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Sukho Sohn WRIT340 MWF 12:00~1:00 Instructor: Elisa Warford, Ph.D Nov, 25 2012 Why should we adhere to old therapies of diabetes? The purpose of this article is to obtain an insight how much the medical progress has been done for curing diabetes, that is one of the most common diseases in the world, and give persons who do not have an information about medical science, practical advice in understanding and supporting further progress that will be made.

Introduction What do you think first in your mind about incurable disease? Most people might be tempted to guess HIV, cancer, or leukemia. However, diabetes is the most prevalent chronic disease among advanced countries. For us who has no disease, the impact of a common disease on us is very often disregarded, but many individuals like me know someone close to them who has the disease have had a long sympathy for the closest person who has diabetes. My old friend, for example, always carries a tiny syringe that contains insulin solution to relieve himself from the sufferings by diabetes. In spite of scientific progress today, many people use an old version of therapy for diabetes, which is called insulin injections. My intention for this article is to show the medical progress made and why such advancements cannot give an alternative approach to conquer the disease.

What is diabetes? Diabetes, or exactly Diabetes mellitus, is a group of metabolic diseases in which a person has high blood sugar, either because the body does not produce enough insulin, or because cells do not respond to the insulin that is produced.[1] And diabetes can be classified

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into three main types, Type 1 diabetes, Type 2 diabetes, and gestational diabetes. When the body could not produce the insulin, it called Type 1 diabetes. Type 1 diabetes mainly occurs in children. Also Type 1 diabetes is called insulin-dependent diabetes, juvenile diabetes, or early-onset diabetes. People with Type 2 diabetes produce insufficient insulin and the cells in the body do not react to insulin. Type 2 diabetes mostly occurs in adults, that's why Type 2 diabetes is called as "adult-onset diabetes". Lastly, gestational diabetes occurs in females during pregnancy due to their high blood sugar level. This gestational diabetes affects babies.

Diabetes Statistics According to the data from the 2011 National Diabetes Fact Sheet (released Jan. 26, 2011), diabetes affects 25.8 million people. This is 8.3% of the U.S population. Among US residents aged under 20 years, 215,000 or 0.26% of all people in this age group have diabetes. In aged 20 years or older group, 25.6 million, or 11.3% of all people in this age group have diabetes. 65years or older group, 10.9 million, or 26.9% f all people in this group have diabetes.[2] According to this graph, it shows us that one out of every 10 adults in the U.S has diabetes and the number of people with diabetes might double or triple by 2050. In addition, prevalence of the disease is expected to rise over the next 40 years because an aging population is more likely to develop type 2 diabetes, increases in minority groups that are at high risk for type 2 diabetes and people with diabetes are living longer.

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<Figure

1: Diabetes prevalence among age groups.>

Research from the Centers for Disease Control and Prevention(CDC), reports that the number of people with diabetes is rapidly increasing every year. Based on these statistics, we know how dangerous the diabetes is.

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<Figure 2 : Number and percentage of U.S. resident with diabetes.>

History of diabetes discovery Diabetes is one of the first diseases described with an Egyptian manuscript from c. 1500 BCE mentioning too great emptying of the urine. [3] The first described cases are believed to be of type 1 diabetes. [3] Indian physicians around the same time identified the disease and classified it as madhumeha or honey urine noting that the urine would attract ants.
[3]

The term "diabetes" or "to pass through" was first used in 230 BCE by the
[3]

Greek Appollonius Of Memphis.

The disease was rare during the time of the Roman

empire with Galen commenting that he had only seen two cases during his career. [3] Type 1 and type 2 diabetes where identified as separate conditions for the first time by the Indian physicians Sushruta and Charaka in 400-500 AD with type 1 associated with youth and type 2 with being overweight. [3] The term "mellitus" or "from honey" was added by the Britain John Rolle in the late 1700s to separate the condition from diabetes insipidus which is also

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associated with frequent urination. [3] While many measure where tried, effective treatment was not developed until the early part of the 20th century when the Canadians Frederick Banting and Charles Best first used insulin in 1921 and 1922. [3] This was followed by the development of the long acting insulin NPH in the 1940s.[3]

Discovery of insulin Insulin is a hormone, produced by pancreas. This insulin is a really important metabolite in our body system. It makes our body's cells absorb glucose from the blood. The glucose is stored in the liver and muscle as glycogen and stops the body from using fat as a source of energy.[4] Insulin was discovered by Dr. Frederick Banting and medical student Charles Best. They isolated the extract from the islets and produced isletin. This isletin <Figure 3 : Frederick Banting(left), Charles became known as insulin. Banting and Best Best, and 92th dog.> 92nd dog.> had done a lot of tests on dogs that had diabetes. The 92nd dog had a successful result that the isletin extract regulated the dog's blood sugar levels. As a result of the discovery of insulin, Banting were awarded the Nobel Prize in 1923.

