Automated Treatment With An Artificial Pancreas
For people that have already lost their insulin-producing cells, a shorter-term solution could be the artificial pancreas a fully automated system that can measure glucose levels and inject the right amount of insulin into the bloodstream, just like a healthy pancreas would.
Type 1 diabetes is very different from your standard disease. Insulin requirements vary greatly from one day to another and there is no way patients can know what they need, saidRoman Hovorka, Professor at the University of Cambridge.
His research group is working on the development of an algorithm that can accurately predict insulin requirements for a specific patient in real-time, which can be used to control insulin delivery via an insulin pump.
Replacing humans with computers could help patients better control their sugar levels and suffer fewer complications in the long term. However, in order to fully automate insulin therapy, there are several challenges yet to be addressed. First of all, faster forms of insulin are needed to react quickly enough to changes in sugar blood. In addition, current algorithms need to significantly improve to be able to make accurate predictions.
Using Incentives To Stimulate Behavior Changes In Youth At Risk For Developing Diabetes
Once referred to as adult-onset diabetes, incidence of type 2 diabetes is now rapidly increasing in Americas youth. Unfortunately, children often do not have the ability to understand how everyday choices impact their health. Could there be a way to change a childs eating behaviors? Davene Wright, PhD, of Seattle Childrens Hospital was granted an Innovative Clinical or Translational Science award to determine whether using incentives, directed by parents, can improve behaviors related to diabetes risk. A study published this year in Preventive Medicine Reports outlined what incentives were most desirable and feasible to implement. A key finding was that incentives should be tied to behavior changes and not to changes in body-weight.
With this information in hand, Dr. Wright now wants to see if incentives do indeed change a childs eating habits and risk for developing type 2 diabetes. She is also planning to test whether an incentive program can improve behavior related to diabetes management in youth with type 1 diabetes. Jacob-Files, E., Powell, J., & Wright, D. R. . Exploring parent attitudes around using incentives to promote engagement in family-based weight management programs. Preventive Medicine Reports, 10, 278284.
Replacing Missing Cells With Cell Therapy
Although still in the very early stages of development, cell therapy is one of the biggest hopes towards developing a cure for diabetes, especially for type 1 diabetes. Replacing the missing insulin-producing cells could potentially recover normal insulin production and cure patients.
However, early attempts to transplant pancreatic cells have largely failed, mostly due to immune reactions that reject and destroy the implanted cells. The lack of donors is also a limitation.
One of the most advanced alternatives comes from the Diabetes Research Institute in the US, which is developing a bioengineered mini-organ where insulin-producing cells are encapsulated within a protective barrier. This mini-pancreas is then implanted into the omentum, a part of the abdominal lining. A phase I/II trial is ongoing, but the DRI announced its first successful results in 2016, revealing that the first patient in Europe treated with this approach no longer requires insulin therapy.
This can be the beginning of a new era in islet transplantation. Our ultimate goal is to prevent the need for lifelong anti-rejection therapy, stated Camillo Ricordi, Director of the DRI.
A similar device is being developed by the US company ViaCyte, in collaboration with the nonprofit organization JDRF. A phase I/II trial is ongoing and has already proved the device is safe. The company is now working on improving the engraftment of insulin-producing cells.
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Researcher Identifies Potential Underlying Cause Of Type 1 Diabetes
Type 1 diabetes occurs when the immune system mistakenly recognizes insulin-producing beta-cells as foreign and attacks them. The result is insulin deficiency due to the destruction of the beta-cells. Thankfully, this previously life-threatening condition can be managed through glucose monitoring and insulin administration. Still, therapies designed to address the underlying immunological cause of type 1 diabetes remain unavailable.
Conventional approaches have focused on suppressing the immune system, which has serious side effects and has been mostly unsuccessful. The American Diabetes Association recently awarded a grant to Dr. Kenneth Brayman, who proposed to take a different approach. What if instead of suppressing the whole immune system, we boost regulatory aspects that already exist in the system, thereby reigning in inappropriate immune cell activation and preventing beta-cell destruction? His idea focused on a molecule called immunoglobulin M , which is responsible for limiting inflammation and regulating immune cell development.
