Diabetes - Finding The Cause
If diabetes could be prevented, then there would be no need for special machines or surgical procedures. Finding the cause would pave the way for prevention of diabetes and is thus extremely important.
The diabetes syndrome, in most of its forms, is basically genetic, or inherited. As noted before, however, it may have many other causes (e.g., it may result from surgery, certain medications, or other stressful diseases). Type 2 diabetes is an inherited disease, but the gene of inheritance, and even the chromosomes that carry it, have not been positively identified. Some genes and chromosomes have been identified but there are probably many genes involved in different forms of Type 2 diabetes. Work to identify them continues since knowing the cause is the first step to finding a prevention or a cure.
The gene, or genes, for Type 1 diabetes is closer to being identified., Type 1 diabetes, which is associated with the immune system (immunology), is a syndrome of diseases rather than one disease. Immunology is closely associated with inherited traits (genetics). People diagnosed with diabetes are often found to have family histories of the disease. Genetic markers are now being revealed, and it someday may be possible for people to take a blood test that will show whether they are predisposed to get one of the diseases of this syndrome. Perhaps some future research will lead to the ability to make changes in the genes by gene splicing or insertion of the new genes, based on such findings so that a person can avoid both developing the disease and passing it on.
Prevention of diabetes, especially Type 1 diabetes, is a highly desirable goal. A study, called the Diabetes Prevention Trial (DPT), is currently under way for this purpose. In DPT -1, first,degree relatives (parents, children, and siblings of persons with Type 1 diabetes) are screened by a blood test that measures antibodies to the pancreas. If these are positive, further testing is carried out to determine how much damage has been done to the beta cells of the pancreas. If these latter tests meet certain criteria, the person can be randomized to either insulin treatment or no treatment. In the treatment group, insulin is given by injection in low doses to see if full,blown diabetes can be prevented. In DPT-2, first, degree and second,degree relatives (aunts, uncles, cousins, and grandparents) are screened with the blood test and, if positive, are randomized to either an oral form of insulin or a placebo. The purpose of the insulin in both groups is not to treat diabetes but to somehow interfere with the immune system and prevent diabetes in those susceptible.
Research is progressing rapidly in determining the relationship of the immune system to Type 1 diabetes and developing chemicals to stimulate or suppress the immune system. Although this work is still in its early stages, we are very hopeful that a way to prevent Type 1 diabetes will be found in the not too distant future. We strongly hope that this is the last generation of children who will develop Type 1 diabetes.
There is also a nationwide study on the prevention of Type 2 diabetes. This is designed to see if Type 2 diabetes is preventable. Known as DPP, it is a study of people who are likely to develop Type 2 diabetes based on screening criteria such as a history of previous gestational diabetes; people who are obese have a strong family history of diabetes and are in certain high, risk ethnic groups; and similar other criteria. These individuals are divided into several groups such as those who participate in support groups with diet and exercise only, groups taking an oral hypoglycemic drug, and groups taking metformin as well as a control group to which nothing is done. The people will be followed for several years to see if the incidence of developing full, blown diabetes is different with different forms of prevention. It is hoped that one or more of the treatments will prevent people from developing Type 2 diabetes and the treatment can then be transposed to the general high, risk population. It should be a lot cheaper in both money and human suffering to prevent than to treat diabetes.
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