Friday, May 26, 2006

Treating the Disease, Not the Symptoms

In diabetes research, we are routinely barraged with what I like to call "dumb" diabetes research virtually every day. The newspapers are filled with reports of stupid studies that have proven the obvious. For example, recently, researchers at the University of Michigan Division of Child Behavioral Health published results from the following study in the journal Diabetes Care:

"Mealtime Interactions Relate to Dietary Adherence and Glycemic Control in Young Children With Type 1 Diabetes", Susana R. Patton, Lawrence M. Dolan, and Scott W. Powers, Diabetes Care 2006 29: 1002-1006.

I always question the necessity of research like this (and how much money was wasted on this study that could have gone into finding a cure). Did they really need to conduct a study to prove that children who act up at the dinner table were likely to report poorer glycemic control? Duh. Anyway, because we so often hear about this wasteful research in the media, sometimes stories that deserve media attention fail to receive it. One such study was a recent study from researchers at the University of California, Davis Medical Center in Sacramento that was published om the journal Diabetes. The source for this study is listed below.

"Increased Monocytic Activity and Biomarkers of Inflammation in Patients With Type 1 Diabetes"; Sridevi Devaraj, Nicole Glaser, Steve Griffen, Janice Wang-Polagruto, Eric Miguelino, and Ishwarlal Jialal; Diabetes 55: 774-779.

Essentially, these researchers reported that the overactive immune response in type 1 diabetes also causes the vessels to become inflamed and damaged. The researchers also identified several inflammation "biomarkers," that give early warning of this reaction, which may enable scientists to investigate therapies to stop the damage and prevent vascular disease.

Although inflammation is a natural bodily response meant to destroy, dilute or isolate both the cause of the damage and the injured tissue, chronic inflammation can make the situation worse. When blood vessels become inflamed, they become stiff and no longer dilate as needed, which creates blockages that lead to heart disease and stroke. This is also why a recent study from Pittsburgh showed that the rates of heart disease and some other diabetes-related complications did not decline over time.

"The 30-Year Natural History of Type 1 Diabetes Complications: The Pittsburgh Epidemiology of Diabetes Complications Study Experience"; Georgia Pambianco, Tina Costacou, Demetrius Ellis, Dorothy J. Becker, Ronald Klein, and Trevor J. Orchard; Diabetes 2006 55: 1463-1469.

These two studies were not done together, but when viewed as part of a bigger picture, they suggest that a) glycemic control alone is insufficient to address the leading killer of patients with type 1 diabetes: heart disease and stroke and that b) once again, the cause for these issues are unique for patients with type 1 and type 2 diabetes. In addition, about 2 years ago, Swedish researchers' findings suggested that autonomic nerve autoantibodies also play a key role in the development and progression of nerve dysfunction in individuals with type 1 diabetes.

"Autoantibodies to Autonomic Nerves Associated With Cardiac and Peripheral Autonomic Neuropathy"; Viktoria Granberg, MD1, Niels Ejskjaer, MD, PHD2, Mark Peakman, MD, PHD3 and Göran Sundkvist, MD, PHD1; Diabetes Care 28:1959-1964, 2005.

Collectively, all of these things suggest that the big enemy for people with type 1 diabetes is the immune system, not hyperglycemia. The faulty immune system contributes towards heart disease, stroke and neuropathy just to name the few "complications" which have been blamed on hyperglycemia which now seem to have an autoimmune basis instead. For decades, doctors have cited the flawed DCCT (I wrote about the flaws last year ... read my previous posts about hypoglycemia for details on that as evidence that normalizing blood glucose levels could reduce the incidence of complications), but that same study also showed that nothing short of consistent glycemia prevented complications 100%. Nevertheless, patients are blamed for not taking proper care of themselves when they suffer from complications, a practice imposed by largely ingnorant people who fail to understand the complexity of the disease and its treatment. But medicine has been so fixated on getting everyone to be "compliant" that they have overlooked the root cause of our problems. Hopefully, now with this additional evidence, these issues will be investigated and they will finally look into the disease itself, rather than focusing exclusively on treating the symptoms of the disease. One can only hope!


BetterCell said...

RIGHT ON SCOTT!!!!!!! Thanks for further elucidating on the topic of "Inflammation", which I had also briefly written about on 5/24/06.

Scott said...

Thanks for your comments. I think the issue of an autoimmune basis for microvascular damage as well as autonomic neuropathy show that the approach to treating type 1 diabetes for the past 90 years (and especially during the past 30 years) is fundamentally flawed since these "complications" cannot necessarily even be prevented because they are caused by the immune system, not high blood glucose levels. I would not be surprised if all type 1 complications are eventually proven to be caused by autoimmunity.

BetterCell said...

......contributing to the excessive amounts of inflammation that are a by-product of the escapade which follows and augments the destruction of vital organs, cells, and vessels. T1DM obviously is more than a Glucose Disease.

BetterCell said...

Scott......Why are you no longer on the "Pump"?

Scott said...

For a variety of reasons. Most notably, it did not result in substantial improvement in my glycemic "control" (if you can call it that). On top of not having a significant improvement,

I also found that with the pump model I had, my basal rates actually could not go any lower than 0.5 unit/hour, which was actually too high for me (I do not use ANY basal insulin except for a small dosage of N overnight so my fasting numbers are acceptable).

Finally, I really did not like wearing a pump. The sets had to be changed every 3 days anyway, and I am not especially bothered by taking a shot from a pen several times daily, so I found the added hassle, expense and lack of improved glycemic control did not justify wearing it. Others swear by the pump, but my experience did not justify continuing to use it.

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