The scientists tweaked the original experiment by isolating IgM from mice prone to developing type 1 diabetes, but before it actually occurred. When mice with newly onset diabetes were supplemented with this IgM, their diabetes wasnot reversed. This finding suggests that in type 1 diabetes, IgM loses its capacity to serve as a regulator of immune cells, which may be contribute to the underlying cause of the disease.
Breakthrough In Battle Against Type 2 Diabetes
Experts from the University of Stirling have made a breakthrough in understanding how people respond to lifestyle treatment for preventing Type 2 diabetes.
The team, including academics from the Faculty of Health Sciences and Sport, discovered a new genomic signature in people whose Type 2 diabetes status improves following a treatment intervention. Significantly, it is the first reliable signature for insulin sensitivity in human muscle.
Scientists believe that the findingspublished in leading journal Nucleic Acids Research – will inform future research by helping understand why not all people are able to eliminate the risk of the condition by changing their lifestyle.
Dr. Iain J Gallagher, of the University of Stirling, one of the research team, said: “Our hypothesis was that, with sufficient numbers of well characterised subjects and our new analysis methods, we could reveal a robust signature for what is known as ‘insulin resistance’ – an important precursor for developing Type 2 diabetes.
“Importantly, because we could also examine how the activation status of each ‘insulin resistance’ gene responded to treatment, we have also discovered a potential explanation for why not all people eliminate their Type 2 diabetes risk by following a lifestyle and exercise training programme.”
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New Method Of Pancreatic Islet Cryopreservation Marks Breakthrough For Diabetes Cure
- University of Minnesota
- Engineering and medical researchers have developed a new process for successfully storing specialized pancreatic islet cells at very low temperatures and rewarming them, enabling the potential for on-demand islet transplantation. The breakthrough discovery in cryopreservation is a major step forward in a cure for diabetes.
Engineering and medical researchers at the University of Minnesota Twin Cities and Mayo Clinic have developed a new process for successfully storing specialized pancreatic islet cells at very low temperatures and rewarming them, enabling the potential for on-demand islet transplantation. The breakthrough discovery in cryopreservation is a major step forward in a cure for diabetes.
According to the Centers for Disease Control and Prevention, diabetes is the seventh leading cause of death in the United States, accounting for nearly 90,000 deaths each year. While diabetes management has improved greatly over the 100 years since the discovery of insulin, even the most modern methods remain a treatment for the condition rather than a cure.
One strategy for overcoming the donor supply problem is to pool islets from multiple donors, achieving high islet dosage with a single infusion. This process is limited by the inability to safely store islets for long periods of time. Previous research has shown storage to be limited to 48 to 72 hours before transplantation.
The study found:
Are You At Risk For Type 2 Diabetes
Diabetes and prediabetes are two of the top pressing health issues in the nation. Recent estimates from the American Diabetes Association state that about 1.5 million Americans are diagnosed with diabetes every year.
Prediabetes occurs when the blood sugar levels are higher than normal but not yet high enough to be classified as type 2 diabetes. Weight loss and increased exercise can help prevent a type 2 diabetes diagnosis.
Even more concerning is the number of Americans who are at risk for these conditions: it was reported by the ADA that of the 34.2 million adults with diabetes, 26.8 million were diagnosed, and 7.3 million were undiagnosed.
Diabetes remains the 7th leading cause of death in the U.S.
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Stopping The Immune Attack
To stop Type 1 diabetes we need to disrupt the immune systems attack on beta cells. And our scientists are working on it. Theyre aiming to develop and test treatments called immunotherapies that target the immune system to stop it destroying beta cells.
This means in the future we could stop people from ever developing Type 1 diabetes.
