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Food is a source of energy for the body. Through the process of digestion, most of the food that we consume is eventually broken down, or converted, into a simple sugar called glucose. Glucose then passes into the bloodstream where it becomes available for the body to use for growth and energy. In order for glucose to be used by cells in the body, a hormone produced by the pancreas, called insulin, is needed.

In diabetes, the pancreas produces little or no insulin, or the cells throughout the body are unable to respond to the insulin that is produced. The end result is a buildup of glucose in the blood, which eventually spills over into the urine. Elevated blood glucose levels are responsible for many of the health problems associated with diabetes.

There are three main types of diabetes:

Type 1 diabetes

• Also known as insulin-dependent diabetes mellitus (IDDM) or juvenile-onset diabetes.
• In this type of diabetes, the pancreas produces little or no insulin.
• Treatment always involves injections of insulin along with diet modifications to control blood glucose levels.
• This form of diabetes accounts for about 5 percent to 10 percent of all cases in the United States.

Type 2 diabetes

• Also known as noninsulin dependent diabetes mellitus (NIDDM) or adult-onset diabetes.
• In this type of diabetes, there is both a state of insulin resistance and a defect in insulin production.
• Treatment may involve diet modification and exercise alone, oral medications and/or insulin injections to control blood glucose levels.
• This form of diabetes accounts for 90 percent to 95 percent of all cases in the United States.

Gestational diabetes

• Gestational diabetes by definition affects pregnant women.
• Treatment may involve diet alone or insulin injections to control blood glucose levels.
• This type of diabetes usually resolves once the pregnancy is over, but women who experience gestational diabetes have a greater risk for developing type 2 diabetes later in life.

How common is type 1 diabetes?

Of the 17 million people in the United States who have diabetes, about 5 percent to 10 percent have type 1 diabetes. Type 1 diabetes usually begins in childhood or adolescence but may begin at any age. It is a lifelong disease because there is no cure for type 1 diabetes.

Type 1 diabetes is an autoimmune disease, meaning that the body stages an all-out war against itself by attacking its own cells. Researchers do not know exactly what causes the immune system to attack and destroy the beta cells within the pancreas, but the end result is the inability of the pancreas to produce the hormone insulin.

Before the discovery of insulin in the 1920s, people with type 1 diabetes usually died within a year of diagnosis. All of that has changed. Although people with type 1 diabetes require insulin injections multiple times each day to balance their blood glucose levels, they can expect to live a long life with this disease.

New discoveries in type 1 diabetes

The discovery of insulin in 1921 was probably the most notable event in diabetes research. Prior to the discovery of insulin, an individual diagnosed with type 1 diabetes had a life expectancy of less than a year. Although not a cure for diabetes, insulin has allowed millions of people with diabetes to live long and productive lives.

More recent research achievements in diabetes care have identified type 1 diabetes as an autoimmune disease. This knowledge may allow the use of more effective treatments aimed at suppressing the immune system and delaying the destruction of beta cells.

In 1993, a 10-year study named the Diabetes Control and Complication Trial (DCCT) proved what researchers believed all along - that intensified care and tight glucose control can go a long way in reducing the long-term complications of diabetes.

Newer, more effective systems for delivering insulin are constantly being studied. One day, continuous and noninvasive glucose monitoring devices could eliminate the need for finger sticks to check glucose levels.

At the American Diabetes Association's 62nd annual meeting, there were reports of new technologies for insulin delivery. There has been successful research for a pill, a transdermal skin patch, a mouth spray and several versions of pulmonary inhaled insulin. That could make life easier for the 3.7 million patients in America who, on average, must take one to five insulin shots daily to control their disease.

Research shows that a drug (an antibody) (in a single 2-week treatment) may stop type 1 diabetes in people newly diagnosed with the disease, decreasing their need for insulin shots. The most important finding of this study is that there can be effective intervention even after onset of the disease. The drug targets specific immune cells and so protects beta cells and insulin production.

The first successful pancreas transplant was performed in 1966, but survival rates for this procedure were initially low until improved anti-rejection drugs became available. By the end of 1997, nearly 10,000 pancreatic transplants had been recorded in the International Pancreas Transplant Registry. Most pancreatic transplantations in patients with diabetes are offered to people with end-stage renal disease and are performed at the same time as or after kidney transplantation. The success rates for pancreas transplants alone are not as good as when both kidney and pancreas are transplanted together. Pancreas transplant is, therefore, usually only offered to a patient who has end-stage renal failure and requires a kidney transplant.

Some of the most promising diabetes research appears to be in the area of islet cell transplants. In this procedure, instead of transplanting most of or the entire pancreas, only the islet cells (those cells responsible for insulin production) are transplanted. This procedure does not involve the surgical risks associated with organ transplantations. Many researchers believe that the cure for diabetes will evolve when improved methods for preventing rejection of the transplanted islet cells are perfected.

The ability to use engineered islet cells, using recombinant DNA to create new islet cells, is another area of diabetes research that could some day lead to a cure for diabetes.

The future for those affected by diabetes looks hopeful. Research efforts during the past 80 years have led to improved management and treatment of diabetes today. Although a lot of work remains in diabetes research, the road to the cure for diabetes is getting shorter.

External Resources: American Diabetes Association's 62nd Annual Meeting, 2002. Brackenridge B. Diabetes 101: A Pure and Simple User Guide for People Who Use Insulin. Chronimed Publishing, 1998. The Uncomplicated User Guide to Diabetes Complications. A Publication of the American Diabetes Association, Inc, 1998.

This article was published on 2002-06-27
This article was reviewed on 2003-02-03