Will there be an FDA approved cure for Type 1 Diabetes by EOY 2032?
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From @NevinWetherill

I think a good rule-of-thumb for existing-patient cures would be "a treatment such that those who undergo the treatment at any point after being diagnosed with type 1 do not have a life noticably inconvenienced by any effects of their condition after the treatment."

Insulin pumps will not count

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I think "cure" needs a tighter definition than is given. There are at least three different things that arguably could be called a cure. Which ones would resolve YES?

  1. If autoimmune activity is detected early, intervene and prevent the pancreas from being destroyed. Two subcategories: a) requires lifelong treatment, i.e. a targetted immunosuppressant drug, or b) one-time treatment that permanently alters the patients immunresponse, i.e. a sort of reverse-vaccine.

  2. Gene-therapy that prevents offspring from inheriting an increased likelihood for the disease.

  3. Reversal of disease symptoms for patients who have already had significant pancreatic damage. Subcategories: a) an implanted "artificial pancrease" that lasts for multiple years (if yes, what characteristics must distinguish it from a traditional implanted insulin pump?), or b) transplanted organ from human or non-human donor, including things like regrowing from patient's own stem cells.

  4. Other. Catch all for stuff I haven't thought of.

I know some people with Type I Diabetes, so I've thought about this topic a little, but my field is neither biology nor medicine.

@DanHomerick i have no expertise here, i am defining cure as a layman, so whichever you think is best i guess

@DanHomerick might need to add 'as defined by manifold' and resolve it by poll when the time comes

@DanHomerick I have Type 1 and have been casually following research in this area.

I think your assessment is excellent, among the best understandings of the specifics as I've seen and can successfully distinguish in non-medical/endocrinology experts.

I think you've got a better understanding than some general practitioners I've met - though they often don't have any reason to keep up with speculative treatments, and GPs not contaminating their memetic landscapes with too much of that is probably a good thing.

Personally, I think the word "cure" is not a crisp concept, and attempts to make that specific word into a crisp category are not going to make it much more useful.

If I ask myself what is the "increasing groan and eye-roll index" for types of treatments called "cure" in a news headline, I get something like this.

  1. Single (1/life) injection/procedure which repurposes/regenerates/introduces some cells in the body which are then functionally identical to Beta Cells in the islets of a healthy human pancreas. Does not have other chronic effects

  2. Multiple injections/procedure is also pretty cheerful, though that is much less cheerful if it is a repeating procedure over the whole lifespan (less cheerful with shorter periods, less cheerful with any higher amount of expense/risk/side effects/inconvenience of the procedure.)

  3. Generally if existing patients are in some way "not, at some point, finished" with the ongoing treatment for Type 1, I'm inclined to groan pretty heavily at calling it a cure. I do not want to incentivize companies/researchers by calling their treatment a cure as long as they're already going to be incentivized by continuing to have patients "on the hook" for continued treatment.

  4. Preventing Type 1 Diabetes from occuring in any new people is... Well, I'm sorta tempted to give them the praise of calling that a "cure" - totally preventing counter-factual harm is actually a huge plus - you are making it such that a person who would otherwise have Type 1 would not have it in actual reality. Even if it doesn't fix me, that just means I keep being an opportunity for an additional cure* (*that works for existing patients.)

  5. Anything which involves a significantly risky/life altering procedure which just so happens to coincidentally fix Type 1 seriously doesn't count IMO. Like, if a Type 1 Diabetic requires a pancreases transplant for other reasons, the docs pump them full of a new immunosuppressant for organ transplants, and they're "cured" of Type 1 in the sense that their new pancreas has working Beta Cells for a while with immunosuppressants - that's not something I'd be cheerful calling a cure.

I think a good rule-of-thumb for existing-patient cures would be "a treatment such that those who undergo the treatment at any point after being diagnosed with type 1 do not have a life noticably inconvenienced by any effects of their condition after the treatment."

Noticable inconvenience would be needing to interface with healthcare more than a non-Type 1. Seriously, currently we can't escape doctors. No, not even if a bottle of insulin/box of supplies is sufficient treatment. You've gotta go to a specific specialist, usually multiple times a year, if only because of insurance/regulations re prescriptions. Even trips to the pharmacy would be a noticeable inconvenience - anything resembling the current state of affairs would likely still be killing diabetics from sheer lifestyle friction.

Hardly-noticeable inconvenience would be doctors needing to acknowledge and understand the specific mechanism/implications of the treatment they underwent in order to provide healthcare in areas not directly related to Type 1. (It's a hardly-noticeable inconvenience if someone who has been "cured" of Type 1 then needs their doctors to not give them a specific other type of treatment, where that other treatment is elective or has usuable-for-them alternatives and needing it isn't any more likely after the diabetes treatment.) Ditto for slight increased risk of overall health outcomes, on the order of living somewhere with 1% worse air quality than another location - i.e. increased risk you wouldn't even normally bother to account for when making life choices.

Unnoticeable inconvenience is if you get dumped by a love-interest after two dates because they found out you once had such a treatment, and that treatment is an "ick" for them [because they "ew" to something like stem cells, vaccines, nano-machines, gene editing, animal cell chimerism, etc. etc.]

Personally, I'm kinda hopeful that curing Type 1 is actually just too easy for the perverse incentives of the medical community to prevent it from happening for too long. It doesn't look terribly difficult. Some small number of clever people just need to actually work on actually curing it using categories/power-levels of tech that look to me to be pretty much already available.

If someone tries to tell me that an automated insulin pump is "basically a cure" again, I'm going to... Well, I'm going to get slightly more bitter on basically the same bitterness trend line - which eventually turns someone into a dramatic misanthropic cliche, and I'm hoping to avoid that.

@NevinWetherill ty for the analysis ill add this to the criteria

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