Insulin treatment and its limitations Insulin is the most common method for diabetes treatment. Insulin is used to treat

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Type 1 diabetes and most of the people who with Type 2 diabetes. In this case, diabetes patients inject insulin by themselves with a small syringe because they cannot produce insulin hormone in their inner body. This insulin injection is an easy and sure treatment, but not a perfect treatment. Unlike many medicines, insulin is an inedible medicine. The only way to get insulin is an injection by syringe. Insulin is usually taken by syringe injection at regular intervals. This treatment is considerably uncomfortable to patients. To help the supply of insulin, insulin pump also used. Every time we prepare the syringe and inject insulin. By contrast, insulin pump has an advantage to control blood sugar level and can avoid the inconvenience that of injecting a needle to our body each time. This insulin therapy is the most well-known and common way to treat the diabetes, however, this therapy is not the way of full recovery. These kinds of therapy, taking insulin, causes the patient to be more dependent on insulin.

<Figure 4: Insulin pump.>

Pancreatic islet transplantation The Pancreatic islet transplantation is an alternative medical technology of insulin

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injection. In Type 1 diabetes, the body destroys insulin-producing cells by mistake and therefore insulin is not produced. In Type 2 diabetes, insulin is produced but the body is not able to use it effectively. If a patient has the pancreas removed because of pancreatitis, trauma, cancer, etc., they become diabetic as well[5] because our pancreas' major functions are production of enzyme for digestion, and production of insulin to control glucose(blood sugar) levels. Diabetic patients require life-long insulin therapy.[5] Here is the point. If the patient's body makes insulin by themselves, they do not need to live with an insulin syringe. Pancreatic islet transplantation consists of supplying patients with just the cells that control blood sugar. (islet is clusters of cells that produce hormones. There are several different types of cell in an islet. For instance, alpha cells produce glucagon, which increases the glucose, type of sugar, level in the blood. And beta cells produce insulin, which lowers the glucose level.) This medical technology can be paraphrased briefly as "cell transplantation". This technology is quite different from an organ transplant. Pancreatic islet transplantation just transplant only regular cells, that makes insulin in the pancreas. Therefore, there is a less chance of immune response than organ transplant.

<Figure 5: The process of Islet transplantation, Naftanel MA, Harlan DM (2004) Pancreatic Islet Transplantation. PLoS Med 1(3): e58>

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Conclusion Pancreatic islet transplantation is a fascinating technology in comparison with the insulin therapy. There are some advantages of islet transplant. First of all, patients' body is able to make their own insulin. That means patients can have built-in glucose sensors in their body. As a result of setting glucose sensors, patients keep glucose levels in the normal range. There is another big difference between insulin therapy and islet transplantation. Another big difference is that patient does not need bring their syringe or insulin pump. Transplanted pancreatic islets can function for an entire lifetime. Islet transplant may be required to reverse Type 1 diabetes. If successful, the transplanted islets can produce enough insulin to control blood glucose levels and respond in real time to the metabolic demand. In this case, no insulin administration is required and no blood glucose monitoring is required. Partial success may result in improved metabolic control, more stable blood glucose level and some insulin requirement.[5] Although islet transplantation does not show a 100 percent success rate, there will be an impressive progress in the not too distant future.

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References [1] Shoback, edited by David G. Gardner, Dolores (2011). Greenspan's basic & clinical endocrinology (9th ed.). New York: McGraw-Hill Medical. pp. Chapter 17.ISBN 0-07162243-8. [2] National Diabetes Fact Sheet, (2011). Centers for Disease Control and Prevention. http://www.cdc.gov/diabetes/ [3] Editor, Leonid Poretsky, (2009). Principles of diabetes mellitus (2nd ed. ed.). New York: Springer. p. 3.ISBN 978-0-387-09840-1. [4] Christian Nordqvist, (2010). Medical News Today. http://www.medicalnewstoday.com/info/diabetes/whatisinsulin.php#.UFe_kY0f7cw [5] UTMB Texas Transplant Center, Pancreatic Islet Transplant Program, http://www.utmbhealthcare.org/