First Reversal Of Type 1 Diabetes Using Precision Medicine
Houston, TX – Oct 8, 2020 – In a letter published today in the New England Journal of Medicine, a team of physicians from Baylor College of Medicine, Texas Childrens Hospital, and the University of California, San Francisco, describe a remarkable case of a Type 1 diabetes patient, who no longer needs insulin to maintain optimal blood sugar levels. The physicians employed a precision/personalized medicine approach to specifically target the underlying genetic mutation, which was the primary driver of this patients diabetes.
To the best of our knowledge, this is the first example of a T1D patient who has experienced a complete reversal of insulin-dependence and we are excited by the prospect that that could be a viable therapeutic strategy for a subset of T1D patients said corresponding author Dr. Lisa R. Forbes, deputy director for clinical services and community outreach for the Texas Childrens William T. Shearer Center for Human Immunobiology and assistant professor of Pediatrics, Immunology, Allergy and Retrovirology at Baylor.
T1D is a chronic condition in which the pancreas produces little to no insulin, a hormone that maintains sugar levels in the blood. Currently, the treatment options available to T1D patients consist of managing blood sugar levels with insulin, diet and exercise to prevent further complications.
A complete list of authors and funders is available here.
Were We Meant To Eat Three Times A Day
Ive written before about the mismatch hypothesisthe idea that our genes have not caught up to our modern lifestyle. Our huntergatherer ancestors probably had periodic variation of food scarcity and hunting success and likely rarely ate three times a day. The ability of animals to deal with food deprivation is an adaptive response that is conserved across species. In times of scarcity, a mild atrophy of tissues and organs minimizes energy expenditure. Upon refeeding, the body can build these tissues back up to their normal volume .
This raises a few interesting questions: is expression of these embryonic genes in adulthood really abnormal? Or is it possible that we are meant to have transient expression of these embryonic genes periodically throughout our lifetime? Could our constantly fed state in most of the Western world be the true abnormal gene expression pattern? I certainly hope to see more research in this area, especially in humans.
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Yes and no. If you learn to live a healthier lifestyle and stay with it for your remaining years, then yes it can be reversed. This assumes you realized your diagnosis early and you are able to get your A1c below 6%. If you realized your diabetes too late or your A1c is not coming down without insulin then probably not. This is easier to reverse when you are overweight or obese but not so if your BMI is below 25.
This healthy lifestyle we refer to is being active 150 minutes or more each week and eating a meal plan low in fat and processed sugar with 3-5 vegetables and 2-3 fruits a day most days. It does not require low or no carbohydrate diet like Atkins or counting carbohydrates every meal. Most folks do better when they spread the carbohydrates out evenly over the day.
And live well whether you reverse your diabetes or just keep it in your side car
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What Is Diabetes And Who Should Care
Diabetes is a problem of energy processing. At the root of the problem is insulin, a hormone made in the pancreas, an organ in the abdomen.
Insulin helps the body regulate the amount of glucose in the body. This is how the body knows how much glucose is needed for energy now, and how much needs to be saved for later.
There are four main types of diabetes:
Type 1 diabetes
Other rare types of diabetes
All have a different problem with insulin, but the end result is the same: harmful, high blood glucose levels in the blood.
Both Type 1 and Type 2 diabetes are chronic conditions. This means that people with diabetes need to live with the condition and usually take medications for the rest of their lives. Diabetes can also cause a myriad of other health problems, so the emotional, physical, and financial costs of living with diabetes really add up.
Type 1 diabetes affects fewer than 5% of people with diabetes. It is usually diagnosed in childhood or the teenage years, and there is nothing you can do to prevent it.
Type 2 diabetes is much more common, affecting about 95% of all people with diabetes. The pancreas often produces enough insulin, but the body doesnt recognize it. Many people with T2D have a family history of diabetes, but with healthy lifestyle changes, the condition can be prevented or slowed down.
How Do You Reverse Diabetes
The strongest evidence we have at the moment suggests that type 2 diabetes is mainly put into remission by weight loss. Remission is more likely if you lose weight as soon as possible after your diabetes diagnosis. However, we do know of people who have put their diabetes into remission 25 years after diagnosis.
If you have obesity, your diabetes is more likely to go into remission if you lose a substantial amount of weight 15kg as quickly and safely as possible following diagnosis.
Its important to know that not everyone who loses this much weight will be able to put their diabetes into remission. But losing 15kg comes with a lot of health benefits, even if you dont lead to remission. Research shows that getting support to lose just 5% of your body weight can have huge benefits for your health. Losing extra weight can lead to:
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As a registered dietitian and certified diabetes educator, I learned through formal training that type 2 diabetes is irreversible. However, as a nutrition researcher and health care provider, I see different resultsin different people.
