Sir, - Congratulations for bringing to the attention of the public the importance of diabetes (January 27th). The new diabetes research into stem cell manipulation and islet cell transplantation may in the future replace insulin injections for people with diabetes.
The new research is tremendously exciting. The success of the Canadian team, which includes the Irish doctor Edmond Ryan, is probably due to the use of new immuno-suppressive agents and avoidance of steroids. A major problem to date has been the number of human pancreata necessary for one transplant making the technique, even if successful, available to relatively few patients due to the worldwide shortage of donors. Hence the interest in stem cell research since stem cells, unlike islet cells, can be induced to multiply and produce insulin.
Another route as taken by the European B-cell Transplant Programme, with which I have been involved since 1988, strives to purify the insulin secreting Bcells so that immuno-suppression, which may itself have serious long-term complications, becomes unnecessary.
Research is taking place in many centres into the implantation of cells in membranes with small enough pores to prevent the immune system from attacking the B-cell, and at the same time large enough to allow the smaller insulin and glucose molecules to pass freely through the pores. With this method it may be possible to utilise animal rather than human cells for transplantation, thus avoiding the need for human pancreata.
As your article stated, 90 per cent of people with diabetes do not require insulin, at least at the onset of their condition. In this group there is, on average, seven years' delay between the onset of diabetes and diagnosis. The alarming figures that your article quoted about the outcome of diabetes are historical and now in the 21st century, with early diagnosis and modern expert treatment we know that both type 1 and type 2 diabetes are compatible with a long healthy life free of complications.
One of the major aims of the Diabetes Federation of Ireland is to persuade the Government that more resources need to be made available particularly in our smaller hospitals and in the community so that early diagnosis and optimum care can be made available to all people with diabetes in our country. - Yours, etc.,
Prof Gerald H. Tomkin, MD, FRCPI, FACP,FRCP (Lond.), Chairman, Diabetes Federation of Ireland, Lower Gardiner Street, Dublin 1.