The "Cure"
One of the most talked about and least believed topics on diabetic web sites is the promise of “The Cure”. We take the issue of a “Cure “ very seriously and I have seen diabetics argue not just about the timing of a “cure” but also and more importantly the definition of a “cure”. I do not have inside information about this issue and I sincerely doubt anyone truly can answer all the questions about what a “cure” means. Despite my limitations in this matter I want to discuss the issue. Now if I offend please excuse the offense and I do not want to start a war so please if you comment, please comment about my writing not about any responses others might make.
The first issue to determine is what is a “cure”? It will likely be different for each of us. I am a type 1 and my “cure” if I ever have one is likely physical and likely involves surgery with antirejection drugs and autoimmune suppressant medicine. I know we have a member, almost one of our original members who had a pancreatic transplant, twice. The reason was that her doctors were seeking a “cure” for her type 1 disease. It even worked for a bit. She told me she was able to not use insulin for a few years. However despite antirejection drugs she had to the use, the same autoimmune process that caused her type 1, renewed its effect on the new islets. Since her surgery scientists have reported some limited success doing these transplants, but even success depends on how you define it. Let’s face it no matter how promising the “cure” it is not perfect and at best it may not work for all of us. So is a cure a cure a cure if it works for my friend and not me? I doubt it, my idea of a ‘cure” is universal not personal.
As it happens I have Rheumatoid Arthritis (RA) and I use targeted immune suppressants (called biologics) to keep my autoimmune system form attacking my joints. That treatment is not a “cure” for RA but like insulin it does make my life bearable. One could imagine that a day might come when a person with diabetes who is identified early could be given targeted immune suppressants to stop the disease process. Like my friend one might imagine a pancreas transplant with a drug cocktail that includes anti-rejection and autoimmune suppressants. However, before anyone jumps for joy I can testify that taking an autoimmune suppressant is not an exact science. Some months they do not work and some months they do work. The issue with diabetes is the difference in the outcome. In RA if the drug does not work, you lose joint function for a month or so which is somewhat corrected with the next drug being taken. With diabetes as most type 1’s know if the drug fails for a month, the islets can be gone before the patient gets back for the next month of treatment. It is two different matters.
A more logical approach may be a “cure” by prevention. One thing that is going on is vaccine research, the idea being that the autoimmune process can be prevented if the trigger to the autoimmune process can be interrupted. There are tons of theories in the literature but it seems likely that individuals who are genetically predisposed to the autoimmune malfunction may be able to receive a vaccine to prevent that reaction from starting. One British scientist estimated this kind of treatment might be in testing 20 years from now (http://www.mirror.co.uk/lifestyle/health/alzheimers-cancer-hiv-diabetes-cures-2360616). I doubt however that most of us would regard this as a “cure”. I personally do, but of course it would not help me yet it might help my great grandchildren someday. I regard that as a “cure” because it should, if used correctly, be able to wipe out type 1 in one or two generations. Unfortunately it would not help me and other type 1’s today.
A type 2 “cure” is more difficult. One researcher believes that type 2 is also an autoimmune disease and that it might be “cured” using immunosuppressant drugs. In fact one of the drugs (Rituxan) being used in this process is the very same drug I am currently using for RA. This line of thinking is controversial and preliminary but it might offer some hope. In effect by interrupting the autoimmune process this scientist believes is responsible for type 2. Here is the web site that explains this idea (http://www.medicalnewstoday.com/articles/222766.php). If this is a possible outcome for Type 2, then indeed a very different treatment for type 2 will be in play.
Unfortunately, even this breakthrough treatment is still a treatment not a cure. Just like with RA, I will always have RA, the biologic drugs simply provide a way to live. Interestingly, if this scientist is correct and type 2 is an autoimmune reaction, then the two types are much closer than ever thought of. It is what most of us have felt for some time. The petition to rename type 1 would of course be even more off base if this line of reasoning is correct. (sorry for bringing that up but I really dislike that petition)
So what about a “cure”? Well if we define the “cure as making everything ok and that we will not need insulin or other drugs I personally do not believe it will ever happen. Despite my doctors assurance in 1974 that there would be a cure in 5, 10 or at the outside 15 years, it looks to me like we are far off from a “cure”. I do not think I will ever check into a hospital to be “cured” and go on my way today or likely at any time in the future. The “cure” either for type 1 or type 2 seems to be the Keyser Söze of the medical world. In my mind Mr. Söze, will not be caught in my life time.
So I realize I might be in the distinct minority with this next statement. But it stretches my sense of propriety when I hear the term Tour De Cure and similar events. I suppose it is marketing and I gladly give time and money to the effort. I just hate it if people are lured into thinking that a “cure” is near. To be accurate, I might re-label the effort Tour De better life. I guess mine is not nearly as catchy or effective. Because who in the public will give money for “a better life”. Again I am likely in the minority because I would and feel better about doing it.
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Rick