WebMD Live Events Transcript
Join Richard Furlanetto, M.D. for a discussion on the current scientific research for type I diabetes. WebMD members are encouraged to attend and bring their questions and concerns to the program.
Event Date: 05/25/2000.
The opinions expressed herein are the guests' alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.
The medical opinions given by Dr. Furlanetto are his and his alone. If you have specific questions or are concerned about your health, please consult your personal physician.
Welcome to the program, Dr. Furlanetto. It's a pleasure having you with us. Before we get into questions on Type I diabetes, can you please tell everyone a little bit about your background and area of expertise.
Dr. Furlanetto: I have MD and PhD degrees. I am a Board certified pediatric endocrinologist. I am currently the scientific director of the Juvenile Diabetes Foundation (JDF).
Moderator: What is the difference between juvenile or Type I diabetes and adult-onset or Type II diabetes?
Dr. Furlanetto: Juvenile diabetes is caused by immune rejection of the insulin producing cells in the pancreas. These are called beta cells. This results in insulin deficiency. Type II, or adult diabetes, is due to a resistance to the effects of insulin -- not to insulin deficiency. Patients with Type II diabetes can, at least early in the illness, make sufficient quantities of insulin but don't respond well to them. They can take pills which sensitize them to the insulin. People with Type I, however, must take insulin injections.
Moderator: What are the warning signs of Type I?
Dr. Furlanetto: Usually the first signs are excessive thirst and urination. In children, bedwetting in a child who has previously been potty trained is not uncommon. In older children and adults, they get up frequently at night to urinate and usually to drink. Other signs include weight loss despite excessive hunger, weakness, and blurry vision. When these signs have been neglected, it can progress to a diabetic ketoacidosis, which is rapid breathing and frequently a loss of consciousness.
Moderator: How many people have Type I diabetes?
Dr. Furlanetto: It's thought that there are about a million people in the US. There are 30,000 new cases diagnosed a year, and about half are in children.
Moderator: Are boys more prone to get it?
Dr. Furlanetto: No. There is an equal gender distribution.
Moderator: What are some of the new research advances being done to curb this disease?
Dr. Furlanetto: There are many, and many are promising and exciting. Perhaps the most exciting is the recent report of successfully transplanting islets into patients with Type I diabetes. Islets contain the cells which make insulin, and by transplanting them, they have cured the patient's diabetes. This treatment is still experimental and will certainly be improved, but it nonetheless is a very important first step for curing this illness.
Moderator: Can anyone with diabetes have this transplant?
Dr. Furlanetto: No. Currently it is for people who have severe hypoglycemia or other complications. It is also not for children. The reason is that it is still experimental, and the drugs which are needed to prevent rejection of the islets may have unforeseen long term complications. It is hoped, however, that ultimately this therapy can be made extremely safe and available to everyone with Type I diabetes.
Moderator: Will this new protocol be replicated elsewhere so more people can participate (again referring to the transplant)?
Dr. Furlanetto: Initially, the studies were done in Edmonton, Alberta, Canada, and eight patients were transplanted. All eight became insulin independent, which was very exciting. The study will now be extended to include 32 patients in the US and Europe in the next 12 to 18 months. Hopefully, many more will then be included.
Moderator: How many pancreases does it take to do this transplant?
Dr. Furlanetto: Currently as it is done at Edmonton, they took islets isolated from two pancreases to cure each patient. One of the first things that researchers will do will be to try to improve on this and cure patients with a single pancreas. This, of course, would double the number of patients who could be treated and essentially halve the cost of therapy.
Moderator: What are some of the biggest challenges you face when researching a cure for Type I diabetes?
Dr. Furlanetto: From a JDF (Juvenile Diabetes Foundation) perspective, one of our major goals has been to recruit more researchers into the field. More researchers will mean more original ideas and more interest in the problems. We think that new advances depend on having new ideas.
Moderator: How does one go about becoming a participant in one of the trials go on or coming up?
