DUKPC highlights part 2: Innovating treatments – by Faye Riley

At DUKPC it’s out with the old and in with the new as we’re updated on cutting-edge advancements in diabetes. Here are some of the exciting areas where researchers across the globe are breaking new ground to treat diabetes in new and innovative ways.

 

Progress towards preventing Type 1

Scientists are building a more detailed picture of the immune attack that causes Type 1 diabetes. They’re now using this knowledge to develop treatments that target it, to delay the onset of the condition or prevent it entirely. A must-see session at DUKPC filled us in on the latest.

TrialNet – an international network of scientists dedicated to the prevention of Type 1 – is a driving force in this field. Prof Polly Bingley explained how TrialNet scientists have unraveled the different stages our immune system goes through before a diagnosis of Type 1 diabetes. They’re running clinical trials at different points on this path to Type 1 to find out when is the best time to intervene to delay or prevent the condition.

TrialNet researchers have seen there’s a key phase, just before the symptoms of Type 1 diabetes appear, when there is a rapid progression in immune activity and in the destruction of insulin-producing cells. If we could treat people at this point it could be game changing.

But scientists are also moving their studies further back and testing if they could act even earlier to prevent Type 1 diabetes. Prof John Todd spoke about a particularly exciting trial, called POInT. It’s finding out if giving oral insulin to babies, who have a high genetic risk of Type 1, could stop them from developing the condition in later life.

POInT is riding on the coattails of recent discoveries about peanut allergies. The idea is that giving tiny amounts of insulin for the first three years of a child’s life could teach their immune system that it shouldn’t react against the insulin that’s found within beta cells.

The global trial has recently started in the UK and will run for 7 years. So there’s a while to wait yet before we get any results, but if successful this could be a vital step towards preventing Type 1.

Ways of targeting the immune system aren’t just being explored for prevention. When you’re first diagnosed with Type 1 your immune system hasn’t quite finished its attack, and you can still have up to 20% of your beta cells surviving. The more of these cells we can protect, the more insulin you’re producing yourself and the better your blood sugar control will be.

Dr Parth Narendran is combining evidence from lots of previous studies that have investigated ways to protect beta cells, to give us a clearer picture of which approaches could help.

Immunotherapies – drugs that target the immune system – are an exciting prospect in this area, and where the bulk of the research is. But they aren’t the only possibilities. Dr Narendren is reviewing studies that have explored if tightly controlling blood sugar levels could give your beta cells a ‘rest’ and help preserve them.

Exercise is another area he’s looking at. We know exercise has an impact on the immune system and some evidence does point to it helping people newly diagnosed with Type 1 keep hold of their surviving beta cells for longer.

Dr Narendren’s review of the research landscape is still underway and we look forward to hearing more.

DIY artificial pancreas

It was standing room only for a session hearing from people with Type 1 diabetes who are making use of available tech to build their own artificial pancreas, otherwise known as DIY looping.

DIY looping is a way of ‘hacking’ your  Continuous Glucose Monitor and insulin pump so they will talk to each other. You still have to tell your pump when and what you’re eating, but the system will do the rest for you to keep your blood sugars in range.

Artificial pancreas

We think there are around 300 users in the UK and more than 10 million looping hours have been built up worldwide. The growing DIY community are sharing the technical know-how and supporting each other to innovate better ways of managing their Type 1. And they’re getting great results: more time in target, less hypos and better quality of life.

Dr Emma Wilmot gave us the healthcare professional perspective. It’s tricky for doctors because this homemade tech isn’t regulated, and they could be held responsible if anything goes wrong. At the same time, Dr Wilmot believes that if doctors have patients who are choosing to do-it-themselves they need to be equipped to support them, and make them aware of the risks. Key organisations, including Diabetes UK, are coming up with a position statement which should help.

Making remission a reality

In the opening plenary on the first day of DUKPC, Professor Roy Taylor set the scene on what we know about Type 2 diabetes remission. Leading small studies on his own, Professor Taylor showed for the first time that losing weight through a low calorie diet, could help people with Type 2 diabetes shed fat around their liver and pancreas, and put their diabetes into remission. At the same time, Professor Mike Lean was researching nutrition and low calorie diet approaches too.

“Diabetes UK exerted their magic and asked us to collaborate” Prof Taylor explained – and so the Diabetes Remission Clinical Trial (DiRECT) was born.

DiRECT has built on these smaller studies, increased their size and taken them one step further by delivering the new trial entirely through primary care. In a nutshell, DiRECT is a weight management programme involving low-calorie meal replacements for 12-20 weeks, food reintroduction and long-term support to maintain weight loss – all delivered through GP practices. The promising first year results showed just under half (46%) of those who took part in the programme were in remission of their Type 2 diabetes. That means blood glucose within healthy ranges, and no diabetes medications. So it came as no surprise that there was an air of anticipation for the second year results later that morning.

With Professors Taylor and Lean co-chairing the session, the year two results were delivered by the DiRECT team. Two years after taking part in the programme, 36% of people were in remission of their Type 2 diabetes. And of those who were in remission after one year, 70% stayed in remission for a second year.

When the results were finally shared, the news was welcomed with a round of applause from the scientific community watching on. Here we had evidence that not only is remission of Type 2 diabetes is possible for some people, but it can also be maintained for two years.

Like the first year results, remission was still closely linked to weight loss, and importantly, maintaining that weight loss. The DiRECT research team were also able to share some new insights into the benefits of taking part in the weight management programme, including a reported better quality of life, and the need for fewer diabetes medications.

Remission can be life-changing. For some people with Type 2 diabetes, losing weight can buy a window of time to be diabetes free.

Now we’re looking at ways to make remission a reality for as many people as possible, by finding something that works for people with Type 2 diabetes who are a healthy weight already, or of different ethnicities.

Watch our animation explaining remission.

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