Type 1 diabetes research highlights from the EASD – by Emily Burns

Me at the EASD
Me at the EASD

In mid-September, I got the chance to head to the biggest diabetes congress in Europe: the European Association for the Study of Diabetes (EASD). Over 17,000 people (mainly researchers and healthcare professionals) were in attendance, and there were a few exciting announcements. Here are the latest research highlights for Type 1 diabetes; you can catch the Type 2 diabetes highlights in my other blog.

Is HbA1c all that?

Professor Irl B Hirsch from the University of Washington argued that a person’s HbA1c isn’t everything. We should now be looking to other measurements as well, such as the time spent within an optimal blood glucose range. Luckily, this is now beginning to be a reality, thanks to continuous blood glucose monitoring technology.

Better Stronger Faster Insulin

injection_300x451A trial involving 38 people with Type 1 diabetes (by companies Eli Lilly and Adocia) has suggested that a new type of insulin called BioChaperone Lispro could be released into the blood stream faster and lead to better blood glucose control than the currently available Humalogue.

The Novo Nordisk ONSET-1 study was testing a new form of insulin called fast insulin aspart (which contains vitamin B3 to improve absorption into the bloodstream) and involved over 1000 people with Type 1 diabetes. They found that the new insulin improved blood glucose control and, interestingly, could also potentially be taken after a meal without negatively impacting blood glucose control (for those that are unsure how much they need or how much they’ll eat).

The results of the two studies above haven’t yet been published in a scientific journal, and the audience had a few questions on the day. Namely around the high dropout rate before the ONSET-1 study started, and the use of a liquid diet in both. The advantage of using a liquid diet in a trial like this is that it’s standardised: everyone has had exactly the same amount of food and you can rule out any impact this might have on the results. The disadvantage is that no one does that in real life. We eat real food.

Can we make new beta cells?

This is a major quest in Type 1 diabetes research: if we want to cure Type 1 diabetes, we need to stop the immune attack and replace the beta cells that have been destroyed.

It’s not science fiction; many labs around the world have now managed to produce insulin-producing beta cells from stem cells. But it’s not easy: using a six-step process, the original stem cell is turned into a different cell at each step, slowly getting closer to becoming the final insulin-producing beta cell. At each step, the activity of specific genes needs to be at the right level – either high or low – and the researchers use these genes (known as markers) to see if they’re still on the right track at every step.

Professor Michael German, Associate and Clinical Director of the UCSF Diabetes Centre, gave a beautiful lecture on just how complex the whole process it – see below.

So the short answer to the heading question is yes, we can make new beta cells. But will it work in humans? Can it be scaled up enough to actually become a feasible way to make beta cells for islet transplantation? Will we be 100% sure that it’s safe every time? These are questions that still need to be answered.

Can some people with Type 1 diabetes fight back against the immune attack?

Diabetes UK-funded researcher, Dr Kathleen Gillespie, presented the latest on an international endeavour to understand why some people with Type 1 diabetes progress far more slowly than others (termed ‘slow progressors’).

Autoantibodies (antibodies that target beta cells and encourage the immune system to attack) can develop from six months of age, but the team know that a subset of people with autoantibodies don’t go on to develop Type 1 diabetes. This was shown in the Diabetes UK-funded BOX (Bart’s-Oxford) family study: the longest running study of families with Type 1 diabetes anywhere in the world.

Kathleen has teamed up with researchers around the world to develop an international study to monitor ‘slow progressors’, and they have 157 so far. The study isn’t complete yet, but they’re comparing the genetics of people diagnosed at different ages (ranging from 0 years to 20 years), to see if there’s a difference.

Devices and desires

We got a chance to see the results of the latest artificial pancreas trial, carried out by Medtronic across nine sites in the United States of America and one in Israel. 124 people with Type 1 diabetes (all previous pump users) were involved, with the three-month (published) study showing that the device tightened bloody glucose variability.

Bi-hormonal artificial pancreases (that can release insulin and glucagon) were also discussed, with data suggesting it’s feasible. However, there were still questions around the long-term safety of glucagon use, and it looks like a six-month trial (plus a further six months follow-up) is needed before we’ll know more.

A new study published in the Lancet has shown that continuous glucose monitoring (CGM) could help people with hypo unawareness. The trial involved 52 people and suggested that CGM could improve the time spend within target blood glucose range and reduce the number of severe hypos experienced. Unfortunately, they didn’t see any improvements in actual hypo awareness.

Dr Nick Oliver was presenting on whether two glucose monitors (the Dexcom and the FreeStyle Libre) could help people with Type 1 diabetes that unable to detect ‘hypos’. They found that the Dexcom reduced the number of hypos experienced, while the FreeStyle Libre had no effect. Why? Possibly due to the fact that the Dexcom had an alarm to warn people about their blood glucose levels.

This blog is brought to you by Dr Emily Burns, Research Communications Manager at Diabetes UK.

Like what you see? Check out the other research blog posts.

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