Gene-Based Diabetes Treatments, A New Frontier in Diabetic Control

Moreover, the amount of yohimbine used in the study was four times as much as is generally needed to induce an erection in men or a sexually receptive state in women. However, the results of administering the herb chemical were clearly beneficial for diabetes control. In type 2 diabetics who had two copies of the relevant gene, treatment with yohimbine increased insulin production as much as 79 percent. In people who do not have two copies of the relevant gene, however, the treatment would have no effect, at least not blood sugar levels. It could still cause unwanted erections in male users.

New diabetes treatments, however, are likely not be based on the principle that "the same treatment (other than insulin) works for every diabetic." New diabetes treatments are likely to be tailored to genetic differences in the diabetics who take them. Here are two examples of how this principle is already being used in treating diabetes:

• In the late 1990's, a class of drugs called the thiazolidinediones, or TZD's (Actos and Avandia) seemed to be a wonder drug for type 2 diabetes. They lowered blood sugar levels by activating PPAR-gamma receptors on the surfaces of fat cells. Even diabetics who had horrible diets could get good results by taking these drugs. However, in a few years, diabetics and doctors learned that easy blood sugar control with TZD's came at a price. Actos and Avandia stimulated the development of stem cells intended to become bone cells or red blood cells into fat cells. Enormous weight gain became all too common among users of these drugs. Because this weight gain involved the creation of new fat cells, returning to normal weight was not a simple matter of diet and exercise. Several TZD's were banned entirely, and Actos and Avandia now come with stern warnings. However, it is now possible to do genetic testing for the number of PPAR-gamma binding sites on fat cells. Some diabetics have too many binding sites and will suffer side effects form the drugs. Some diabetics will have too few binding sites and not respond to the drugs. Some diabetics will have just the right number of binding sites and respond well to Actos and Avandia. For these diabetics, TZD's may truly be wonder drugs.

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• In some parts of the world, up to one fifth of the population has a mutation in the genetic code from the production of an enzyme called methylene tetrahydrofolate reductase, or MTHFR. In these people, the body lacks an enzyme for the efficient conversion of folic acid to methylfolate, its active form. People who have the MTHFR mutation suffer especially severe MTHFR symptoms as complications of diabetes that can be prevented simply by taking a safe, inexpensive, and widely available B vitamin supplement, methylfolate, costing just $5 to $10 a month, and avoiding folic acid supplements. Testing for this mutation is so common that it is now covered by health insurance in the United States and most other countries, but only a small percentage of diabetics who would benefit from MTHFR testing know about the benefits of the supplement.

Gene-based therapies for diabetes can be tremendously successful for the diabetics who need them. Ask you endocrinologist about appropriate testing that lead to a much easier experience of managing your condition.