TAMPA - Research on new ways to treat diabetes ranges from inventing high-tech implantable devices to improving the old-fashioned advice about diet and exercise.
Scientists hope that one day, diabetes will become an easily cured inconvenience instead of the chronic disease that today exacts a staggering toll of death and disability.
"I'm convinced that in 20 or 30 years, we'll look back and say, "Gee, those turkeys were really primitive,' " said Dr. Tony Morrison, co-director of the Diabetes Center at the University of South Florida.
Diabetics now take insulin to replace what their bodies can't make. They also take drugs that help them use their bodies' own insulin more efficiently and work to control their blood sugar with diet and exercise. The vast majority of diabetics have Type 2 diabetes, in which their bodies either can't make enough insulin, or can't efficiently use what they do make.
One of the research areas getting the most attention is work to develop an artificial pancreas - an insulin pump that would work with a sensor that records blood sugar continuously and would supply exact doses of insulin to keep sugar levels stable.
Such technology could help Type 1 diabetics, whose bodies don't produce any insulin, and the many Type 2 diabetics whose diabetes is severe enough that they need to take insulin.
Many diabetics who need insulin now use a pump to deliver the hormone, which moves sugar from the blood into muscle, fat and other cells for energy. But the artificial pancreas, such as the one being developed by Medtronic Inc., would provide much tighter control of blood sugar and could include implantable insulin pumps and sensors. Company officials hope their device will be available in four to five years.
"That's going to be a huge breakthrough, something that will continually measure blood sugar," Morrison said. "Then that would be like a cure."
On a more low-tech level, federal scientists have started one of the largest diabetes trials ever, a study of 10,000 patients that will examine how stricter control of blood sugar, blood pressure and blood fats affects diabetics' long-term health.
"How low should you go with blood sugar?" said cardiologist Michael Domanski, head of the Clinical Trials Group at the National Heart, Lung and Blood Institute. "That's a key question. If you control the blood sugar better, do you get fewer blockages of blood vessels?"
Medical guidelines now call for diabetics to lower their blood pressure and blood sugar, but not to levels considered normal in people without diabetes. The trial will evaluate whether the risk of heart disease falls for patients who are treated more aggressively. The study will run through 2009 and is being conducted at 70 sites across the United States and Canada.
Other broad studies are being conducted by drug companies, which already make several drugs to treat diabetes and stand to make millions from them as diabetes becomes widespread. For example, Novartis is conducting a study of two drugs to prevent diabetes and/or heart attacks in a trial that involves 7,500 patients.
GlaxoSmithKline enrolled 5,000 patients in trials to show that its drug Avandia was safe and effective. Sales of the drug, which was approved in the 1990s to help the body use insulin more efficiently, reached $1.5-billion last year. Since the drug was approved, the company has invested about $300-million on research to make it more effective, said company spokesman Rick Koenig.
The company is researching other drugs that would act similarly to Avandia, but also is working on new compounds. One is designed to help the body excrete more glucose in the urine. Another is a protein that would affect insulin production.
"There's a real commitment here," Koenig said, "because there's a recognition that there's a very important medical need and a significant business opportunity."
Investigators also need to study diabetics who don't develop problems, said Dr. George King, research director at Joslin Diabetes Center and a Harvard Medical School professor. For example, while many diabetics develop kidney disease, most don't, even among some people whose blood sugar isn't well controlled.
That makes King wonder: Why not? Do those people have some protein, some gene, that prevents kidney disease?
"Even though they have high glucose, they're somehow protected," King said. "If we could find out what's protecting them, we could develop protections."
King pointed to other research under way at Joslin. Scientists know that exercise is important for diabetics because it makes the body use insulin more efficiently. Joslin researchers also are studying how exercise activates enzymes in muscle cells that help glucose move out of the bloodstream and into the muscles.
It's an important point for Morrison as well, and one that he thinks diabetic patients need to hear more often.
"The other party . . . we don't emphasize nearly enough is exercise," he said.
One of the most important recent studies about diabetes shows that even high-risk people can avoid developing the disease entirely, said medical epidemiologist K.M. Venkat Narayan, with the federal Centers for Disease Control and Prevention.
"That paves the way for saying that with lifestyle modification, we can delay or prevent diabetes," Narayan said.
The study, the Diabetes Prevention Program, focused on people with prediabetes, or who already have higher than normal blood sugar. Study participants who exercised 30 minutes a day and lost an average of 5 to 7 percent of their body weight cut their risk of developing diabetes by 58 percent.