Diabetes developments – by Simon O’Neill

In a regular blog series, Simon O’Neill, Diabetes UK’s Director of Health Intelligence and Professional Liaison, rounds up the latest diabetes research. Simon was diagnosed with Type 1 diabetes in 1992.

SnoringSimon-O'Neill-Director-of-H alert!

A research team have examined the associations between symptoms of sleep-disordered breathing (such as loud snoring or sleep apnoea, when you stop breathing for a while during sleep) and glucose metabolism and Type 2 diabetes in older adults. They studied 5,888 people over the age of 65 for up to 10 years and found that apnoea, snoring, and daytime sleepiness were all associated with higher fasting blood glucose levels, higher glucose levels after food and greater insulin resistance.

Those who had sleep apnoea had an almost two-fold increased risk of developing Type 2 diabetes and those who snore had a 27% increased risk, compared with normal sleepers. Whether the same is true in younger people needs further research, but the researchers suggest that people with these symptoms should be considered for screening for Type 2 diabetes or considered higher risk.

Breakthrough in beta cells

Researchers at Harvard University have claimed a breakthrough in stem-cell related research which could lead to a ‘cure’ for Type 1 diabetes. The scientists have created insulin-producing cells, which are almost identical to those found in the human body using embryonic stem cells. They have also managed to do this in large quantities, which, if they work as predicted, could mean that islet cell transplantation would be possible on a large scale.

The stem cells, currently undergoing trials on animals, are still producing insulin after several months. Human transplant trials using the created cells are expected to start within a few years if the animal trials continue to be successful.

Interestingly the cells not only produce insulin, but are also able to act as glucose sensors, as they do naturally in people without diabetes. The hope would be that, as they are based on embryonic stem cells, they could be produced in such a way that the body wouldn’t need anti-rejection medication as is currently the case with donated islet cells. However, because the immune system in Type 1 is geared up to destroy islet cells, you might still need to dampen down the immune response or have regular ‘transplants’ of the cells to keep topping them up.

In separate research from Miami, a team of scientists have transformed non-beta cells in the pancreas into insulin-producing cells. The scientists added a protein called BMP7, which helps bones to mend, to pancreatic cells, 98% of which don’t normally produce insulin. This transformed the cells into insulin producing cells, which secreted even more insulin when exposed to glucose.

The scientists then put treated cells into diabetic mice whose own beta cells had been destroyed, where they acted like healthy beta cells. Obviously this is still at a very early stage, but the team believes that they could inject BMP7 directly into human pancreases to allow people with T1D to start producing insulin again, although immunosuppressive drugs would also be needed to protect the new cells. The other possibility is to create new beta cells from donated pancreases and implant these. If all the pancreatic cells could be converted into insulin producing cells, they estimate that one donated pancreas could treat 7 people, whereas now more than one pancreas is often needed for an islet cell transplant.

And in early January another team produced results showing that they could take human skin cells and transform these into insulin producing cells. The trial is still at the mouse-model stage, but was effective at preventing diabetes in mice, responding to raised glucose levels just as beta cells do. The advantage of this approach is that the skin cells used were adult cells, which are in plentiful supply and could be taken from the individual who needs the beta cell transplant, hopefully greatly reducing the risk of rejection, though the immune system would still attack them. The big advantage of this approach is the speed with which cells could be manufactured.

Health Apps

A new online national survey of Americans’ health app use shows both positive and negative aspects of mHealth adoption. 65% of the 1,600 people surveyed indicated that apps improved their health, and a majority had strong faith in the accuracy and effectiveness of the apps with 42% downloading five or more health-related apps.

About 65% reported using health apps on a daily basis with the most popular being those used to track physical activity (53%), food consumption (48%), weight loss (47%), and exercise instruction (34%). But 46% also admitted to having downloaded an app they no longer used.

The most common reasons for people not downloading apps were lack of interest, cost, high volume of information that needed to be entered on a daily basis, and concern about apps collecting their personal data. The survey suggested that the main challenges are about keeping users engaged with a specific app, especially as new ones, that may promise more, are being released all the time.

3D Printed Pills?

Manufactured medicines, by their very nature, do not allow for any degree of customization which could account for an individual’s weight, race, or kidney and liver functions. However, some researchers have suggested that adjusting for these factors could be a new way of increasing effectiveness and reducing side effects and have come up with an interesting solution to deliver such personalized pills.

Researchers in the US have developed a prototype computer algorithm, including software for 3D printing with dosage-adjustment information. Individual medical and biological characteristics are inputted into the system and the software then calculates personalized doses and automatically generates 3D printing data which can be used to produce active pills of differing doses very accurately.

Although at a very early stage of development, the researchers state that this method is not aimed at replacing the current ways the pharmaceutical industry makes medicine, but could add a new method to compound medications, especially for titrating doses. This could be beneficial for people who don’t respond well to a standard dose of medication or for whom side-effects are problematic. Obviously more research is needed so that a standard adjustment formula for individual drugs can be established as well as establishing whether such 3D drug printing techniques are cost-effective.

Stem Cell Transplants

An interesting, but small, study was presented at the IDF World Diabetes Congress looking at the impact of transplanting stem cells from umbilical cords along with bone-marrow stem cells to help treat people with established T1D.

In the study, the researchers used mesenchymal stromal cells extracted from umbilical cords. These cells are multipotent stem cells and have been shown to modulate immune responses and tissue repair. But as other studies have suggested that their affect alone might not be sufficient, the participants also received transplants of their own bone-marrow mononuclear cells. Both types of cells should help regeneration of the individual’s own insulin-secreting cells, while the mesenchymal cells inhibit the autoimmune response against the newly formed beta cells.

People in the study had been diagnosed with T1D for longer than 2 years but less than 16 years.

After one year, the transplant group had significantly increase C-peptide levels, suggesting they were producing more of their own insulin, while this level fell in the control group. HbA1c levels also dropped from 70 mmol/mol (8.6%) to 58 mmol/mol (7.5%) with the transplanted cells, while remaining largely unchanged in the control group. The transplant group also saw a significant reduction in fasting blood glucose levels, a nearly 30% reduction in insulin requirements and fewer severe hypos. They also had lower levels of anxiety and depression and improved quality-of-life scores.

This was a small study, but the outcomes are certainly of great interest and longer-term and larger studies will be needed in order to fully evaluate the intervention as to efficacy.

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