Stopping Diabetes Before It Starts-Scientific Research

 

November 14^th is National Diabetes Day and diabetes is the number seven cause of death in the US, resulting in nearly 85,000 deaths annually. (National Center for Health Statistics, 2020) Many people globally are dying because they can’t afford their insulin, which results in diabetic ketoacidosis, when cells dehydrate and the body stops functioning. According to the World Diabetes Organization, there are over two million deaths worldwide annually, due to high glucose resulting in ketoacidosis. Children’s hospitals in the US report a rate of death of .25 out of 100,000 from Diabetic ketoacidosis (DKA) and the United Kingdom reported .21 out of 100,000 deaths of children and youths. (Denis Daneman, 2001) There are also an equal number of deaths from cerebral edema. This means that 54 people under the age of 19 died from diabetes due to hypoglycemia or DKA in the United States in 2009 and it is now estimated at 185 deaths. (US Census Bureau, 2010) One of the reasons for the increase is the escalating unaffordability of insulin, which is ten times more expensive in the US than any other country. (Rajkumar, 2020)  This article features scientific research on the cause of Type1 Diabetes and the imminent potential for a cure.

The Cure

Benaroya Research Institute is the global principal investigator in the T-1 study and has the largest bank of T-cells from which it has multiple active studies devoted to understanding the cause of diabetes and how to cure this terrible disease. Dr. Marika Bogdani leads a team of researchers studying the Hyaluronan deposits in islet cells and how that precedes insulin dependent diabetes. Her research findings were recently published in Springer Nature. (Marika Bogdani, 2020) Substantial deposits of cellular hyaluronan (HA) are characteristic of insulin dependent diabetes and her recent research investigated HA accumulation in islet cells prior to disease progress to diabetes. Her study used BioBreeding rats from 40 days of age until diabetes onset.  Pancreas tissue from 15 non-diabetic organ donors who were positive for the islet autoantibodies and 14 control donors, were analyzed for HA islet cell staining and the presence of insulitis. Here are her team’s findings:

·        1.   50% of the donors positive for islet autoantibodies showed large accumulations of HA, four times that of the control samples.

·        2.  Further, 21% of the islet cells contained the largest HA accumulations based on the HA-stained areas.

·        3.  Among those seven donor samples, 4 did not show islet immune-cell infiltrates, which means HA accumulated independently and in the absence of inflammatory cells in those which were positive for islet autoantibodies.

·         4. The accumulation of HA islets was evident up to 8 weeks prior to the onset of insulitis, which starts the pancreatic damage eventually resulting in the need for insulin. HA cells were largest in the donor rats at high risk of developing Type 1 diabetes.

·        5.  Insulitis was first detected in 9 to 10-week-old rats, where HA deposits were abundant in the islets and was associated with expansion of immune cell infiltrates, leading to an 85% loss of their beta cells.

The global T-1 study already has the ability to identify persons at risk of Type-1 Diabetes, an auto-immune disease which is prevalent in family groups. Bogdani’s research aims to identify those at risk and find a way to reprogram islet cell activity to prevent the HA mutations which result in pancreatic damage. The goal is to stop diabetes before it starts.

https://www.benaroyaresearch.org/our-research/diabetes-clinical-research/find-study

 Support for Those Living with Diabetes

I have been involved with the Lown Institute’s Right Care Alliance since 2005 and their current Affordable Insulin advocacy is an issue close to my heart. The group is hosting a nationwide Zoom program on Sunday, November 15, for those who care to participate, it is from 11:00AM to 1:00PM Pacific time. Here is a link to the program to register:

https://www.eventbrite.com/e/insulin-story-slam-tickets-124914732327

 Trouble Affording Insulin

Here are some organizations which may be able to help with insulin access.

Insulin for Life USA is a nonprofit that reclaims unused insulin and provides it to people globally.  There are 90,000 children throughout the world with Type 1 Diabetes.

https://iflusa.org/#:~:text=Insulin%20for%20Life%20USA%20is,to%20these%20life%20saving%20necessities.

