of sunshine – in the form of Vitamin D and early exposure to cow’s milk protein in the first year of life.
Clinical research studies are ongoing to attempt to understand the role each of these factors can play. For the people who have been identified as “higher” risk for diabetes, which means they have the genes and their body is already starting to show the early immune response, many clinical trials have been undertaken to attempt to use medication to prevent this. These trials include using insulin, oral insulin, high dose Vitamin B and drugs that block immune response (the trigger). So far nothing has worked, although the use of oral insulin did show some promise. Much work is still to be done. We are always hesitant to screen the population for risk of disease, when we still have no solution to offer.
What about type 2 diabetes - the one we thought we could cure? Well, we no longer think that but we do think that it is possible to normalize blood sugars. Large clinical trials have been done looking at the effect of healthy lifestyle (good nutrition and physical activity) on the progression to type 2 diabetes in people identified to be at risk. These people are referred to as having pre-diabetes.
There was one overwhelming outcome in these trials – there was a 60% reduction in the onset of diabetes when lifestyle intervention was followed. This is why we tell people to live healthy to prevent diabetes, rather than trying to live healthy to treat diabetes. Studies have also looked at using medications like metformin and acarbose with success rates of about 27 – 30%. Using insulin right at diagnosis seems to also “reverse” diabetes for a period of time. I cannot say how long this time is as that work continues today.
What about the risk identification of type 2 diabetes? Unlike type 1 diabetes we do not have the known genes, with the exception of some genes found in very high risk populations. In the general public, there is no screening test for genes. We do know factors that put someone at higher risk of developing diabetes, such as being overweight, having high blood pressure or high blood fats. Also things like previous heart disease and polycystic ovary syndrome. We also understand clearly that certain ethnic populations have a higher risk. Likely the most important risk factor for you to know is family history. Time has taught us that unlike type 1 diabetes, if you are a first degree relative of someone with type 2 diabetes, you have a 50% chance of developing type 2 diabetes.
Today, I wish I had better news. I want to assure you that researchers are working around the world and right here in Canada to try to prevent both type 1 and type 2 diabetes and we understand so much more than we did 25 years ago. When will it happen? I will never say 5 years but I hope it is soon!