Zeroing In on Diabetes

Jill Eastman’s suitcase is packed. Psychologically, she’s ready to go.

Now, she’s just waiting for the telephone call. The one that will tell the 35-year-old Los Angeles resident that it’s time to head to Miami, where she’ll participate in groundbreaking--and potentially life-changing--medical research.

Eastman has been accepted for an investigational study in which she will receive transplanted islet cells, pancreatic cells that produce insulin. The goal is to eliminate the need for supplemental insulin, which Eastman has relied on since she was found at 18 months to have diabetes.

Critics complain that the experimental procedure has been hyped out of proportion to its promise because it might ultimately help only a small percentage of diabetics.

But Eastman, who works for the Los Angeles County Office of Education as a job search specialist for welfare recipients, views her upcoming transplant as “a possible step toward a cure.” Not to mention an end to her constant fatigue and the chore of monitoring her blood sugar four to 10 times a day. “There’s never a vacation from diabetes,” says Eastman, who began wearing an insulin pump more than 10 years ago. “Diabetes affects every area of your life.”

That’s a fact well-known among other diabetics--at least those who have been diagnosed. An estimated 16 million people in the U.S. have diabetes, says the American Diabetes Assn., although about half are not aware of their condition. This year, about 625,000 will learn they have diabetes; more than 178,000 deaths will be blamed on the disease or related complications.

Some will be found to have insulin-dependent diabetes (type I), in which the body does not produce any insulin, the hormone that helps glucose move from the bloodstream into the cells and make energy. Most often, type I affects children and young adults, who must take daily insulin to survive. The other 90% of diabetics have non-insulin dependent (type II) diabetes, a metabolic disorder resulting from the body’s inability to make enough insulin or to use it properly. About 40% of type II patients need supplemental insulin.

In Los Angeles, the number of diabetics is probably proportionately higher than in other areas, reflecting the ethnically diverse population, says Dr. David Lewis Geffner, an L.A. endocrinologist and diabetes specialist who serves as president of the Los Angeles board of directors for the American Diabetes Assn. Latinos, African Americans and Native Americans are at higher risk for type II than other populations.

The fight against diabetes has been long and tedious. When supplementary insulin was discovered 75 years ago, Geffner says, the medical community at first believed the problem was solved. “How naive we were,” he says.

Now, specialists know the disease is not simply a problem of glucose metabolism but a “multi-metabolic” disease, with diabetics more prone than others to kidney problems, blindness and vascular complications.

While the picture sounds bleak, there is reason for hope, as researchers and entrepreneurs work to find out more about the disease. Among some recent developments:

* In late January, a new drug, Rezulin (triglitazone), was approved by the Food and Drug Administration for type II diabetics whose disease is not controlled well by other oral medications or by insulin therapy. It aims to attack insulin resistance, says Jeff Baum, spokesman for Warner-Lambert Co., the manufacturer. In clinical studies, about 15% of patients on Rezulin could discontinue their insulin entirely, he says, and 41% decreased the number of injections needed.

* Transplantation of the islet cells--the experimental procedure Eastman is anticipating--is being fine-tuned by researchers. At the University of Miami Diabetes Research Institute, researchers are hoping to overcome the problem of the transplanted islet cells provoking a powerful immune response (and the need for large doses of anti-rejection drugs that in turn leave patients vulnerable to infection and cancer). Their solution is to transplant bone marrow stem cells (immature white blood cells) from the same donors at the same time.

* Last year, two genes that cause maturity-onset diabetes of the young (MODY), an unusual form of diabetes type II, were identified by University of Chicago researchers, who say the disease should be considered not just a metabolism defect but a defect in gene expression.

* Other researchers are studying the possibility of delivering insulin in pill form by putting the drug into tiny plastic beads so that it won’t be destroyed by digestive juices.

* Also under study is the development of devices to monitor blood glucose non-invasively, eliminating the need to prick the finger for a blood sample.

* Under development, too, are “artificial pancreases” containing islet cells that might better control insulin requirement than do the injections. Other researchers are exploring encapsulated cell therapy in which islet cells are injected once a year while the patient is under a local anesthesia.

* Other studies are focusing on preventing or delaying type I diabetes in those at risk. Last fall, the National Institutes of Health launched a nationwide study to determine if taking capsules of insulin crystals can prevent or delay the disease.

* The NIH’s Diabetes Prevention Program focuses on volunteers with impaired glucose tolerance, a condition in which blood sugar levels are higher than normal but not high enough to be classified as diabetes. The goal is to delay onset of type II diabetes.

(BEGIN TEXT OF INFOBOX / INFOGRAPHIC)

Resources

* American Diabetes Assn., Southern California office, (213) 966-2890, offers referrals to physicians, information on educational programs and seminars, brochures. Or, call the national information line, (800) DIABETES.

* International Diabetic Athletes Assn., a membership organization, (800) 898-IDAA, offers brochures on exercise, workshops and conferences.

* Diabetes Research Institute Foundation at the University of Miami School of Medicine staffs a telephone line from 6 a.m. to 2:30 p.m. weekdays, (800) 321-3437. Offers information about diabetes, new meal plan guidelines, research updates, new trends in treatment.

* Juvenile Diabetes Foundation International, (800) 533-2873, offers referrals to local chapters and information on research.

* For information on the NIH Diabetes Prevention Trial, call (800) HALTDM-1.

* For information on the NIH Diabetes Prevention Program, call (888) DPP-JOIN.