There’s a cliche in the diabetes community that a cure has been “five years away” for as long as anyone can remember. Even 50 years ago, some of our readers were told that researchers were on the verge of a miraculous breakthrough. It wasn’t true.
Is there a cure for diabetes? The short answer is: no. At least, not yet.
But scientists are hard at work and making real progress. While it doesn’t seem that a true cure is on the horizon—there’s little suggestion of a pill that just makes diabetes go away—some treatments and technologies could be effective enough that they would arguably represent a cure, depending on how you define the word.
Everyone at Diabetes Daily is extremely excited for the day when diabetes is cured. We interview the greatest researchers in the world and are amazing by the continuous advances in understanding diabetes. In this section, we will look at the progress experts have made toward curing type 1 and type 2 diabetes.
Is There a Cure for Type 2 Diabetes?
There is currently no known treatment that will permanently eliminate type 2 diabetes.
However, there are treatments that can cause diabetes to go into remission.
At Diabetes Daily, we prefer using the word “remission” over other terms such as “cure” or “reversal.” This reflects the new global expert consensus, and recognizes the fact that any remission may be temporary—and may also require very hard work to maintain. Remission officially occurs when a patient’s A1C returns to sub-diabetic levels (< 6.5%) for at least three months without the use of insulin or glucose-lowering medication.
There are two treatments widely available to patients now that are known to result in type 2 diabetes remission, and they both involve dramatic weight loss:
Weight Loss Surgery
A high percentage of people who undergo bariatric surgery for weight loss enjoy diabetes remission. In a retrospective Swedish study, researchers found that 69.9% of patients with type 2 diabetes who received the surgery did not need diabetes medication five years later. A similar study of American patients found that 68.2% experienced diabetes remission.
These remissions don’t always last. In the sample of American patients, 35.1% of those that experienced remission would later relapse and once again develop type 2 diabetes. Nevertheless, the health benefits should be considered extremely significant, even among those that do relapse. The average duration of remission was 8.3 years, a long period of improved glycemic control that will likely have major positive effects for patients and their long-term health. Even patients that do not experience relapse benefit from improved blood sugars.
Different types of bariatric surgery may result in different success rates.
While bariatric surgery is effective, it is also very intense and expensive. Any major surgery comes with some risks, and it may be a struggle to convince insurance to pay for the surgery for even the most perfect candidates. You may also need to restrict your diet after surgery.
Diet, Exercise, and Weight Loss
If you’re not a candidate for bariatric surgery, you can always try to lose weight the old-fashioned way.
It is universally acknowledged by experts that diet, exercise, and weight loss can play a large role in slowing the progression of diabetes. In some cases, people have been able to fight their diabetes into remission through lifestyle changes alone.
The DIRECT trial placed adults with type 2 diabetes on a very low-calorie diet for 3-5 months and then offered significant weight management training and support for up to two years. An impressive 36% of participants achieved diabetes remission by the end of the second year. The group as a whole enjoyed significant weight loss and blood sugar improvement. Among those that lost at least 10kg (about 22 lbs), a majority (64%) achieved remission.
A more recent trial placed patients on a high-protein, low-calorie diet for 12 weeks. 35.7% discontinued their use of glucose-lowering medication, and about half of that total, 17.3% of the dieters, also achieved an HbA1c below 6.5%, putting them on track to official remission.
Due to the progressive nature of type 2 diabetes, remission is not always possible, and relapse or lack of remission should not be considered signs of failure. Most studies of this sort have found that patients with a long history of diabetes have a tougher time achieving remission, even when they achieve such significant weight loss.
We know that dieting is unbelievably difficult. If you’re targeting major weight loss to improve your diabetes, you should speak to your doctor before drastically cutting your calories.
Novel Treatments
A cure for type 2 diabetes is one of the holy grails of medical research. There is a great deal of work being done by researchers on new therapies, such as novel surgical and pharmaceutical techniques. However, nothing like a true cure seems likely to be discovered in the near future.
In the meantime, patients with type 2 diabetes ought to keep using medication and lifestyle adjustments to keep their blood sugars in a healthy range and minimizes your long-term risk of complications.
Is There a Cure for Type 1 Diabetes?
