The diabetes cure: A century after Banting and Best’s ‘message of hope,’ science is actually close

Lisa Hepner still remembers the shock of being diagnosed with Type 1 diabetes as a 21-year-old student. She thought she was just tired from too much partying.

But her pancreas had stopped making the insulin needed to break down sugar, doctors said. It could shorten her life and cause a raft of complications: blindness, stroke, kidney disease and even amputation.

The University of Toronto English major learned how to check her blood sugar and inject insulin to stay alive, and left the hospital feeling optimistic.

“They said a cure was five years away.” That was 30 years ago.

Lisa and I were 20-something roommates enjoying Toronto in the years following her diagnosis. We didn’t think a condition that affects more than 300,000 Canadians could slow her down, but it almost killed her.

There were bouts of hypoglycemia, which left her confused and shaking from too much insulin. There was an ICU stay for diabetic ketoacidosis from too little insulin.

Still, Lisa stayed confident and began filming a documentary about finding a cure for diabetes. She’s still waiting. And now, a century later, so is the world.

Hope for a cure was front-page news 100 years ago this week when the Star reported that two U of T scientists, Frederick Banting and Charles Best, had announced the discovery of insulin. The story ran under a banner headline: “Toronto Doctors on Track of Diabetes Cure — Diabetes Sufferers Given Message of Hope.”

But, as Banting and Best themselves noted in 1922, insulin injections are not a cure for diabetes but only a treatment to prolong life.

In the 30 years since Lisa’s diagnosis, diabetes has slowly but stealthily eroded her organs. The toxic roller-coaster of high and low blood sugars has left her with impaired vision and nerve damage in her hands and feet.

She has endured six surgeries on her hands and fingers to preserve blood flow and mobility, and had to terminate a pregnancy knowing high blood sugars put her nine-week-old fetus at risk. The birth of her seven-year-old son, Jack, was possible only with the help of a surrogate.

“I work hard now at keeping my blood sugars in a normal range. But I still worry that I won’t be there for Jack.”

But Lisa is no longer hoping in vain that diabetes may one day be cured.

Several “very, very promising” biomedical trials suggest that a full cure for diabetes is in sight, says Sarah Linklater, chief science officer at the Juvenile Diabetes Research Foundation Canada. In these trials, the function of a patient’s pancreas is replicated by implanting functional insulin-producing cells in the bodies of people with Type 1 diabetes.

Canada continues to play a pivotal role and has deep roots in this research. Stem cells, core to regenerative treatments for diabetes and other diseases, were discovered in 1961 at Princess Margaret Hospital in Toronto. Forty years later, University of Alberta researchers isolated the insulin-producing islets that enable the cell-based cures being tested around the world.

Now, two world-leading diabetes biotech companies — ViaCyte and Sernova — have Canadians in leadership roles and are conducting trail-blazing clinical trials in Vancouver, Edmonton and Toronto.

For more than 10 years, Lisa and her husband, cinematographer Guy Mossman, have been filming research at ViaCyte, a biotech start-up in San Diego, Calif., for their documentary feature “The Human Trial.” The company had been working on a Type 1 diabetes cure for years. Its idea was groundbreaking: program stem cells to produce insulin, assemble insulin-producing cells in high-tech permeable pouches and implant the pouches into humans. The cells would then mature and release insulin to regulate glucose levels.

ViaCyte’s chief science officer, Timothy Kieffer, a biomedical engineering professor on leave from the University of British Columbia, reports that recent trials on 15 Vancouver patients show transplanted cells can secrete insulin as a natural pancreas would.

Now, ViaCyte has designed genetically modified cells to produce insulin without triggering the body’s immune rejection response.

“This is a world first,” said Kieffer. “I am convinced hook, line and sinker, that this is going to work.”

Sernova, based in London, Ont., has patients in a trial of its cell pouch device, which creates an organlike environment to “function like a mini pancreas,” says Philip Toleikis, the company’s president and chief executive officer. Sernova says the first two patients in the study, amazingly, no longer need insulin.

But many questions remain, according to Linklater. What is the ideal source for insulin-producing cells? How can one best avoid the body’s natural immunosuppression? How long will cell therapies last?

To save more lives, public policy expert Esther Krofah of FasterCures, a Washington, D.C., think tank, says science needs to accelerate diabetes research in the same way Pfizer-BioNTech and Moderna developed their pioneering mRNA COVID-19 vaccines.

Distributing COVID-19 vaccines so quickly was the “medical parallel of a man landing on the moon,” say experts. In the U.S., Operation Warp Speed involved clinical trials simultaneously rather than sequentially, manufacturing the vaccine at the same time and authorizing the vaccine under “emergency use,” said Krofah.

“This is an extremely optimistic time for biomedical research,” she added. “But we need to keep pandemic research paradigms and platforms active.”

Diabetes researchers can shorten the search for a cure by formalizing collaboration, accelerating collection and use of real-world data, communicating more regularly with regulators and trying new ways of conducting clinical trials, said Krofah.

Canada needs to support “hubs” of research teams, and attract the best and the brightest minds to careers in diabetes research, says Dr. Seema Nagpal, vice-president of science and policy for Diabetes Canada.

Researchers also need money.

Toleikis said funding from the National Research Council was instrumental in Sernova being able to start clinical trials, as were grants from the Juvenile Diabetes Research Foundation. “They believed in us before our investors did.”

Money is also the key to speed for ViaCyte, said chief medical officer Howard Foyt, because it allows researchers to take more risks and test a variety of approaches more often.

Lisa lifts her sweater to show me her newest insulin pump and checks her blood-sugar on her phone app. Her personal quest for a cure, “The Human Trial,” will open in theatres in person and virtually in June.

She hopes it will motivate audiences to get as hungry for breakthroughs as she is.

“I know diabetes will be cured. We’re so close.”