Diabetes: Basic Information and Federal Funding Page: 4 of 6
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minority populations are growing as a percentage of the overall population, so for
Americans as a whole, the number of people with diabetes is likely to increase.
Innovations in Treatment and Management
The underlying causes of diabetes are unknown, although genetic predisposition,
behavior, and environmental factors are believed to play roles. Diabetes may be caused
by various genes, all resulting in high blood sugar. Several chromosomes have been
identified as possible sites for genes which predict or even cause diabetes, but no specific
genes have been determined to be causal. Research continues to try to clarify the
underlying genetic, molecular or cellular causes of diabetes. Also there is ongoing
research on the prevention of the disease. NIH's Diabetes Prevention Program is testing
whether life style and drug interventions can prevent or delay the onset of Type 2 diabetes
in at-risk individuals including minority populations.
Type 2 diabetes is often treated with oral medications. Four classes of oral drugs are
now available. The oldest, called "sulfonylureas," work by stimulating the pancreas to
produce more insulin. Maintaining a normal weight, which helps control NIDDM,
becomes more difficult when taking sulfonylureas. A newer class of oral medication for
Type 2 patients, biguanides, includes metformin, which lowers cells' resistance to insulin
produced by the liver. Glucosidase inhibitors, which include acarbose and miglitol, slow
the digestion of carbohydrates and delay the absorption of glucose from the intestine. The
fourth class, as represented by troglitazone, allows diabetics to make better use of their
own insulin by resensitizing body tissues to the insulin. In March 1998, researchers found
that metformin and troglitazone work even better in combination than they do alone for
hard-to-treat cases of diabetes.9
Currently being tested in clinical trials is a finely powdered insulin which, when
inhaled into the lungs, goes directly into the blood stream. Although it may be two years
before it can be marketed, patients in the trials appear to prefer this new application over
injections. So far there have been no detectable negative side effects reported.0
Type 1 diabetes is an autoimmune disease, in which the body misidentifies its own
beta cells as foreign, and destroys them. This autoimmune response may stem from a
viral infection to which the body over-responds, or from some other cause." Prevention
in susceptible individuals is being researched, as well as replacement of damaged beta
cells by transplantation of new pancreatic tissue. The main impediment to transplantation
is the body's immune system. Once it detects the transplanted cells, it attacks and kills
them, a process called "rejection." Diabetics who develop kidney failure may be
9 S.E. Inzucchi et al., "Efficacy and Metabolic Effects of Metformin and Troglitazone in
Type II Diabetes Mellitus," The New England Journal of Medicine, v. 338, 26 March 1998, 867.
10 Thomas H. Maugh II, "Inhaled Form of Insulin Seen as a Breakthrough," Los Angeles
Times, Wednesday, 17 June 1998, A1,A7.
" M. Trucco, and R. LaPorte, "Exposure to Superantigens as an Immunogenic Explanation
of Type 1 Diabetes Mini-epidemics," Journal of Pediatric Endocrinology and Metabolism, 8(1),
January-March 1995, 3-10.
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Vogt, Donna U. Diabetes: Basic Information and Federal Funding, report, July 15, 1998; Washington D.C.. (https://digital.library.unt.edu/ark:/67531/metadc807815/m1/4/: accessed June 19, 2021), University of North Texas Libraries, UNT Digital Library, https://digital.library.unt.edu; crediting UNT Libraries Government Documents Department.