Diabetes research is ongoing, and some amazing developments in the diagnosis and management of diabetes are coming your way. Here are 10 diabetes breakthroughs you should know about!
1. Artificial pancreas
One of the most exciting developments in diabetes research is the artificial or “bionic” pancreas, which can automatically make decisions about insulin and glucagon dosing. The bionic pancreas bridges the gap between two pieces of diabetes technology that already exist: the insulin pump and the continuous glucose monitor.
With an artificial pancreas, a computer program – instead of the person with diabetes – calculates how much insulin the pump delivers based on readings from the continuous glucose monitor. This “closed-loop system” requires little to no input from the user. The artificial pancreas acts automatically to keep blood glucose levels within a target range; however, a person using the device has the option to make dose adjustments in certain situations.
In a recent study, a bionic pancreas significantly increased the percentage of time adults with type 1 diabetes had glucose levels between 4 and 10 mmol/L, compared with multiple daily insulin injections or a continuous subcutaneous insulin infusion.
A number of models of bionic pancreas are in development, and are expected to be available later in 2020.
2. Stem cell research
Researchers at the University of California San Francisco have transformed human stem cells into mature insulin-producing cells, a major breakthrough in the effort to develop a cure for type 1 diabetes.
These insulin-producing cells look and act like the pancreatic beta cells that people without diabetes produce. When the cells were transplanted into healthy mice, they became functional in a matter of days – producing insulin in response to blood sugar much like the animals’ own islet cells. Trials in humans are planned for the future.
University of Alberta researchers are conducting a study to remove stem cells from patients’ bone marrow and place them in the bloodstream. It is thought that these stem cells will travel to the pancreas, where they will transform into insulin-producing cells. The two-year study is set to begin in late 2020.
3. Islet cell transplantation
Islet cell transplantation is the transplant of isolated islet cells from a donor pancreas into a person with type 1 diabetes. Once transplanted, the islets begin to produce insulin, regulating blood sugar levels. The first islet cell transplantation was done in Edmonton, at the University of Alberta. Since then, the transplantation process – which has become known as the “Edmonton Protocol” – has been done in many centres around the world. While patients who undergo the process aren’t actually cured, they remain “insulin-independent” (i.e. they don’t need to administer insulin) for up to five years.
Results of a recent study showed that islet cell transplantation provided optimal glycemic control, restoration of hypoglycemia awareness, and protection from severe hypoglycemia events in subjects with impaired awareness of hypoglycemia and a history of frequent severe hypoglycemia events. In fact, one year after islet transplantation, 7 out of 10 transplant recipients had an A1C level below 7% percent and did not have episodes of severe hypoglycemia. Islet transplant recipients also experienced significant improvements in their diabetes-related quality of life. Even those who still needed to take insulin to manage their diabetes experienced these improvements.
Click here for more information about islet cell transplantation.
4. The five types of diabetes
A group of researchers in Sweden and Finland recently conducted a study that suggested there are five types of diabetes instead of only two (type 1 and type 2). The five new proposed types of diabetes are:
- Severe autoimmune diabetes. This form is similar to type 1 diabetes.
- Severe insulin-deficient diabetes. This is similar to “severe autoimmune diabetes;” however, in this category of people, the immune system is not the cause of their diabetes.
- Severe insulin-resistant diabetes. This type of diabetes occurs in people who are overweight and have high insulin resistance.
- Mild obesity-related diabetes. This form of diabetes occurs in people who have a milder form of the disease.
- Mild age-related diabetes. This form of diabetes is similar to “mild obesity-related diabetes,” and is the most common form of diabetes.
Early detection and proper categorization are important for the appropriate management of diabetes. According to researchers, the purpose of these new classifications is to enable appropriate treatment and provide an improved prognosis for patients with each type of diabetes.
