As she scrolled through her annual lab results, she was expecting the usual cascade of results, but her heart skipped a beat and began racing once she came across an usually high number. A couple of phone calls and appointments later, she had to face the harsh truth she was so adamant to avoid. Her kidneys had been permanently damaged, the ultimate connection being made to her type 1 diabetes. She had been diagnosed at nine years old, but did not expect any major repercussions until well into old age. Type 1 diabetes mellitus is an autoimmune disease in which one’s body is unable to produce insulin — the hormone needed to process sugar intake. For those who do not get insulin through injections or insulin pump therapy, this disease can be fatal. Even for those with access to medicine, the possibility of death and disability is increased through complications arising from the disease such as stroke and blindness [2]. The possibility of a cure is so enticing because it could prevent the onset of such complications and give millions of people around the world a new experience of life free of constant stress and worry.
Currently, to reverse type 1 diabetes and essentially cure it, a patient would have to receive a pancreas or islet tissue transplant. However, the success of such an intervention is likely to be extremely low. Not only are there not enough donors for this type of transplant, but the likelihood that someone would be able to produce insulin following such a treatment is not high [4]. This outcome does not fit the definition of a cure for the disease, for which the main criteria is the ability of the body to produce insulin independently for a sustained period of time [3]. The reality of a cure seemed like an impossible feat until quite recently, when the use of induced pluripotent stem cells was able to cure one man from Type 1 diabetes permanently in 2021 [6].
While this cure has its drawbacks, such as a required regimen of immunosuppressants with known side effects, the options it provides to diabetics could mean better health outcomes and independence for patients worldwide.
The cure, coming to fruition in 2007, uses induced human pluripotent stem cells. These are stem cells that come from human body cells, such as skin cells, which are then differentiated into cells with specialized functions [4]. With type 1 diabetes, the stem cells are specifically differentiated into “insulin-producing islet β cells” –– cells which are destroyed in individuals who have type 1 diabetes mellitus [6]. The presence of these cells in patients would allow them to produce insulin on their own and forgo the use of injections or needles to manually administer insulin [1]. Although this cure sounds very promising and exciting, it is still too early to celebrate.
For the first person to essentially be cured from diabetes, a serious question to consider is the advantages of being able to produce insulin independently versus the costs of taking immunosuppressants. Immunosuppressants are needed to prevent the body from rejecting the stem cells [2]. However, they may cause side effects that adversely affect a patient’s quality of life and health. This would primarily be through increased susceptibility to infections [5]. Thus, the feasibility of a cure must be weighed against the impact on a patient’s overall ability to live life with good health. The cost of the cure, especially for patients who are unable to afford it, must be explored as well. This would enter an ongoing conversation about the cost of insulin — a cost which has proven to be fatal to many. Another important factor to consider is the efficiency with which the pluripotent stem cells would produce insulin in the body of the patient in which they are placed [6].
If insulin production is not high, then the cure would not be feasible and the patient would require other forms of insulin to replace the insulin that is not being produced. However, these factors should not discourage hope that an effective cure may one day become a reality.
Although stories of those facing complications as a result of diabetes cannot be changed, the possibility of independent production of insulin is promising to prevent these stories from continuing and damaging more lives. To ensure an expansion of options for diabetics worldwide, more research should be conducted on the benefits and drawbacks of stem cell therapy as a cure. To create such an option could mean a new life and new possibilities for patients suffering with this difficult and complex disorder.
References
1. Inoue, R., Nishiyama, K., Li, J., Miyashita, D., Ono, M., Terauchi, Y., & Shirakawa, J. (2021). The Feasibility and Applicability of Stem Cell Therapy for the Cure of Type 1 Diabetes. CELLS, 10(7), 1589. https://doi.org/10.3390/cells10071589
2. Kolata, G. (2021, November 27). A cure for type 1 diabetes? for one man, it seems to have worked. The New York Times, from https://www.nytimes.com/2021/11/27/health/diabetes-cure-stemcells.html
3. Roep, B. O., Montero, E., van Tienhoven, R., Atkinson, M. A., Schatz, D. A., & Mathieu, C. (2021). Defining a cure for type 1 diabetes: a call to action. LANCET DIABETES & ENDOCRINOLOGY, 9(9), 553–555. https://doi.org/10.1016/S2213-8587(21)00181-9
4. Saleem, M. ( 1 ), Sabir, S. ( 2 ), Saleem, U. ( 2 ), Saleem, A. ( 2 ), Akhtar, M. F. ( 3 ), Zahid, S. ( 4 ), Niazi, S. G. ( 5 ), & Naeem, M. ( 6 ). (n.d.). Stem cell therapy for diabetes mellitus: Recent progress and hurdles. Critical Reviews in Eukaryotic Gene Expression, 29(5), 471–482. https://doi.org/10.1615/CritRevEukaryotGeneExpr.2019025723
5. Stucker, F., & Ackermann, D. (2011). Immunsuppressiva - Wirkungen, Nebenwirkungen und Interaktionen [Immunosuppressive drugs - how they work, their side effects and interactions]. Therapeutische Umschau. Revue therapeutique, 68(12), 679–686. https://doi.org/10.1024/0040- 5930/a000230
6. Todd, J. A. (2009). Stem Cells and a Cure for Type 1 Diabetes? Proceedings of the National Academy of Sciences of the United States of America, 106(37), 15523–15524. https://doi.org/10.1073/pnas.0908373106