Diabetes developments – by Simon O’Neill

Simon O'NeillIn a regular blog series, Simon O’Neill, Diabetes UK’s Director of Health Intelligence and Professional Liaison, rounds up the latest diabetes news.

This week Simon looks at new food structures, healthcare technologies and recommendations.

Sugar lite?

At the end of 2016, Nestlé announced that it has developed a way of restructuring sugar, so that it can break down easily and more quickly in your mouth but with less going into the digestive system. The company described the new molecule as having the same sugar exterior, but a hollow core meaning that it should taste as sweet as normal sugar in the mouth, but will have 40% less calories.

It is planned that the new sugar will be introduced in Nestlé products from 2018, and that more details about it would be released this year, once it has patent protection. The hope is that the new formulation of sugar will enable the company to produce products that taste as sweet as now, but are effectively “reduced sugar”, as far less reaches the digestive system.

The company may also sell the new sweetener to other companies. Unfortunately, however, the new formulation can’t be used to sweeten liquids, so won’t be replacing the sugar in fizzy drinks, one of the main sources of sugar in the average diet.

Artificial eye?

Google’s life sciences company Verily has developed an alliance with Nikon’s retinal imaging subsidiary Optos. They plan to develop machine learning to create improved care solutions for diabetic retinopathy and diabetic macular oedema, leading causes of blindness worldwide.

Google’s DeepMind Health, using artificial intelligence to work with data on a huge scale, has already established a relationship with the NHS, lending its technology to the Moorfields Eye Hospital NHS Foundation Trust.

In initial studies, the company’s machine learning capabilities achieved over 90% diagnosis accuracy for both DR and DMO using archived images. Optos has already developed a retina imaging platform called Optomap which can capture around 82% and 200 degrees of the retina in one image.

The new collaboration will look to create better screening methods for both conditions as well as assisted reading programmes to help specialists diagnose either disease at an earlier stage.

Wound repair

A gel made from a patient’s own blood and vitamin C is proving effective in managing foot ulcers in people with diabetes. The new gel builds on a technique called platelet-rich plasma (PRP) which has been used for some time – but the novel factor here appears to be the addition of vitamin C.

Doctors take a sample of a patient’s blood and then spin it in a centrifuge to separate out the plasma, which is rich in platelets (cells important for clotting) and proteins called growth factors that help with healing. Importantly the technique also separates out thrombin, a protein which helps activate the platelets and boosts tissue regeneration.

Vitamin C is then added, as it is involved in the production of collagen, which can help rebuild damaged tissue and help with wound closure. The resulting gel is then placed directly onto the wound, which is then dressed with a standard dressing. The whole process can be done at the patient’s bedside. It’s believed that the gel boosts a patient’s own natural repair mechanisms, leading to rapid wound closure.

In an initial trial on patients with wounds that hadn’t responded well to other treatments for nearly a year, 90% saw an improvement. A larger trial is now being conducted to see if these results are replicable.

Consensus on hypoglycaemia

In January the International Hypoglycaemia Study Group published a recommendation that glucose levels lower than 3.0 mmol/l should be recorded in all clinical trials of glucose-lowering diabetes drugs.

Although this might sound a little strange, currently hypoglycaemia is not captured systematically in clinical studies, with the use of different classification systems by various groups leading to difficulties in comparing treatments from different research projects.

This group identified the importance of understanding the hypoglycaemic risk of any diabetes treatments, as hypos can prevent people achieving their glycaemic targets and can harm the individual. If no single cut off point is agreed upon, it is impossible to determine hypoglycaemic risk in a standardized way.

The ADA had previously defined a hypo as any episode of abnormally low glucose that could result in harm to an individual. But they had not agreed a single blood glucose measurement.

The group initially considered glucose levels of less than 3.0 mmol/l and less than 2.8 mmol/l as both these levels have been found to lead to impairments in patients’ awareness of hypos but felt that a level of 3.0 mmol/l was a distinctly low level that generally does not occur under physiological conditions in individuals without diabetes.

The recommendations have been supported by the ADA and the European Association for the Study of Diabetes. The group has also presented their case to the FDA and the EMA and hopes that others in the industry will now agree to adopt the same classification of hypoglycemia to be required in clinical trials.

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