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Deccan Herald » Living » Detailed Story
Renewed hope for the diabetic
Dr Menaka Ramprasad and Dr Arpandev Bhattacharyya
While Insulin is a must for type 1 Diabetes, type 2 Diabetes is THE problem for us (more than 98% of all people with Diabetes), a standard treatment plan for which includes diet and exercise, tablets and Insulin.

 Despite progress in understanding of the underlying disease mechanisms for diabetes, there is still a paucity of effective therapies. Unfortunately till today we do not have a perfect Diabetes tablet or another way to take Insulin other than the injection. Researchers have stumbled upon various new modalities of treatment for Diabetes. They include:
*Inhaled insulin
*New tablets
*DPP IV inhibitors
*Sodium glucose transport inhibitors
*nPancreatic transplant
*Stem cell therapy for diabetes

Inhaled Insulin
Here Insulin is delivered directly to the lungs by an inhaler akin to those used by people with Asthma. This only can work for 3-4 hours, so the long acting insulin has to be still taken as an injection. The absorption depends on various factors like presence of flu, nasal allergy, asthma, chronic bronchitis, etc.

DPP IV Inhibitors
This group of medication works increasing the blood Insulin, because it inhibits the enzyme called Dipeptidyl peptidase (DPP)-IV which normally degrades Insulin. Inhibitors are a promising new approach to Type 2 diabetes that function as indirect stimulators of insulin secretion. They may be available as tablet or injection, one tablet has been launched in US, going to be available in our country soon. One form of injection is available with us here recently. The beauty of this group of medicine is that they are less likely to cause low sugar because they inhibit the enzyme when sugar is high but not when normal.

SGT inhibitors
This unique group of medicine is different from all others as they spill extra sugar from the blood to urine when blood sugar goes above a certain level. Researches are ongoing with this molecule.

Pancreatic transplant
This is a treatment option mainly for people going for Kidney transplant when a portion of the Pancreas of the donor is taken and implanted, in that way same medicine to prevent rejection can be used to protect the transplanted pancreas. If only the part of the pancreases is transplanted the side effects of the chemotherapy are much more detrimental than Diabetes and this does not offer any guarantee.

Stem cell therapy
Human beings are made from one cell in the beginning of the development; the cell multiplies and they take individual responsibilities. So initial rows of cells are unspecialised cells, later when they take up individual responsibilities they are called specialised cells. unspecialised cells are called Stem cells. The two broad categories of human stem cells are (a) Embryonic stem cells, derived from aborted fetal tissue and (b) Adult stem cells that are found in adult tissues. There is a lot of Ethical, Moral, Legal and scientific issues are there in embryonic stem cell therapy knowing the fact very well that this type is better suited for the job.

To treat diabetes, stem cells need to be cultivated into insulin-producing cells.

Once that has been accomplished, researchers plan to transplant stem cells that have been cultivated into insulin-producing cells into diabetic patients. Currently, those who receive transplants must take drugs that suppress the body’s immune system. If a person’s own stem cells could be cultivated and used for transplant, such drugs would not be needed.

Before any cell-based therapy to treat diabetes makes it to the clinic, many safety issues must be addressed.  A major consideration is whether transplanted stem cells can grow uncontrolled and induce tumours.

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