5. Smart pens for insulin injections
A number of diabetes device companies are developing “smart pen” systems for insulin injections, which will offer users a single platform for adjusting insulin. The system includes a pen that integrates with an app to dose and track basal, bolus and basal/bolus insulins. The system will take readings from either a blood glucose meter or a continuous glucose monitoring system, and then recommend insulin dosing changes based on the patterns that are detected. The first insulin smart pen was recently approved for use by the U.S. Food and Drug Administration. It is expected that Health Canada will approve smart pens for use in the near future.
6. Diabetes medications that treat heart disease
The risk of heart disease is higher in people who have diabetes than those who don’t. Evidence from clinical trials now shows that some of the newer diabetes drugs, besides lowering blood sugar, also reduce the risk of heart disease in people with diabetes and prevent hospitalization from heart failure.
Liraglutide (Victoza®) and semaglutide (Ozempic®) are drugs in a class of medications called glucagon-like peptide-1 (GLP-1) receptor agonists. They have been proven to reduce the risk of major adverse cardiac events such as heart attack, stroke and death from cardiovascular disease.
Empagliflozin (Jardiance®), canagliflozin (Invokana®) and dapagliflozin (Farxiga®) are drugs in a class of medications called sodium-glucose co-transporter-2 (SGLT-2) inhibitors. They have also been proven to reduce the risk of major adverse cardiac events but have the added benefit of reducing hospitalizations for heart failure in people with diabetes.
For more information about these medications and how they were studied, click here.
7. Diabetes medications that protect the kidneys
Kidney disease is a common and serous complication of diabetes. Two classes of medications used to lower blood sugar levels have also been found to prevent kidney failure in people with type 2 diabetes: GLP-1 receptor agonists and SGLT-2 inhibitors. In large clinical studies, these medications greatly reduced the risk of kidney failure or death in people who had both type 2 diabetes and diabetic kidney disease. They also reduced the progression of diabetic kidney disease in people who already had the condition.
8. Intranasal glucagon
Glucagon is a hormone that increases blood sugar levels quickly. It is given as a medication to people with diabetes who are having a severe blood sugar emergency (usually when blood sugar levels are less than 2.8 mmol/L). In the past, glucagon was given only as an injection. Recently, a new route of administration for glucagon was approved in Canada, in the form of a nasal powder. It comes in a small tube that has a plunger on one end. The tube is gently inserted into a nostril and when the plunger is pressed, the dose of glucagon nasal powder is administered. The nasal powder is not inhaled or breathed in. It is absorbed through the nose
9. Use of technology and virtual care
Virtual care is defined as any remote interaction between a patient and their healthcare team, using various forms of communication or information technologies. Means for interacting with healthcare teams can include phone calls, text messages, online communication portals, video calls on a computer or mobile device, apps – or a combination of these methods. Like care delivered in person, virtual care can involve interacting remotely with various members of your healthcare team, including doctors, nurses, pharmacists and dietitians.
Virtual care has been evolving for many years, and in Canada has mostly been used to interact with patients who have difficulty accessing care in person, such as people in rural or remote locations. The COVID-19 pandemic means that virtual care is suddenly being used in different ways and by a much wider range of people.
Virtual care is now being used to support people with diabetes for needs such as:
- Reviewing blood sugars and making medication or insulin dosing adjustments with a diabetes healthcare team member
- Reviewing food logs or blood sugar records with a diabetes educator
- Troubleshooting diabetes device issues
- Addressing mental health concerns
10. Use of continuous glucose monitoring in pregnant women
In July 2020, Health Canada authorized the use of continuous glucose monitoring (CGM) systems by pregnant women with type 1, type 2 or gestational diabetes. This expanded indication was granted because of the role that CGM can play in the prevention and management of COVID-19 by significantly reducing in-person interactions between pregnant women with diabetes and their healthcare team. The use of CGM by pregnant women with diabetes during the COVID-19 pandemic will allow them to closely monitor their blood sugar levels and share the data with their healthcare team remotely, thereby limiting the potential spread of COVID-19, and helping to identify periods of hypoglycemia and hyperglycemia and achieve glycemic targets. This is especially important during the pandemic, as people with chronic illnesses such as diabetes are at higher risk for complications related to COVID-19.