Dr. Furlanetto: The trials that are sponsored by JDF funded researchers are posted on the JDF web site. This web site also has links to other sites where other government and industry research is posted. Patients can read the study design, determine if they're eligible for the studies, and phone numbers to contact the researchers are included. However, people interested in participating in research studies should be aware that this is clinical research, and no guarantees are made. They should familiarize themselves with the rights of patients enrolling in studies, and the obligations of the researchers performing them. Only when they've had all of their questions answered should they volunteer to participate. Patient safety is really our utmost concern. The web site address www.jdf.org .
girlsarefun_WebMD: How long before the islet transplant would become reality to the general population (considering current status, cost/reimbursements, etc.)?
Dr. Furlanetto: It is not a matter of cost as much as it is availability of islets and perfecting the techniques themselves. The Edmonton study is only a first step and we would expect that within the next few years, great advances will be made in improving it. It will become safer, we'll learn better about the drugs we're using, and hopefully, we can use fewer pancreases. Right now, the real limiting factor may turn out to be the number of pancreases available. About 30,000 are donated per year, which barely keeps up with the number of new patients. To cure 1 million patients, would take a lot of pancreases. JDF is supporting research aimed at developing beta cells in the laboratory. Hopefully, this could provide an inexhaustible supply of beta cells, but it's a long way off.
Moderator: Is there a push for more Pancreases donors? Or what is the likelihood of creating a pancreases?
Dr. Furlanetto: There are a number of studies which suggest that we can get beta cells to increase in number in cell culture, that is, in a laboratory. There is also research aimed at developing new beta cells using a variety of techniques. The past year, there have been a few reports which have shown success with mouse beta cells, and now people are turning their attention to doing similar studies with human beta cells. The question of pancreas donors is really a question of organ donation in general. A number of organizations are trying to increase awareness of the need for organ donation to cure diabetes, but also kidney disease, liver disease, heart disease, and many other illnesses. Efforts are important, but in the case of diabetes, I doubt that we will ever be able to get enough pancreases to truly cure everyone.
Moderator: Is there a preventative diabetes vaccine being worked on?
Dr. Furlanetto: YES. This has become an area of interest in the last few years. There are two studies underway, one in the US and one in Europe, to try to prevent diabetes from occurring in people who are at risk for developing the disease. The results are not available for either study, so we can't say if it is working yet. The JDF has also initiated a large program to develop new vaccines for preventing Type I diabetes. We've been joined by the Australian Medical Research Council, and we expect the National Institutes of Health to also support this. We really believe that prevention of Type I diabetes is possible, and will be the most cost effective method of treating Type I diabetes.
cddcgd_WebMD: Have pancreas transplants from animals been done?
Dr. Furlanetto: Animal pancreas and islet transplants have not been done in humans. There has been considerable research aimed at trying to perfect this technique using animal models. The JDF supports a large effort aimed at determining if animal islets can be transplanted into humans. The species of choice is pigs. Their metabolism is very much like humans, and their islets respond to similar blood sugars and nutrients. However, the barrier to transplanting between species is even greater than that within a species, so it has proved quite difficult. Nonetheless, pig islets are readily available, and if they could be transplanted, there probably would not be a supply problem limiting therapy.
Moderator: We are almost out of time. What other clinical trials are going on currently?
Dr. Furlanetto: There's a broad range of trials. On one hand, there are additional trials aimed at preventing the progression or worsening of diabetes in patients who have just gotten the illness. New onset diabetics still have about 20 percent of their islets remaining, and if these can be preserved, their diabetes will be much easier to control and the incidence of complication much lower. The JDF and others are supporting studies aimed at preserving the remaining islets in new onset patients. There are also numerous studies underway to try to reverse or prevent some of the complications of diabetes such as kidney disease, eye disease, and nerve disease. These studies are listed on the JDF and other web sites.
null_null: How do parents stay up on the latest research and developments in finding a cure?
Dr. Furlanetto: Good question. The best way is probably in Countdown Magazine. This is published by the JDF. Each issue outlines one area of research, sometimes more, in diabetes. There are also a number of web sites devoted to diabetes, many of which include information on new studies and therapies. Asking your doctor can also be helpful.
cddcgd_WebMD: Is weight gain common among Type I patients?
