Future Directions

Among the most feared diabetes complications are those affecting the eyes. Indeed, diabetes is the leading cause of partial vision loss and blindness in the working age population in many countries. The good news is that it does not have to be so.

The science of diabetes is experiencing dramatic change and the implications for everyone affected by diabetes are enormous. We have good grounds for optimism and real expectations of a 'cure' for Type 1 diabetes in the longer term. This future would release us from the drudgery and risks of living with diabetes, and from the discrimination and social difficulties that go with it. Yet esoteric scientific advances are only part of the story. Each advance precedes the resulting improvements in treatment by many years, and in most parts of the world will seem irrelevant.

We usually assume that the ups and downs of blood glucose are solely responsible for changes in the release of insulin into the circulation, such as in response to a meal. However, the release of insulin from the pancreas is supported by signals from the alimentary canal (gut). When food is transported from the stomach into the small intestine, from which glucose, fat and proteins are absorbed into the blood, gut hormones are released into the circulation. Around 50%

People with diabetes are prone to cardiovascular disease (CVD). In people with Type 2 diabetes, the rate of heart-related death is two to four times that in people without diabetes. Traditional risk factors for the build-up of cholesterol-rich plaques in the arteries (atherosclerosis), such as high blood pressure, obesity, smoking, and high blood fat levels (dyslipidaemia), are known to increase the cardiovascular risk in people with diabetes. However, other factors may be operative as well.

In the last 10 years, genomic and proteomic technologies have been applied to identify and develop a new generation of diabetes treatments. While these technologies have become increasingly automated, producing a deluge of potential therapeutic targets and biological insights, projections estimate that individual drug development time and cost will continue to rise and soon exceed 1 billion USD. A significant contributor to this rising cost is the large

Diabetes has many complications which can take decades to develop. Scores of therapies are now available for the prevention of Type 2 diabetes, and the complications of diabete. People with diabetes vary widely in their risks and histories of diabetes-related complications. How, then, can we choose from the many treatment options which are currently on offer to people with the condition?

The relative roles of pancreas transplantation and islet transplantation in the management of diabetes are perhaps best examined in the context of the American Diabetes Association (ADA) position statement - revised in 2003. Given the growing success of islet transplantation, it seems worthwhile to examine whether the ADA recommendations should be reconsidered.

People develop Type 1 diabetes when their immune system specifically seeks out and destroys the insulin-producing ß-cells in their pancreas. The interaction of environmental factors with a number of gene variants results in the immune disturbance which causes the condition. In this article, Tony Merriman looks at the approaches used to identify the genes which make a person susceptible to Type 1 diabetes.