Diabetes developments (research) – 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 news.
This week Simon updates on research.
A Cure In Mice?
Researchers at the UT Health Science Center at San Antonio have managed to reverse Type 1 diabetes in mice by making other cells in the pancreas produce insulin. This is interesting as it is very different from most approaches which are looking at transplanting new islet cells and/or suppressing the immune response.
The researchers used a “gene transfer” technique on the mice, delivered via a virus that activated insulin production in cells already in the pancreas. They described this as not fundamentally changing the cell, but just giving it one additional task to do. Although this has never been used in diabetes before, this technique is quite well established in other disease areas.
Interestingly the mice immune systems did not attack the new insulin-producing cells. But also the cells produced the right amount of insulin to keep blood glucose levels stable. A year after the gene transfer, the mice still have shown no sign of diabetes.
The researchers hope to start human trials in three years, following further larger animal studies and dependent on funding.
For many people diagnosed with T1D, initiation of insulin often leads to a honeymoon period, lasting weeks or months, where there is a partial clinical remission of the condition, allowing the pancreas to make just enough insulin to control blood glucose levels either with no injected insulin or only very small doses.
In children this can cause problems, when a family have just been told that their child has T1D and will need insulin injections for the rest of their lives, and they then find that they are giving minimal injections. But it is also problematic for the 57% of children and adolescents who don’t go through a honeymoon phase and therefore need closer management of their diabetes in the initial stages.
A new tool has been developed by researchers in Massachusetts to help doctors predict which newly diagnosed children with T1D are likely to not have a honeymoon phase. The tool has been shown to be 73% accurate and is based on several measurements including blood bicarbonate and diabetes-associated auto-antibodies to help doctors predict whether the young person is likely to experience the clinical remission.
Those who don’t go through the honeymoon phase often end up needing more insulin in the long run and are more likely to suffer from diabetes-related problems in later life so getting the management right at the earliest stage is really important.
Putting Type 2 diabetes into remission
Recent research has shown that T2D can be put into ‘remission’ following major weight loss interventions, such as bariatric surgery or following a very low calorie diet. But researchers have also been looking at whether very intensive medical interventions can also bring about remission.
A small study looked at people with T2D who had been diagnosed for less than 3 years. These were divided into three study groups: a control group receiving standard care and two study groups, the first following an 8 week intervention and the second following a 16 week intervention. The interventions included a personalized exercise plan and a suggested meal plan, which reduced their daily calorie intake by 500-750 calories a day. They also used metformin, acarbose and basal insulin glargine.
People were regularly followed up to receive medications, to tightly manage their blood glucose levels, and to track their progress for 52 weeks.
After three months of completing the intervention, 11 out of 27 subjects in the 16 week group and 6 out of 28 individuals in the 8 week group met HbA1C criteria for complete or partial diabetes remission versus 4 out of 28 individuals in the control group. 40% of people who achieved remission remained medication free at 3 months.
More research is needed to see whether this remission can be maintained for the longer term but the early results are encouraging and stress the need to overcome patient and HCP inertia and to treat T2D more aggressively