Dr. Furlanetto: Unlike Type II diabetes, where obesity actually contributes to the diabetes, obesity is not a cause of Type I diabetes. However, patients with Type I often lose significant weight before the diagnosis is made, so when insulin therapy is instituted, they gain weight back. However, insulin therapy itself can sometimes lead to excessive weight gain if used inappropriately, particularly in patients who do not adhere to a meal plan and get regular exercise. However, under NO circumstances should patients withhold insulin to try to lose weight. This is dangerous!!
null_null: Does the JDF offer educational programs for newly diagnosed patients of Type I diabetes?
Dr. Furlanetto: Actually, no. The JDF can get you in touch with organizations that do, and we have a list of learning materials that are available. But the JDF is primarily a research organization. And it doesn't provide extensive educational materials themselves.
Moderator: What are the JDF's fundamental goals of their research program?
Dr. Furlanetto: There are four major research goals. To prevent Type I diabetes, to cure Type I diabetes, to prevent the complications of diabetes, and to cure the complications.
Moderator: Is there a priority?
Dr. Furlanetto: The JDF does have priority areas of research, and we've just done an internal review to reassess our priority areas. These will soon be published on the web site. Some of the areas include restoration of normal blood sugars, complications, hypoglycemia (low blood sugars), and vaccines.
Moderator: What are some of the complication of diabetes?
Dr. Furlanetto: There are four main complications of diabetes: eye disease leading to blindness if untreated, kidney disease which can lead to kidney failure if untreated, nerve disease, and hypoglycemia. Diabetics are also at risk for vascular disease such as heart attacks and strokes. It is important to realize, however, that good blood sugar control dramatically reduces the risk of all complications except hypoglycemia. Unfortunately, good control increases the likelihood of low blood sugars. This is the reason this has become a priority area of JDF research.
cddcgd_WebMD: What blood sugar level is ideal for diabetics?
Dr. Furlanetto: Fasting blood sugars between 80 and 120 are the targets; after eating, blood sugars less than about 170.
JHMCPHC_WebMD: My friend had triple by-pass surgery last November and was at that time put on insulin to treat his diabetes. He is now very moody, glum, and short tempered. Is this a manifestation of his disease or are they unrelated?
Dr. Furlanetto: In my experience, they are unrelated. Diabetes itself and, certainly, insulin do not usually result in personality problems. But diabetes is a chronic disease, and people with chronic illnesses have a higher incidence of depression and mood disorders. Your friend should be urged to get counseling for this.
cddcgd_WebMD: How many low blood sugars in a year should one expect to have with good control?
Dr. Furlanetto: Unfortunately, with good control, low blood sugars are much more common. One cannot really give a number. We hoped by therapy to minimize the low blood sugars, but it's virtually impossible to do if one is striving for good control. If one is having more than one severe low a month, you should definitely discuss this with your physician.
Moderator: How would someone go about donating to the research for Type I diabetes?
Dr. Furlanetto: You can go to our web site and the methods are outlined there. That's at www.jdf.org . In many towns, JDF sponsors fundraising events such as walks, galas, golf tournaments, and other such social activities. One can also contact the office directly to make a contribution at 1-800-JDF-CURE.
Moderator: We are almost out of time. Do you have any closing comments?
Dr. Furlanetto: I think this is an exciting time for diabetes research. I think that in the past 10 years, significant advances have been made, and we expect that in the next 10 years, even more will be made. We think the outlook for people with diabetes today is much brighter than any time in the past. Patients should continue to monitor their blood sugars and treat complications, so that when the cure becomes available, they can then lead a nice healthy, long life.
Moderator: We had another question come in.
cddcgd_WebMD: Do you have any idea how many traffic accidents are caused every year by people having low blood sugar episodes?
Dr. Furlanetto: No, I don't, but we're quite aware of the problem. I know with children, when they begin to drive, we counsel them at every visit to test their blood sugar before getting in the car, to take some sugar-containing material with them along with their meter, and if they don't feel well, don't drive. Nonetheless, some patients develop hypoglycemia unawareness, where they don't realize they're low, and therefore, will drive with a low blood sugar and impaired judgment. It's a real problem and it takes constant vigilance on the part of the patient, and the discipline to test their blood sugar before they drive.
Moderator: Unfortunately we are out of time. It's time to wrap up today's discussion on Type I diabetes. Thank you to Dr. Furlanetto for being our guest speaker this afternoon. It was a pleasure having you on WebMD Live. Take care everyone and have a great day.
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