In people who are at high risk of getting Type 1 diabetes, immunotherapies tested in trials have been able to delay the onset of the condition for a few months. Scientists are now exploring whether giving treatments earlier on, in younger children, could have better success at preventing Type 1 entirely.
Immunotherapies also have potential to help people newly diagnosed with Type 1 diabetes. Researchers hope to be able to slow down or halt the immune attack to protect surviving beta cells. And it seems they might be able to, at least in the short-term. Treatments that have been tested so far can preserve the amount of insulin people make and improve their blood glucose control. But the protective effects appear to dwindle over time.
Work is now being done to look at how we can combine immunotherapies to target different parts of the immune system, and have a greater impact. Find out more about how immunotherapies work and our research in this area.
A New Way To Prevent Immune Cells From Attacking Insulin
Replacing insulin-producing beta-cells that have been lost in people with type 1 diabetes is a promising strategy to restore control of glucose levels. However, because the autoimmune disease is a continuous process, replacing beta-cells results in another immune attack if immunosorbent drugs are not used, which carry significant side-effects. This year, Dr. Song reported on the potential of an immunotherapy he developed that prevents immune cells from attacking beta-cells and reduces inflammatory processes. This immunotherapy offers several potential benefits, including eliminating the need for immunosuppression, long-lasting effects, and the ability to customize the treatment to each patient.
The ability to suppress autoimmunity has implications for both prevention of type 1 diabetes and improving success rates of islet transplantation.
Haque, M., Lei, F., Xiong, X., Das, J. K., Ren, X., Fang, D., Salek-Ardakani, S., Yang, J.-M., & Song, J. . Stem cell-derived tissue-associated regulatory T cells suppress the activity of pathogenic cells in autoimmune diabetes. JCI Insight, 4.
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Whats Next In Diabetes Treatment
The global diabetes drugs market is expected to reach a massive 68B by 2026, and we can expect all sorts of revolutionary technologies to come forward and claim their market share.
Researchers are already speculating about microchips that can diagnose diabetes type 1 before the symptoms appear, nanorobots traveling in the bloodstream while they measure glucose and deliver insulin, or silica particles that can slow down the digestion of food to prevent diabetes and obesity.
Whatever the future brings, it will undoubtedly make a huge difference in the lives of millions of people worldwide.
This article was originally published in November 2016 and has since been updated to reflect the latest developments in diabetes treatment.
Images via DRI Biohub MaSTherCell
Basic Research Pointed To The Pancreas
Diabetes had been known since antiquity. The first symptoms were often a prodigious thirst and urination. Within weeks the patient would be losing weight. Within months, the patient would enter a coma, then die. For centuries, no one had any clue about what caused diabetes.
People had, though, been aware of the pancreas for centuries. The Greek anatomist Herophilos first described it around 300 B.C. Based on its anatomical location, people suspected it was involved in the digestive system. But no one knew whether the pancreas was an essential organ, like the stomach, or extraneous, like the appendix.
In 1889, Oskar Minkowski, a pathologist at the University of Strassburg, in what was then Germany, was one of the most talented surgeons of his time. As part of a study, he performed a surgical feat that was thought to be impossible: keeping an animal alive after totally removing its pancreas.
The dog he operated on survived the surgery, but to Minkowskis surprise, it began exhibiting all the symptoms of diabetes. Minkowski had discovered that removing the pancreas caused diabetes. Today, this is known as an animal model of the disease. Once an animal model of a disease is established, researchers can experiment with different cures in the animal in hopes theyll find something that will then work in people.
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The Future Of Type I Diabetes
There is strong evidence that type 1 diabetes happens when an individual with a certain combination of genes comes into contact with a particular environmental influence. Past research has identified some good candidate genes, and raised suspicion on others. However, we know less about the nature of the particular changes in the involved genes, and how, as a result, their function may be different.
Treatment Of Diabetic Neuropathy
In case that a patient is suffering from neuropathy caused by diabetes, nerves can become damaged and cause pain and some much more serious conditions such as sepsis. Also, neuropathy can hurt the brain and spinal cord. While it is very hard to treat this condition, there are some improvements related to a new method of therapy where molecules are used to prevent neuropathy, especially the type that is affecting the brain.
