Highlights from the 2016 ADA by Emily Burns
Last month I got the chance to attend the 2016 American Diabetes Association (ADA) meeting in New Orleans. Not only is New Orleans an incredible city to visit (I managed to squeeze in a few oysters and some jazz), but 16,000 diabetes researchers and healthcare professionals in one place is a pretty amazing sight as well.
The annual conference lasts for five days, and this was its 76th year. The programme has a really wide remit, covering all types of diabetes and research. As such, I spent the majority of the time legging it from one end of the convention centre to the other, trying to fit in as many talks as I could!
As expected, the American presence is huge, but it was great to see so many UK-based researchers – especially those that have been funded by Diabetes UK – in attendance. I have to admit I got a feeling of real pride when the Diabetes UK logo appeared at the end of a presentation, or in the corner of a poster. We can’t forget that research funded by Diabetes UK is up there on a world-class platform.
Islets and transplants
Islet transplants and how to improve them was on the agenda. We know that there are a few things stopping islet transplants from being as transformative as they could be: we don’t have enough donor pancreases, the islets are often unhappy during and after the transplant process, and the immune attack that characterises Type 1 diabetes is still there.
Researchers from around the world were proposing ways to overcome this: improving the pancreas donor system, xenotransplantation (as in, could we use islets from other animals?), or creating new beta cells from stem cells.
While the idea of making an unlimited pool of beta cells isn’t a new one, Dr Cowan, from the Harvard Stem Cell Institute, is proposing a method that also stops the immune attack. He wanted to edit the DNA of the beta cells (using a technique called CRISPR) so that they could be transplanted into anyone and wouldn’t trigger the immune system to attack – a bit like O negative blood.
Diabetes UK-funded PhD students, Scott Anderson and Sarah Armour from Newcastle University, were also showcasing their islet research on posters. They’re both looking at the identity of beta cells: all types of cells have a specific combination of key molecules that makes it unique and give it an identity. Beta cells appear to be able to lose this identity – in both islet transplants and Type 2 diabetes – and so they don’t work as well, and researchers need to find a way to stop this from happening (1,2).
Closing the loop
There were many presentations about artificial (or ‘bionic’) pancreas technology, and it was very clear that progress is being made at a rate of knots. Algorithms were the subject of lots of discussions (the precise calculations involved in how much insulin to use), along with the possibilities of using dual-pumps – with both glucagon and insulin.
Dr Helen Murphy was on hand to talk about her Diabetes UK-funded study testing the artificial pancreas system in pregnant women with Type 1 diabetes. The women wore the devices during pregnancy, birth and while caring for their new-born babies, and we’re hoping there will be some announcements around the outcome of that study later this year (3).
Dr Hood Thabit, who works with Professor Roman Hovorka in Cambridge, also presented findings from their Diabetes UK-funded study, testing the artificial pancreas system in people in hospital with Type 2 diabetes. They’ve shown that the technology is safe and feasible in this group of people, and there were some hints that it could better control blood glucose levels as well. So a real step forward in expanding the potential uses of the artificial pancreas (4).
Is metformin protective?
Metformin was the topic of many conversations, having been first synthesised nearly a century ago. It’s now the most used drug for Type 2 diabetes around the globe, and other benefits are beginning to emerge.
There were discussions around metformin’s potential ability to protect against cancer. Some studies have found that people with Type 2 that take metformin have lower rates of cancer (and associated deaths) than those taking other drugs, and early lab studies have suggested metformin might have protective effects.
But as it’s never that simple, some academics have criticised the methods behind the studies that found this lower rate of cancer, and suggested that the lab tests used doses much higher than people would actually use. On top of this, the first couple of clinical trials to finish (both in pancreatic cancer) have been negative.
With more than 100 clinical trials still to complete, the jury’s still out.
Getting the Type 1 immune system under control
We’re funding research into finding a way to harness the immune system and prevent it from attacking beta cells, and we’re not the only ones. Trials are underway around the globe, with lots of different strategies.
Professor Malek, from the University of Miami, is focussing on the group of immune cells that keep the rest under control (known as regulatory T cells), to see if their power can be used as a therapy (5). Professor Gitelman, from the University of California, is taking a different approach, to see whether an anti-cancer drug (called imatinib) could be repurposed for Type 1 diabetes (6). Others argued that we actually need combination approaches, using different drugs to control the immune attack at the same time.
And while the ADA is over for another year, you can still check out the entire program online, and it’s only two months until the European Association for the Study of Diabetes (EASD) conference in Munich…
This blog is brought to you by Dr Emily Burns, Research Communications Manager at Diabetes UK.
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