Researchers get closer to insulin alternatives | Science| In-depth reporting on science and technology | DW | 15.10.2012
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Researchers get closer to insulin alternatives

As the living conditions change around the world, the number of diabetics continues to rise. It's raising pressure on researchers to find new alternatives to insulin.

Worldwide diabetes affects at about 300 million people and that number could reach 400 million by 2030. In Germany, over seven million people suffer from diabetes. That's about nine percent of the total population.

Oliver is one of them – but he has no idea how it happened. All of a sudden, fatigue swept over him. He lost weight for no apparent reason and had to urinate constantly. Eventually, he was diagnosed with Type 1 diabetes.

Oliver was 18 at the time. Ten years on, he still has to take insulin everyday.

"I give myself an injection before bed every night. And I test my blood sugar before meals and in the morning on an empty stomach," says Oliver. "It's always at the back of your mind, around the clock. You're always thinking about it."

There are two main types of diabetes, but both mean that the body is not producing insulin as it should. We need insulin to move sugar into cells, where it is stored until it is needed for energy. It's produced by special cells - called beta cells - in the pancreas. But when Type 1 Diabetes develops, those beta cells are destroyed and the body is unable to use the sugar – or glucose – for energy.

An insulin molecule

New treatments for Type 1 Diabetes have found ways to prevent the immune system from attacking insulin-producing beta cells

Worldwide search

Worldwide, scientists have been looking for new treatments in the hope that patients, like Oliver, can stop taking daily shots of insulin. They might even be able to think about something else for a while.

One new approach is called 'immune intervention'. It uses monoclonal antibodies to stop the body's immune system from attacking the beta cells.

"It's a very interesting treatment because it only has to be administered once," says Elmar Jäckel of the Hannover Medical School in Germany.

Patients receive a concoction of drugs, such as Teplizumab and Otelixizumab.

The treatment is thought to be effective for Type 1 diabetics – if diagnosed early enough - because often at the time of diagnosis, many patients still have about 15 percent of their insulin-producing cells. And the monoclonal antibodies would then protect these remaining cells. As a result, patients could reduce the amount of insulin they take.

The immune intervention treatment has been tested on humans in international clinical trials, but the results vary from country to country.

Results so far show that people with Type 1 diabetes from Europe and America, who are young and slim, benefit from the concoction of drugs. But patients from Asia benefit less from the treatment.

Jäckel and his colleagues have worked on the trials.

"Type 1 diabetes in Asia could have different causes because this destruction of the beta cells starts on a genetic level, but environmental factors can also contribute. And these two factors could be different in Asian countries. But the patients who were tested were also considerably older and more overweight than their counterparts," says Jäckel.

Experimenting with stem cells

Researchers have also experimented with different cells from patients. Brazilian researchers have tried using blood stem cells. It is similar to treatment for leukemia.

First, radiation destroys the body's immune system, and then the body is infused with fresh blood stem cells. This is supposed to "calm" the immune system to a point at which it no longer destroys beta cells. The first clinical studies have shown promise.

An insulin injection

Researchers across countries are looking for ways to free diabetics from regular insulin injections

And in Israel, the US and Germany, researchers have been focused on the liver as a means to a new treatment for diabetes.

"These are the first attempts to take liver cells - which we have a lot of and which regenerate themselves - and to reprogram them," says Jäckel.

The reprogrammed cells would then be able to produce insulin again.

"It's worked so far in trials on animals," says Jäckel. "The next five to ten years will show whether it can be an alternative for humans."

Type 2 diabetes

There is also good news for Type 2 diabetics.

Whereas Type 1 Diabetes is thought to be caused by an autoimmune disorder, resulting in a lack of insulin – Type 2 Diabetes is a metabolic disorder, characterized by insulin resistance. So, with Type 2 Diabetes, your body fat, liver and muscles do not respond as they should to insulin and that means that glucose remains in the blood, resulting in high blood sugar levels, known as hyperglycemia.

Jäckel says a new drug – likely to be called Forxiga – is due for approval and it could be a very big deal if it succeeds. The drug stimulates the kidneys to flush out excess blood sugar through urine. This also has the potential to free patients from taking insulin in the future.

"Seventeen substances, in all, are in clinical development," says Jäckel,"which goes to show that a lot of large companies are working on this."

It is hoped that Forxiga will become the first of the new drugs on the market by the end of year, giving Type 2 diabetics access across the European Union.

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