Research news from the EASD – by Anna Morris
The European Association for the Study of Diabetes (EASD) conference drew to a close in Berlin last week. Anna Morris, our Assistant Director of Research Strategy and Partnership, was there to bring us back the latest diabetes research news. First up, Type 1 highlights.
Evidence continues to build for the artificial pancreas
In 2017 the first artificial pancreas became available in the US for use at home and while it isn’t yet available yet in the UK, the evidence for its benefits continues to build.
Professor Roman Hovorka from the University of Cambridge presented new results showing that using the artificial pancreas gives better blood glucose control than sensor-augmented pump therapy. With this type of pump the person wearing it decides on their insulin dose — whereas the artificial pancreas automatically calculates and adjusts insulin requirements for you.
The study involved 86 people with Type 1 diabetes aged six and over with high blood glucose levels. For 12 weeks, half got to try the artificial pancreas and half the sensor augmented pump therapy.
Those people wearing the artificial pancreas had better HbA1c, spent longer with blood glucose levels in the target range and had less hypoglycaemia.
We’ve been at the forefront of research into the artificial pancreas since the beginning and it’s exciting to see more evidence of its benefits.
Getting the diagnosis right
We know that identifying whether someone has Type 1 or Type 2 diabetes based on simple characteristics alone, like age or BMI, can be difficult. Dr Bev Shields from the University of Exeter updated us on research that aims to help doctors get the diagnosis right. This is really important, as people with Type 1 diabetes need to start on insulin immediately and misdiagnosis could be life threatening.
The researchers have developed a type of calculator which uses a number of features which individually can go some way to tell who has Type 1 or Type 2 diabetes (such as age, ethnicity, BMI and markers in the blood that indicate an immune attack). But the calculator combines all of this information to give a much more accurate picture of which type of diabetes someone has.
Results showed that it can almost perfectly discriminate between Type 1 and Type 2 diabetes. Excitingly, it will soon be available as an online tool and as part of an app, helping people get the right diagnosis and treatment.
Combining drugs for better outcomes in Type 1 diabetes
Professor Julio Rosenstock from the University of Texas presented the results of the EASE trial, looking at whether an existing Type 2 drug could be beneficial for people with Type 1 diabetes. The trial involved 975 people with Type 1 diabetes who took either 2.5mg, 10mg or 25mg of the drug empagliflozin, alongside their insulin.
The trial showed that empagliflozin led to better blood glucose control – increasing time in range and reducing HbA1c – compared to insulin alone. And it didn’t increase hypoglycemia.
Better blood glucose control was seen at all doses but was most improved with the higher doses.
But it wasn’t without side effects. Higher doses were linked to an increase in severity of diabetic ketoacidosis (DKA), with women and those using an insulin pump at greater risk.
Professor Lori Laffel from the Joslin Diabetes Centre followed up by talking about the potential for using the drug to treat people with Type 1 diabetes in the real world. She concluded that 2.5mg of empagliflozin might be the ‘sweet spot’ to gain the benefits of improved blood glucose control but without the increased risk of DKA. She highlighted that education on the risks and benefits would be necessary for people taking the drug, family members and healthcare professionals.
A new vision for Type 1 diabetes
In the final session of the conference Professor Colin Dayan from Cardiff University set out his vision for Type 1 diabetes in 2041 – 120 years after the discovery of insulin.
He reminded us that while no autoimmune condition has ever been prevented or cured, others, like rheumatoid arthritis and psoriasis, already have treatments that work by altering the immune system. They’re known as immunotherapies and are being used to improve the lives of people living with these conditions.
We’re backing research to make immunotherapies a reality for Type 1 diabetes and exciting progress is being made. Our scientists are working hard to prevent Type 1 in those at risk and slow the immune attack in those who already have it.
Off the back of the pioneering research that’s going on right now, Professor Dayan described a future world where people at risk of Type 1 diabetes can be identified earlier and therapies to retrain their immune system are available, so they never develop Type 1 diabetes. Immunotherapies are also able to preserve remaining beta cells in those newly diagnosed and lost beta cells can be replaced. The incidence of Type 1 diabetes has fallen and people with Type 1 diabetes who produce little or none of their own insulin are rare.
With three trials testing immunotherapies for Type 1 diabetes reporting results in 2019 these are hopeful times and we’ll be watching this space with great interest.
In the meantime, you can read more about all of the research projects we are currently funding.