Next generation treatments for type I diabetes – Biology vs Engineering

Some time ago I produced an article for the science website Apptheneum on the future of type I diabetes treatments which focused on gene and cell therapy as potential cures:

http://www.apptheneum.com/next-generation-treatments-type-diabetes/

These are purely biological solutions, however the engineers also have their own.

The solution offered by the engineers has one distinct advantage – the immune system is irrelevant. One of the problems of using gene or cell therapy is that type I diabetes is an autoimmune disease. This means that even if you “cure” the disease it is likely to recur unless the underlying immune dysfunction is also dealt with or circumvented. There is a long way to go on this front. The engineers solution is an artificial pancreas which is not exposed to the immune system as it rests outside of the body.

“The artificial pancreas is not a replica organ; it is an automated insulin delivery system designed to mimic a healthy person’s glucose-regulating function”:

http://news.harvard.edu/gazette/story/2016/01/artificial-pancreas-system-aimed-at-type-1-diabetes-mellitus/

You can argue as to whether the name is appropriate as blood glucose regulation is only one aspect of the function of the pancreas but I’m sure someone has already. The NIH launched a $20 million program to fund artificial pancreas clinical trials in 2014:

http://grants.nih.gov/grants/guide/rfa-files/RFA-DK-16-008.html

So it looks like improved insulin delivery devices will become available in the not so distant future. However the problem with non-biologically engineered solutions is that they cannot perfectly regulate blood glucose levels (as cell and gene therapies potentially can) and it is likely that over time people with type I diabetes using artificial pancreases will still develop problems with their feet associated with reduced circulation and nerve damage. Cardiovascular disease, retinopathy (eye damage), general nerve damage, kidney disease, and sexual dysfunction will still be major problems. However artificial pancreases will no doubt be a vast improvement over manual insulin injection.

For this reason I believe that the engineers will win the race but lose the war. It is only a matter of time until the immune system is understood to a level where the underlying autoimmune disease can be dealt with.

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