Diabetes

Diabetes is a disorder in which the blood sugar levels are not regulated properly by the body. There are two major types of diabetes: type 1 and type 2, but other subsets such as LADA and gestational are also medically recognized. It is a chronic, debilitating disease affecting every organ system. Diabetes is the leading cause of kidney failure, adult blindness, non-traumatic amputations and a leading cause of nerve damage. People with diabetes are two to four times more likely to have heart attacks or strokes than someone without disease. Life expectancy of people with diabetes averages 15 years less than people without the disease.

This metabolic disease is characterized by an inability to properly store and utilize glucose and is caused by either a deficiency in the ability to secrete insulin or insulin resistance. Insulin treatment for diabetes is not a cure, but merely life support. The common manifestation of all types of diabetes is a persistent state of abnormally high levels of blood glucose, referred to as hyperglycemia. The long term dangers of diabetes arise from organ damage caused by sustained elevations in the blood glucose level. According to the American Diabetes Association, diabetes is the seventh leading cause of death by disease in the United States.

Diabetes is estimated to afflict 18.2 million Americans with 5.2 million cases undiagnosed. Every minute, two more people in the U.S. are diagnosed with diabetes representing approximately 1.3 million new cases aged 20 years and older each year. Each year approximately 200,000 Americans die from diabetes-related complications. According to a report from the Centers for Disease Control and Prevention, the current rapid increase in the prevalence of diabetes in the US should continue due to the increasing rate of obesity in the population. Diabetes rates worldwide are expected to increase substantially as additional countries consume a higher fat calorically dense diet.

The annual cost to the US healthcare system for health related expenditures associated with diabetes in the United States is approximately $100 B. Diabetes is the leading cause of blindness in people aged 20-47 and approximately 40% of all new cases of kidney failure are caused by diabetes. Addressing the preservation of the insulin producing β-cells of the pancreatic islets in these patient populations is a major unmet medical need in the diabetes regimen of care.

Type 1 Diabetes

Type 1 diabetes is an autoimmune disease that results from the body's destruction of the pancreatic β-cells that produce insulin - the hormone that "unlocks" the cells of the body, allowing glucose to enter and fuel them. Since glucose cannot enter the cells, it builds up in the blood and the body's cells literally starve to death. Approximately 130,000 new cases of type 1 diabetes are diagnosed each year in the United States and there are an estimated 1.3 million people with type 1 diabetes in the United States today. The risk of developing type 1 diabetes is higher than virtually all other severe chronic diseases of childhood. Currently, treatment of type 1 requires a strict regimen that typically includes a carefully calculated diet, planned physical activity, blood glucose testing several times a day and multiple daily insulin injections or use of a constant insulin delivery pump.

At this time, there is no cure for type 1 diabetes; insulin injections are considered life support. While outcomes are constantly improving, whole pancreas transplants are considered major surgery and have inherent limitations and islet cell transplants are still experimental.

Type 2 Diabetes

Type 2 diabetes is the most common form of diabetes and may account for up to 90 - 95% of all diagnosed cases of diabetes. Risk factors for type 2 diabetes includes older age, obesity, family history, prior history of gestational diabetes, impaired glucose tolerance and physical inactivity.

A major problem in type 2 diabetes is the presence of “insulin resistance,” a reduction in the ability of a given level of insulin to reduce glucose levels. However, people with type 2 diabetes also show an impairment of insulin secretion from the islet cells and increased glucose production from the liver. New research shows that type 2 diabetes is associated with progressive loss of insulin producing cells over time as a result of inflammatory damage to the β-cells. Diet and exercise are very important methods of reducing insulin resistance and improving blood sugar levels.

There are also several classes of oral agents to lower blood sugar that either: a) improve insulin secretion, b) improve insulin resistance, or c) reduce glucose production by the liver. However, 30% of type 2 diabetics still require insulin to achieve good blood sugar levels.

Latent Autoimmune Diabetes in Adults (LADA)

Latent Autoimmune Diabetes in Adults (LADA) is a newly recognized subset of type 1 diabetes. It has similar characteristics to typical childhood onset type 1 diabetes, but beta cell destruction is less aggressive. When diagnosed, it is in individuals who are older than the usual age of onset of type 1 diabetes (i.e., over 30 years of age at diagnosis). Alternate terms that have been used for "LADA" include Late-onset Autoimmune Diabetes of Adulthood, “Slow Onset Type 1” diabetes, and sometimes also “Type 1.5” diabetes.

Often, patients with LADA are mistakenly thought to have type 2 based on their age at the time of diagnosis. Such misdiagnosis is easy to make when the person is older, and initially responds to treatment with oral therapy, but patients with LADA do not generally have insulin resistance, as do people with type 2. It is now thought that up to twenty percent of patients with apparent type 2 diabetes actually have LADA.

Diabetic Nephropathy

Diabetic nephropathy, or kidney disease, is one of the most frequent complications of diabetes. Up to 21% of all patients with diabetes have nephropathy. Nephropathy often ends in kidney failure or end-stage renal disease (ESRD). Approximately 43% of new cases of ESRD are a result of diabetes progression. Although certain high blood pressure medications have been found to be helpful in slowing the progression of kidney disease in diabetics, there is no cure.

Diabetic Retinopathy

Diabetic retinopathy leads to proliferation of blood vessels in the retina of the eye and is another frequent complication of diabetes. It represents the major cause of blindness in adults. Nearly all type 1 diabetics who have the disease for 20 years or more will have evidence of diabetic retinopathy. As many as 21% of people with type 2 diabetes have retinopathy at initial diagnosis and most eventually develop some degree of retinopathy. It is estimated that between 12,000 and 24,000 people lose their sight in the U. S. each year to diabetes, making it the leading cause of new cases of blindness in adults. There is no cure for diabetic retinopathy.

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