I am a 21 year old diagnosed with type 1 diabetes 18 years ago, and I have no current complications, but I am so scared because I am not perfect, and my blood sugars are not always normal. How close to a cure are we?

At your stage in type 1A (autoimmune) diabetes, there are almost certainly no insulin-producing islet cells remaining. There have been thoughts. and I believe trials, of using proteins like INGAP to promote islet regeneration from the pancreatic ducts, but all the evidence is that this will not work because of the latent autoimmunity.

Probably the first approximation to a ‘cure’ will be the development of a reliable indwelling glucose sensor that can be safely linked to a pump, making what might be called a virtual external pancreas. Trials have already started, but it will some years before this approach is likely to be made safe. The next best hope is for further advances in transplantation technology. Two years ago, a Canadian team in Edmonton took a big step forward in this direction, but the two major problems of the lack of donors and the need for lifetime immunosuppression remain. There is however a great deal of research on both these issues, in the development of surrogate cells, perhaps stem cells or genetically engineered cells for one part and on ways to induce graft tolerance with very brief period of immunosuppression on the other.

In the meantime the most important goal must be, with the help of your diabetes team to make sure that you use all the recent advances in management to ensure good control and a critical component of this should talking about your anxieties to the Medical Social Worker in the group.

DOB