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A New Target To Improve Insulin Sensitivity
The hormone insulin normally acts like a key, traveling through the blood and opening the cellular lock to enable the entry of glucose into muscle and fat cells. However, in people with type 2 diabetes, the lock on the cellular door has, in effect, been changed, meaning insulin isnt as effective. This phenomenon is called insulin resistance. Scientists have long sought to understand what causes insulin resistance and develop therapies to enable insulin to work correctly again. This year, Dr. Summers determined an essential role for a molecule called ceramides as a driver of insulin resistance in mice. He also presented a new therapeutic strategy for lowering ceramides and reversing insulin resistance. His findings were published in one of the most prestigious scientific journals, Science.
Soon, Dr. Summers and his team will attempt to validate these findings in humans, with the ultimate goal of developing a new medication to help improve outcomes in people with diabetes.
Chaurasia, B., Tippetts, T. S., Mayoral Monibas, R., Liu, J., Li, Y., Wang, L., Wilkerson, J. L., Sweeney, C. R., Pereira, R. F., Sumida, D. H., Maschek, J. A., Cox, J. E., Kaddai, V., Lancaster, G. I., Siddique, M. M., Poss, A., Pearson, M., Satapati, S., Zhou, H., Summers, S.A. . Targeting a ceramide double bond improves insulin resistance and hepatic steatosis. Science , 365, 386392.
How Might Treatment Evolve
The current standard of care for T2DM consists of screening for elevated HbA1c levels or, in some cases, fasting plasma glucose, with diagnosis followed by management with lifestyle modifications and metformin except where contraindicated . For patients who do not achieve HbA1c targets, antidiabetes medications are added to metformin subsequently, patients are monitored and further oral antidiabetes drugs or insulin are added if needed.
Clearly, the care of patients with T2DM is currently suboptimal, largely because our healthcare system has traditionally been based on an acute-care model. In contrast, chronic disease management emphasizes a team approach, medication management and patient adherence, prevention of complications, lifestyle modifications as well as coordination of care among subspecialists. Guidelines for the prevention of T2DM emphasize moving beyond the healthcare system towards integration with other areas, such as government and the media . There is already evidence that intervention at the public health level could significantly impact rates of T2DM . In the future, coordination of care using case managers, technology that helps patients between medical visits, such as mobile health and telemedicine, and restructuring care using patient-centered medical homes and accountable care organizations may be better suited for T2DM management .
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Several Very Very Promising Biomedical Trials Suggest That A Full Cure For Diabetes Is In Sight 100 Years After Frederick Banting And Charles Best Announced The Discovery Of Insulin
Lisa Hepner still remembers the shock of being diagnosed with Type 1 diabetes as a 21-year-old student. She thought she was just tired from too much partying.
But her pancreas had stopped making the insulin needed to break down sugar, doctors said. It could shorten her life and cause a raft of complications: blindness, stroke, kidney disease and even amputation.
The University of Toronto English major learned how to check her blood sugar and inject insulin to stay alive, and left the hospital feeling optimistic.
They said a cure was five years away. That was 30 years ago.
Lisa and I were 20-something roommates enjoying Toronto in the years following her diagnosis. We didnt think a condition that affects more than 300,000 Canadians could slow her down, but it almost killed her.
There were bouts of hypoglycemia, which left her confused and shaking from too much insulin. There was an ICU stay for diabetic ketoacidosis from too little insulin.
Still, Lisa stayed confident and began filming a documentary about finding a cure for diabetes. Shes still waiting. And now, a century later, so is the world.
Hope for a cure was front-page news 100 years ago this week when the Star reported that two U of T scientists, Frederick Banting and Charles Best, had announced the discovery of insulin. The story ran under a banner headline: Toronto Doctors on Track of Diabetes Cure Diabetes Sufferers Given Message of Hope.
Researchers also need money.