Diabetes Treatment (cont.)
Intranasal, Transdermal
Other routes for the delivery of insulin have also been tried. Intranasal
insulin delivery was thought to be promising. However, this method was
associated with poor absorption and nasal irritation. Transdermal insulin (skin
patch delivery) has also yielded disappointing results to date. Insulin in pill
form is also not yet effective since the digestive enzymes in the gut break it
down.
The future of pancreas transplantation
Ultimately, the goal in the management of type 1 diabetes
is to provide insulin therapy in a manner that mimics the natural pancreas.
Perhaps the closest therapy available at this time is a transplant of the pancreas. Several
approaches to pancreatic transplantation are currently being studied, including
the whole pancreas and isolated islet cells (these groups of cells contain beta
cells that are responsible for insulin production). Data available from 1995
indicates that almost 8,000 patients underwent pancreatic transplantation. Most
patients undergo pancreatic transplantation at the time of kidney
transplantation for diabetic kidney disease.
Transplantation is not without risk. Both the surgery itself and the
immunosuppression that
must occur afterward pose significant risks to the patient. For these reasons,
the kidney and pancreas are usually transplanted at the same time. At present,
there is disagreement about whole pancreas transplantation in patients not
currently requiring kidney transplantation. The issue of whether the benefits
outweigh the risks in these patients is under debate. There is also a chance
that diabetes will occur in the transplanted pancreas. Selectively transplanting
islet cells is an interesting alternative to whole pancreas transplantation.
However, the concern over rejection remains.
Attempts to disguise the islet cells in tissues that the body won't reject (for
example, by surrounding the islet cells by the patient's own cells and then
implanting them) are underway. In addition, researchers are exploring artificial
barriers that can surround the islet cells, provide protection against
rejection, and still allow insulin to enter the bloodstream.
A Final Word
These last few years have been an exciting time in diabetes care. Many agents
for the treatment of type 2 diabetes are under development and the options for
insulin therapy continue to grow and methods for insulin delivery continue to
become more refined. While research continues to expand in these areas, one
thing remains constant. Achieving the best blood sugar control possible remains
the ultimate goal in both type 1 and type 2 diabetes. We now know, beyond a
doubt, that good blood sugar control minimizes the long-term complications of
diabetes, including blindness, nerve damage, and kidney damage. Finally, a
healthy lifestyle can do nothing bad...it should remain the cornerstone of
management for diabetes.
Last Editorial Review: 8/3/2009
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