Diabetes : Prognosis, Characteristics

by Food and Drug Administration (FDA)

(Page 4 of 4)

"From the biologics perspective," says Philip Noguchi, M.D., director of the FDA's division of cellular and gene therapy, "emphasis on products for diabetes is clearly experimental at this time, but potentially very promising." In islet cell transplantation, doctors extract islet cells from the pancreas of a person who has recently died and then infuse them via a catheter into the liver of the person with diabetes. The liver instead of the pancreas is the location for the transplant because it is easier and less invasive to access the large vein in the liver than a pancreatic vein, and islet cells that grow in the liver closely mimic normal insulin secretion.

Because the cells are very fragile, the procedure is fraught with problems. One of the biggest obstacles is the availability of fresh islet cells. There is a shortage of organ donors in the United States, and the supply of islet cells, like kidneys and pancreases, is limited. Another challenge is the ability to isolate the cells. It takes several donor pancreases to isolate enough islet cells for a single transplant.

Still, "when it comes to trying new treatments," says Keister, "I'm going to push the envelope." Since his diabetes was detected prior to glucose meters, Keister says the greatest contribution he can give back to society is his "participation in new trials using the latest technology to learn more about the effects of treatment on the disease."

While additional studies are underway to learn more about the long-term effects of islet cell transplantation, Noguchi says, "at the moment there are a number of well-established procedures for type 1 and type 2 diabetes that let people live normal lives."

Prognosis

Saudek says it's a scientific fact that the outlook for people with diabetes can be excellent if the disease is well taken care of. Several major studies, including the Diabetes Control and Complications Trial Research Group, in which people with type 1 diabetes have been followed for years, compared the effects of standard and more intensive diabetes treatments on the development and progression of long-term complications. The more intensive treatments prevented or slowed diabetes complications.

So, says Saudek, "It's doable. Taking advantage of what's available puts people in the best possible position to be strong and healthy when diabetes is ultimately cured."

Characteristics of Type 1 Diabetes

• Age of onset under 40 years old, most common in children; some older people develop this type
• Thin to normal body weight
• Quick onset with thirst, frequent urination, and weight loss symptoms developing and worsening over days to weeks
• Usually no known family history, but in rare cases there can be
• No major risk factors; risk is increased if strong family history exists
• Usually more than one shot daily of insulin treatment always needed to control diabetes
• Difficult to keep fluctuating blood sugar in ideal range
• Blood sugar is sensitive to small changes in diet, exercise, and insulin dose
• Can be caused by a combination of heredity and exposure to some factor during life that triggers autoimmune destruction of the insulin-producing beta cells in the pancreas

Characteristics of Type 2 Diabetes

• Age of onset over 40 years old, most common in adults; some younger people develop this type
• Overweight; occasionally occurs in people of normal weight
• Usually slow onset with thirst, frequent urination, and weight loss symptoms developing over weeks to months, or even years
• Can be "silent disease"
• Usually runs in families
• Treatment usually begins with diet and exercise, progressing to pills and later to insulin
• Easier to control without fluctuating blood sugar range
• Blood sugar may respond to weight loss, and/or change in diet and exercise; blood sugar may be less responsive to small changes in insulin dose
• Can be caused by combination of heredity, insulin resistance, and deficiency of the insulin-producing beta cells of the pancreas

Advances at a Glance

GlucoWatch: Glucose monitoring device worn like a watch; detects blood glucose levels through the skin; must be calibrated to a glucose meter; approved March 2001. Cygnus Inc., Redwood City, Calif.

Sof-Tact: Semi-automated home blood glucose monitor that uses light suction vacuum to hold skin in place while integrated apparatus lances skin. Device automatically transfers small amount of blood to a biosensor strip, and blood glucose test result is delivered in 20 seconds. Eliminates need for traditional finger-stick method; can be used on forearm or upper arm; approved November 2000. Abbott Laboratories, Abbott Park, Ill.

Continuous Glucose Monitoring System: Continuous measure of tissue glucose levels in adults with diabetes. Records levels at five-minute intervals for up to three days; information is then downloaded on computer for review by health-care practitioner; must be used in conjunction with finger-stick tests; approved June 1999. MiniMed Inc., Sylmar, Calif.

Lasette: Portable, battery-operated laser; means for drawing blood without using traditional lancets (small, razor-sharp devices for puncturing skin); for adults and children; approved December 1998. Cell Robotics International Inc., Albuquerque, N.M.

Q-103 Needle Management System: Used to remove certain hypodermic needles from insulin syringes and store them safely for later disposal; device holds up to 5000 removed needles; approved December 2000. QCare International LLC, Marietta, Ga.

Apligraf: Wound dressing that helps heal diabetic foot ulcers, open foot sores that can lead to amputation; approved June 2000. Organogenesis Inc., Canton, Mass.

Dermagraft: Skin substitute used to help in the wound closure of diabetic foot ulcers; helps replace and rebuild damaged tissue in diabetic foot ulcers; approved September 2001. Advanced Tissue Sciences, La Jolla, Calif.

Other devices: Over 100 glucose meters and several external insulin pumps approved in the last several years.

About the Author

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FDA is A United States government body that oversees medical devices, including contact lenses, intraocular lenses, excimer lasers and eyedrops. In the US, these products must be approved by the FDA before they can be marketed.