Pharmaceutical makers of insulin do have patient assistance programs which can provide free insulin for a period of time, these include; Nova Nordisk, Sanofi Aventis, and Eli Lilly.

Any hospital emergency department in the US must provide insulin on an emergency basis, so if you have skipped doses and are in danger please go to an ER within 24 hours of missed doses. It doesn’t matter if you have insurance, they must provide treatment. Hospitals have medical assistance programs which provide substantial subsidies for patients who are income challenged.

If you are rationing insulin because you can’t afford your refill, call your clinic and explain your dire need and they should be able to provide a free sample.

If you use the traditional insulin which was originally derived from the pancreas of cows and pigs, but is now lab produced with E Coli bacteria, it is less expensive. The typical price in 2018 for Novolin, the needle and syringe insulin variety, was $24.88 for a vial. (Harrar, n.d.) The current list price for laboratory produced Humalog (U100-10ml) is $274.70 for 1,000 units. Perhaps Novolin won’t work as well but it will keep you alive. One hundred units of Novolin is $58 today if you buy it online. However, like everything else in healthcare, what you actually pay depends on your insurance plan.

Subsidized Medical Insurance

If you lack medical insurance, enroll in the Affordable Care Act, which has federal subsidies for the monthly premiums, based on your income, so this program could make your insulin more affordable. And there is no discrimination because of pre-existing conditions. Word to the wise, the Trump Administration and the Republicans have been trying to get rid of the Affordable Care Act, known as Obamacare and there is a Supreme Court case to be heard on November 10^th regarding the Commerce Clause and the validity of the act. If the Trump-packed court rules the law invalid, about 22 million people will lose their medical insurance. Further, the act mandated coverage for pre-existing conditions for all, which impact well over 100 million people, which were formerly denied access to health insurance.

This is the healthpolicymaven signing off encouraging you not to sign blanket releases when consenting to a medical procedure, do indicate that for which you consent and decline.

 Roberta Winter is an independent journalist and health policy analyst who accepts no money from anyone in the healthcare, insurance, pharmacy, or medical supply sectors. Her guidebook to the US healthcare system was published by Rowman and Littlefield in 2013.

https://www.amazon.com/Unraveling-U-S-Health-Care-Personal/dp/1442222972

 

Works Cited

Denis Daneman, M. B. (2001, May 24). Diabetes-Related Mortality-A Pediatrician's View. Diabetes Journals, 10(5), 801-802. doi:https://doi.org/10.2337/diacare.24.5.801

Harrar, S. (n.d.). Free Insulin: Strategies for Getting It When You Can't Afford Your Prescription. Retrieved 11 10, 2020, from Ontrack Diabetes.com: https://www.ontrackdiabetes.com/live-well/diabetes-management/free-insulin-strategies-getting-it-when-you-cant-afford-your-prescript

Marika Bogdani, C. S. (2020). Hyaluronan deposition in islets may preced and direct the location of islet immune-cell infiltrates. Springer Nature. doi:https://doi.org/10.1007/s00125-019-05066-7

National Center for Health Statistics. (2020, 11 9). Diabetes Facts. Retrieved from Centers for Disease Control and Prevention: https://www.cdc.gov/nchs/fastats/diabetes.htm

Rajkumar, S. V. (2020). The High Cost of Insulin in the United States-An Urgent Call to Action. Mayo Clinic Proceedings. Mayo Foundation for Medical Education and Research.org. doi:DOI:https://doi.org/10.1016/j.mayocp.2019.11.013

US Census Bureau. (2010). US Census Brief-Population By Sex and Selected Age Groups-2010 Census. US Commerce Department-Census Bureau. Retrieved 11 9, 2020, from https://www.census.gov/prod/cen2010/briefs/c2010br-03.pdf