The good news is diabetes is not a static condition and a type 2 diabetes diagnosis doesnt mean the condition will progressively get worse. Mounting research finds plant-based eating patterns can prevent, manage, and, in some cases, eliminate diabetes symptoms, significantly reducing or eliminating the need for medication and insulin.
At the Physicians Committee for Responsible Medicine, we conducted a randomized controlled diabetes trial and found participants who ate a low-fat vegan diet lost more weight, had greater reductions in hemoglobin A1C, and had greater improvements with cholesterol than the control group .
Some in the vegan diet group eliminated the need for medications altogether, and their blood glucose numbers and A1C fell into a healthy range. These results could be classified as reversing the disease since reverse technically means to turn in the opposite direction.
How does it work?
Here are the five dietary guidelines used in the studies:
Eliminate all animal products: Steer clear from meat, fish, dairy products, and eggs.
Limit high-fat foods: Avoid added oils, pastries, fried foods, and limit olives, avocado, nuts, and seeds.
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Once you have diabetes, it is there for life. I help people to get their blood glucose levels back to or as near as possible the normal range. Firstly this will help you to feel better in the short term but it also helps to protect your blood vessels which can become very irritated and damaged by high glucose levels. Focussing on healthy eating, limiting unprocessed foods and getting a wide variety of fruits and vegetables in the diet helps.
Try to keep carbohydrate amounts stable across the day , stand more and sit less and include activities that increase the heart rate and also strength based activities most days across the week. Think about the amount of stress you experience to see how it is increasing your blood glucose levels. If you smoke stop because it is speeding up the damage to your blood vessels. If you drink alcohol, limit how much you drink.
Even if you aim to lose 5% of your body weight, if overweight, you are likely to see a fall in your blood glucose levels back into the normal range but even then we cant say diabetes has been reversed or gone away. These actions build-up the bodys ability to respond to rising levels but if you get sick, eat more carbohydrate or gain some weight, more than likely your blood glucose levels will be on the rise again into the diabetes range.
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Can Type 2 Diabetes Be Reversed
Type 2 diabetes can be a life-long, chronic disease in which the body either does not produce enough insulin or the cells in out body doesnt respond to insulin correctly. Because of these two problems, there isnt enough insulin to move the glucose from the blood into the cells. When glucose builds up in the blood instead of going into cells, the bodys cells cant function properly.
Type 2 diabetes is more likely to occur in people who are over the age of 40, overweight, or have a family history in diabetes. Certain ethnic and racial groups also have higher risk for type 2 diabetes, including black, Hispanic/Latino, American Indian, Asian American and Pacific Islander. However, over the past decade the incidence of type2 diabetes has been increasing in adolescents and the young adult population.
According to recent research, type 2 diabetes cannot be cured, but individuals can have glucose levels that return to non-diabetes range, or pre-diabetes glucose level The primary means by which people with type 2 diabetes achieve remission is by losing significant amounts of weight.
We talk of remission and not a cure because it isnt permanent. The beta cells have been damaged and the underlying genetic factors contributing to the persons susceptibility to diabetes remain intact. Over time the disease process reasserts itself and continued destruction of the beta cells ensues. An environmental insult such as weight gain can bring back the symptomatic glucose intolerance.
How To Reverse Erectile Dysfunction From Diabetes: Know And Address The Risk Factors
While up to 75 percent of men with diabetes develop ED, 25 percent do not. ED is not inevitable. If you do develop ED, youre not doomed for life. Knowing risk factors for this sexual disorder can help you prevent it from happening or treat it when it develops. Common risk factors for erectile dysfunction in diabetes include:
- Poorly managed blood sugar levels, including chronically high blood sugar
- Being overweight or obese
- Taking certain medications, such as for diabetic nerve pain, blood pressure, or depression
Part of reversing erectile dysfunction with diabetes involves managing these risk factors, for the more you can eliminate, the better your chances of ending ED.
In addition to addressing the risk factors, there are other treatment approaches to reverse ED: medication herbs, supplements and alternative remedies, and lifestyle. Lets explore each of these.
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How Long Does It Take To Reverse Diabetes
Theres no set timeframe for when people with Type 2 diabetes may start to see their hard work pay off. In general, diabetes experts say with medication and lifestyle changes, diabetes patients could notice a difference in three to six months. It may take one month to stabilize blood sugar , and then a couple of months or more for lifestyle changes to take effect.
With enough work and time, you can do it,says Stephanie Redmond, Pharm.D., CDE, BC-ADM, co-founder of diabetesdoctor.com.The longer youve had diabetes and the higher your sugars have been for a sustained time, the harder this might be. Redmond adds that despite their best efforts, it may be impossible for some to become diabetes-free. Your pancreas just cant produce the insulin it needs. Theres no point in stressing or beating yourself up. Work with your healthcare provider on the best medication plan for you.