There is no biological cure for type 1 diabetes.
Researchers have spent a huge amount of effort and investment to find a medication that might be able to prevent, slow, or reverse type 1 diabetes. Despite some encouraging results, nothing has worked, and nothing’s available. Any biological cure, should we be so lucky to discover one, is likely many years away.
The problem of curing type 1 diabetes is multifaceted. At a minimum, any cure would have to both stop the autoimmune attack that defines type 1 diabetes and restore or regenerate the lost insulin-producing beta cells.
However, the last two decades have yielded tremendous progress on other technologies and therapies that could practically cure type 1 diabetes, even if they do not reverse the autoimmunity that caused it in the first place.
Pancreas Transplants
The pancreas transplant is arguably the closest thing the medical world has to a true cure for type 1 diabetes. And yet, they are only very rarely performed. Pancreas transplant surgery is expensive and dangerous, and recipients need to take anti-rejection pills for the rest of their lives, and still face a risk that the pancreas will be rejected or that they’ll continue to require insulin. And on top of it all, pancreas donors are exceedingly rare. Healthy pancreases must be harvested from deceased organ donors (“beating heart cadavers”).
As a result of all this, pancreas transplants are usually (but not always) limited to patients with extreme management issues that are already receiving a kidney transplant.
Islet Cell Transplantation
Less invasive than the pancreas transplant is the islet cell transplant. This is the possibly most exciting field of research in diabetes today.
We know that pancreatic islet cell transplants—in which insulin-secreting cells are transplanted into a patient with type 1 diabetes—work very well. Some lucky transplant recipients have enjoyed healthy blood sugar without the use of insulin for a decade or more.
Until recently, there were two major obstacles to the widespread adoption of islet cell transplantation.
The first is that doctors have historically only been able to harvest viable cells from the pancreas of a deceased organ donor. That obstacle has now been solved. Multiple biotech firms have successfully created viable islet cells in a laboratory, growing them from pluripotent stem cells. That gives doctors an essentially limitless supply of healthy islet cells.
The early results are excellent: when Vertex Pharmaceuticals treated its first patient, he was able to reduce his insulin usage by 91% while enjoying huge benefits in his A1C. A second firm, ViaCyte, is racing to try its own lab-grown cells.
The second major obstacle with islet cell transplantation is the immune system. Today, transplant recipients need to take anti-rejection medications to protect their new islet cells from attack. This immunosuppressive regime can bring heavy side effects, and for some patients may be more trouble than it’s worth.
Some of the most advanced diabetes research in the world is now bent on the problem of how to hide islet cells from the immune system. There have been many extremely exciting advances in recent years:
Imagine if an islet cell transplant could regulate your blood glucose levels without the use of insulin or of immunosuppressive drugs. Would that count as a cure? Dr. James Shapiro, the surgeon who pioneered islet cell transplants and is now collaborating with ViaCyte on their gene-edited islet cells, told us that it might be “as close to a cure as we can get.”
Closed-Loop Systems: The “Artificial Pancreas”
Although an insulin pump will never be a true cure for diabetes, it’s worth reviewing the recent progress made in diabetes technology. The latest devices promise to remove much of the cognitive burden of living with type 1 diabetes.
The FDA has defined the “artificial pancreas” as “a system of devices that closely mimics the glucose regulating function of a healthy pancreas.” Such systems combine the continuous glucose monitor (CGM) and insulin pump so that they communicate with each other. A computer-controlled algorithm, which might reside in a smartphone or on the pump itself, decides exactly how much insulin to use.
Today’s closed-loop systems, such as the Tandem and Medtronic systems, have shown that they can improve blood glucose results while substantially removing the burden of diabetes decision-making. Many people love them.
Few would consider today’s closed-loop systems a “cure.” Even if you ignore the cost and hassle of these wearable devices, patients are still strongly recommended to manually pre-bolus for food, and still need to ingest sugar to fight off hypoglycemia. But in the future, we may have closed-loop systems that work so quickly that patients will no longer need to count their carbs. There has even been work on bi-hormonal insulin pumps that use tiny amounts of glucagon to raise blood sugar when necessary. It’s possible to imagine a pump system so good that it lets you forget about your diabetes—at least for a few days at a time.