"Persistence of Diabetes" - Why Has Research into Type 1 Diabetes not Made Significant Advances?

Diabetes mellitus (DM) constitutes a heterogeneous group of diseases. The two major forms of the disorder can be classified according to insulin dependence, or independence. Insulin-dependent DM, also known as type 1 (T1DM), is a chronic condition manifested by the lack of functional pancreatic islet β-cells which results in failure to produce natural insulin within the body. Without the control mechanism provided by insulin, the body’s blood glucose level cannot be maintained within a physiologically acceptable range. Insulin-independent DM, or type 2 DM (T2DM), is also a chronic condition. It is caused either by insufficient production of insulin by the pancreatic islets, or by the failure of body tissues to process the hormone. T1DM is the more acute form of the condition and affects approximately 10.0% of all diabetic cases worldwide. As noted above, it is manifested by the lack of insulin-secreting β-cells as a result of their destruction by diabetogenic T cells. T2DM is different in origin, but is also strongly associated with obesity. Despite the different causes of the two forms of diabetes, the outcome is largely the same in both, namely the emergence of hyperglycemia and the potential to cause metabolic disturbances which damage other body systems including nerves and blood vessels. According to the World Health Organization, the total number of people with T1DM and T2DM was estimated at approximately 30 million in 1985. By 2000, diabetes had increased to an estimated 171 million affected persons [1, 2]. This dramatic increase clearly shows that, in the absence of an effective cure, diabetes is a major uncontrolled and increasing health problem with many of the affected patients continuing to suffer from its complications and an increased risk of premature death. The condition is an enormous burden for patients and economies across the world. DM impairs the quality of life and shortens life-expectancy. As much as 15.0% of the total health care cost in industrialized countries is needed to manage diabetes and to minimize the development of its complications. Despite centuries of seeking an ultimate cure rather than a lifelong treatment that just mitigates the symptoms, no such cure is yet available. So, what are the reasons for the failure of research into diabetes, and what actually needs to be found for a curative therapy? These questions must be addressed if we are to make real progress and set the future direction of diabetes research. This article seeks to revisit the reasons for past failures and to identify future challenges on the avenue of research towards a cure of T1DM, the more acute form of the disease.