An A1C test measures average blood sugar levels over the previous two to three months. A hemoglobin A1C below 5.7% is normal, between 5.7 and 6.4% is a sign of prediabetes, and 6.5% or higher indicates diabetes. People managing their Type 2 diabetes should get an A1C test at least two times a year and more often if they change medications or have other health conditions.
Tests For Type 1 Diabetes
There are a few tests a doctor may perform to diagnose type 1 diabetes.
This test looks for specific antibodies that the body makes when it attacks the beta cells in your pancreas. This test is usually given to direct relatives of people with type 1 diabetes because it can help to predict whether or not someone may develop type 1 diabetes up to one year before they have any symptoms.
This test may also be given to people with close relatives who have type 1 diabetes. It can help to identify if someone has a genetic predisposition to getting the disease.
Fasting plasma glucose test
This test checks your blood sugar levels. The fasting test is taken after you have not eaten anything for eight hours. There is another non-fasted version of this test. Either one can give a snapshot of blood sugar levels to help determine if you have diabetes.
Hemoglobin A1c test
This test measures how much glucose is found in your red blood cells. High glucose levels shown in this test can be a sign of type 1 diabetes.
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Vaccinating Against Type 1 Diabetes
Autoimmune diseases are characterized very often by an overexpression of a specific cytokine a specific protein that we do produce normally, but which in case of disruption of the immune system is produced in excess, Miguel Sieler, previous CEO of Neovacs, told me.
Based in France, Neovacs aims to block this excess cytokine production to stop autoimmune diseases in their tracks. To do so, the company is developing a vaccine that stimulates the immune system to neutralize the specific protein that is being produced in excess.
In the case of type 1 diabetes, that protein is known as interferon alpha. In excess, it induces the appearance of immune cells that attack and destroy insulin-producing cells. We can stop type 1 diabetes by neutralizing the excess of interferon alpha, said Sieler. Its the same principle as a viral vaccine.
Neovacs has already tested the same vaccine in people with lupus, another autoimmune disease. Results have shown that the vaccine can keep the patients immunized for 5 years. This means that a person with type 1 diabetes would only need to receive an initial treatment of 6 months and then a booster every 4 to 5 years.
This would make treatment with insulin no longer necessary, and of course reduces the cost considerably compared to a lifetime treatment, explained Sieler.
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Can We Reverse Type 2 Diabetes?
This is a great question that is somewhat controversial in the diabetes world. We all know the person that was on multiple diabetes medications, lost a moderate to significant amount of body mass, that now no longer requires medications for his/her diabetes.
This is truly a cause for celebration. For all practical purposes, after the weight loss and glucometer readings are in the normal range & the A1c reading is in the normal range, this person has effectively reversed their diabetes.
Conversely, it must be understood that this person has an increased risk of developing diabetes if the weight gain sneaks back on. I believe this person needs at least a yearly A1c lab test to make certain that he/she hasnt had a return of higher blood sugars.
If the person has reverted to old eating habits and/or decreasing physical activity and gaining weight, the A1c should be repeated sooner than once yearly.
The argument has been that the Type 2 Diabetes isnt really reversed, but in my minds eye, as long as the person stays the same weight & physical activity level, it is reasonable to conclude for the time-being that, indeed, the disease is reversed. That person needs to be aware that they have accomplished an amazing achievement.
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Type 2 diabetes can be controlled to the point where it looks as though diabetes has gone away. This is sometimes seen when someone has lost a significant amount of weight. The blood sugar levels may be in a safe category and diabetes meds may have been decreased or discontinued.
As time goes on, however, blood sugar levels can begin to rise again. Diabetes is a progressive disease which means that what is done today to care for it, may not work as well a year or two from now. A key to keeping blood sugar levels under control is to be active, watch portions of all foods, include all food groups and visit your doctor to make sure the blood sugar levels are staying at a safe level.
Teaming Up With Bacteria
The bacteria in our gut have a strong connection with our immune system. ActoBio, a company based in Belgium, wants to exploit this connection to treat type 1 diabetes. Our product candidates are based on the use of Lactococcus lactis bacteria that are genetically modified to express proteins, peptides, antibodies or human cytokines, Lothar Steidler, CTO of ActoBio, told me.
Our guts are familiar to this bacterium, as its used to produce cheese and buttermilk. In the case of type 1 diabetes, the bacteria are engineered to produce the insulin precursor human proinsulin and a signaling molecule called interleukin 10. Together they signal the gut-associated lymphoid tissue, where immune cells are stored, to restore the tolerance of insulin-producing cells with the goal of slowing down or stopping their destruction.
It is potentially a safe oral treatment that will be given for a limited period of time and could lead to patients who develop type 1 diabetes not needing to use insulin, or delay the need for insulin after diagnosis added Pieter Rottiers, CEO of ActoBio.
The company is now running a phase I/II clinical trial in the US and Europe in people with type 1 diabetes as young as 12 years old. Patients will have to have some remaining capacity for production of insulin, said Rottiers. Results are expected this year.
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