A ‘cure’ for diabetes and its complications

The new millennium has brought continued hope for a ‘cure’ with major developments in immunology and understanding of pathogenesis of diabetes and its complications. Intervention studies to slow the progression of beta-cell destruction by using insulin to induce immune tolerance have shown promise in some subsection analysis but without overall benefit for primary outcome. The ongoing INIT 11 study delivers insulin nasally. The TRIGR study eliminates cow milk in babies at risk with promising effect for antibody generation. Stem cells also offer promise. Islet cell transplantation from cadavers is minimally invasive and has shown great promise, but has been slowed due to lack of donors and immunosuppression needs. For those with established diabetes, randomised controlled trials have demonstrated minimising and slowing of progression of diabetes vascular complications. These interventions include intensive glycaemic treatment, blood pressure lowering and lipid lowering agents. Good randomised controlled clinical trials provide the best evidence of these benefits, which must then be followed by more research to better understand mechanisms of disease pathogenesis and treatment effects.