The streetlight effect--is there light at the end of the tunnel?

Abstract

Autoimmune type 1 diabetes research and treatment are seemingly plagued with problems. Large and small, mostly well-thought out clinical studies and trials since the early 1980s have basically been negative. None of the treatments tested have reached clinical routine to replace current lifesaving insulin replacement therapy. A combination type of therapy to diminish the requirement for insulin is yet to be found. The chronic autoimmune disease at the time of clinical onset of type 1 diabetes has been the “winner” in all attempts made so far to stifle the disease process. The disease is also the “winner” over islet transplantation, a potential cure for diabetes. Islet transplantation research was drastically reduced after it was found that the so-called Edmonton protocol did not yield sustainable insulin independence despite short-term restoration of endogenous insulin production and glycemic stability (1). The Diabetes Control and Complications Trial (DCCT) study, well known to all, continues to underscore the importance of glucose control. The reduction in the risk of complications resulting from intensive therapy in patients with type 1 diabetes persisted at least for 4 years after the study was completed, despite increasing hyperglycemia (2). Notwithstanding progress in the overall diabetes management, we were all recently reminded of the fact that type 1 diabetes remains a deadly disease (3). Although mortality was the highest in patients with poorly controlled diabetes, it was reported that patients with type 1 diabetes with A1C of 6.9% or lower had a risk of death from any cause that was twice as high as the risk for matched control subjects (3). Against this background of an uphill battle, the current issue of Diabetes contains a Perspective by Battaglia and Atkinson entitled “The Streetlight Effect in Type 1 Diabetes” (4). In their Perspective, the authors put forward several remedies to …