From stem cells to smart tech, final thoughts from the EASD – by Emily Burns

Emily BurnsAs Lisbon recovers from the 15,000 scientists and healthcare professionals descending onto its streets for the EASD, you might have caught our updates on science that made the headlines and the talk of the town: genetics.

So for the final EASD installment, I’m bringing you some of my personal highlights…

Is it still all about the beta cells?

Producing functioning beta cells in the lab is always a hot topic. This means taking stem cells (special cells that have the ability to turn into lots of different types of cell, like a heart cell or a muscle cell) and giving them a cocktail of chemicals that turns them into insulin-producing beta cells.

And why might we want to do that? Firstly, islet transplants as they are (where islets are collected from a donated pancreas and transplanted into a person with Type 1 diabetes) are quite inefficient. Often more than one pancreas is needed for a single transplant, lots of the cells die in ‘transit’ and then the transplants need to be repeated down the line.

If we were able to produce cells in the lab, creating an unlimited supply of beta cells at our fingertips, islet transplants could become beneficial for many more people.

Real beta cells

Professor Jim Johnson, who recently became head of the Novo Nordisk Research Centre in Oxford, gave an honest review of where we are. He warned that while lots of progress has been made, with scientists around the world now able to make ‘insulin-producing cells’ (although maybe not exactly beta cells), there’s a way to go before stem cell therapy for Type 1 diabetes becomes a reality.

While we’re getting closer to producing beta cells, tests comparing the ‘lab-grown’ cells to real beta cells show that they’re nowhere near as good.

He recommended that scientists start to collaborate more openly, sharing what works and what doesn’t, so that the field can progress at a faster pace. In genetic research, scientists pool their data to learn more from it – should beta cell scientists be doing the same? He also called for more consistency in how the cells are created and tested, and just more knowledge in general about the beta cell itself.

Prof Johnson thinks we’re in “the golden age of human islet biology”, but there’s a huge leap between cells looking good in the lab and something you’d actually consider using as a treatment in people. As a spectator in the field, he thinks the community is climbing a mountain. We’re gaining altitude, but to make the summit, we’ve got some work ahead.

Redefining hypos

A team of researchers, including Professor Stephanie Amiel, proposed that we need a fresh look at hypoglycaemia (dangerously low blood glucose levels).

We currently have a level of glucose in the blood (called 3.9mmol/l) that is considered the ‘threshold’ for hypoglycaemia, but there are some issues with this. 3.9 is not that low. Lots of people don’t have any noticeable hypo symptoms at this stage, but that doesn’t mean they can’t sense hypos. There also hasn’t been that much analysis on the cost effectiveness or impact on quality of life of using that particular level.

Then there’s severe hypoglycaemia, currently defined as a hypo that requires help from someone else. This (thankfully) rarely happens in clinical trials, which means it’s difficult to assess the impact that new drugs have on severe hypos.

Because of this, the group are proposing to introduce a definition for a third level of hypo, to capture something in between. They want to find the blood glucose level that, below this point, seriously affects health. The level at which the brain, cardiovascular and blood systems are affected; at which the risk of death begins to rise; and the level that impacts on mental health. But what should the number be?

Research suggests that this sort of damage begins to take effect at around 3mmol/l. The team are proposing that we use three definitions for hypos:

  • Level 1: 3.9mmol/l or less (a hypoglycaemia alert)
  • Level 2: Less than 3mmol/l (serious and important hypoglycaemia)
  • Level 3: Serious hypoglycaemia requiring external assistance (even if none was available)

Getting smart with technology

With millions of apps available on your phone, everything from hiring a car to getting a recipe for the best ever guacamole has been made easier. So what about managing your diabetes? Dr Pratik Choudhary argued that many people are already taking advantage of ‘smart technology’ to help them with their condition.

Smart technologies can help us develop habits that make our lives easier – or healthier. For the general population, that could include managing diet or activity levels. For someone with diabetes, it might include monitoring blood glucose levels, counting carbs or calculating insulin doses. And to do these better, apps could be used to find patterns in your diabetes management or connect you with a healthcare professional.

There are several apps already out there, like One Drop, mySugr or Accu-Chek. But we need to keep an eye on the impact they genuinely have on health. How do we sift out apps based on high quality evidence? Is it easy to identify those you can believe in and those you can’t?

New ideas around technology could transform healthcare, but it’s important that regulatory bodies (organisations that review treatments and devices to check they’re effective and safe for people to use) keep up.

What might lie ahead when it comes to diabetes and technology? We could be moving toward an era where we can get intelligent advice to help us manage our lifestyles and conditions, with the ability to see into our future health. While Dr Choudhary acknowledged we’ve got a few barriers ahead, sounds like exciting stuff.

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