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In part 4 of this Exclusive Interview, Raghu Mirmira talks with Diabetes in Control Publisher Steve Freed about the different ways diabetes can be treated today compared to 50 years ago, and the methods of treatment that are promising for the future.
Raghu G. Mirmira, PhD, MD is the director of pediatric research at Indiana University.
Transcript of this video segment:
Freed: So, how does having type 1 today differ from 15, 20 years ago?
Mirmira: Well, I think that our treatment of type 1 diabetes has advanced quite a bit. I think many people would look at it and say, “Geez, we still give insulin.” That’s true. We did that beginning in 1923 when insulin was discovered, but what we have now are many new things. So, we have different types of insulins that can be really used in a very personalized way. They have different kinetics of action. And then the second thing is we have different modes of delivery. So, now we have pump systems and we’re developing closed-loop systems. There’s also people that are studying different types of insulins that might be smart insulins, so to speak, that only act when the blood sugar is high. And some of these prototypes, if you will, are already out there, so there are a lot of people that are using different types of insulins today that didn’t exist 15 years ago. And then, certainly the pump and drug delivery technology has improved substantially. So, I think for those reasons there are — it’s a very different disease in the way we treat it today. And I think for that reason it’s not the disease that’s so easily treated by a general practitioner whether it’s a pediatrician or an adult practitioner. I think it really does require specialized therapy that not even your average endocrinologist can do. I think there really is a new field of diabetology. And I think a lot of these more advanced systems requires multidisciplinary care with diabetologists, nurse practitioners, nutritionists, social workers, so it’s a very different disease in that respect.
Freed: And what are the new concepts emerging in type 1 diabetes today and how may they change the way we treat diabetes now and into the future?
Mirmira: So, as I said that, apart from the technologies which I think are really beginning to move rapidly, the area that I think is really quite exciting is the area of induced pluripotent stem cells. I think that’s exciting because it can potentially get over one big barrier that exists in transplantation of beta cells today and that is this concept of alloimmunity, recognizing a cell that’s not coming from yourself. So, that we can take your blood cell or your skin cells and then convert them into beta cells, I think means that there is the potential for an endless supply of your own beta cells. And I think that’s going to be a very important tool going forward. But the other thing that I think has been emerging in the last few years is understanding that the islet is made up of more than just the beta cell. There are alpha cells, pancreatic polypeptide cells, and some anastatin producing cells. So, I think we’re going to need to be able to recapitulate that little organoid, understanding the complex interplays between the different cell types. So, I think going forward I’m really excited about induced pluripotent stem cell technology. I think that it really does offer the potential for a cure. If only that somebody requires transplantation every six months of their own cells, I think most people would find that acceptable if they could be insulin free in the interim. And then there are other — with that in mind, there are other encapsulation technologies to preserve the longevity of these cells. So, I think apart from technology, I think our understanding of how to create new cell types using your own cells as assort is really an exciting avenue.