Addressing The Legacy Effect Of Diabetes
Several large clinical trials have demonstrated the importance of tight glucose control for reducing diabetes complications. However, few studies to date have tested this in the real-world, outside of a controlled clinical setting. In a study published this year, Dr. Laiteerapong found that indeed in a real-world setting, people with lower hemoglobin A1C levels after diagnosis had significantly lower vascular complications later on, a phenomenon known as the legacy effect of glucose control. Her research noted the importance of early intervention for the best outcomes, as those with the low A1C levels just one-year after diagnosis had significantly lower vascular disease risk compared to people with higher A1C levels.
With these findings in hand, physicians and policymakers will have more material to debate and determine the best course of action for improving outcomes in people newly diagnosed with diabetes.
Laiteerapong, N., Ham, S. A., Gao, Y., Moffet, H. H., Liu, J. Y., Huang, E. S., & Karter, A. J. . The Legacy Effect in Type 2 Diabetes: Impact of Early Glycemic Control on Future Complications . Diabetes Care, 42, 416426.
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.
Diabetes Breakthrough Increases Insulin Producing Cells
A potential cure for Type 1 diabetes looms on the horizon in San Antonio, and the novel approach would also allow Type 2 diabetics to stop insulin shots.
The discovery, made at UT Health San Antonio, increases the types of pancreatic cells that secrete insulin.
UT Health San Antonio researchers have a goal to reach human clinical trials in three years, but to do so they must first test the strategy in large-animal studies, which will cost an estimated $5 million.
Those studies will precede application to the U.S. Food and Drug Administration for Investigational New Drug approval, Bruno Doiron, Ph.D., a co-inventor, said.
The scientists received a U.S. patent in January, and UT Health San Antonio is spinning out a company to begin commercialization.
The strategy has cured diabetes in mice.
It worked perfectly, Dr. Doiron, assistant professor of medicine at UT Health, said. We cured mice for one year without any side effects. Thats never been seen. But its a mouse model, so caution is needed. We want to bring this to large animals that are closer to humans in physiology of the endocrine system.
Ralph DeFronzo, M.D., professor of medicine and chief of the Division of Diabetes at UT Health, is co-inventor on the patent. He described the therapy:
The pancreas has many other cell types besides beta cells, and our approach is to alter these cells so that they start to secrete insulin, but only in response to glucose , he said. This is basically just like beta cells.
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Giving Patients A Choice
Doctors stress that patients should be supported in making diabetes management a priorityhowever they choose to do soregardless of whether the aim is remission.
The majority of patients dont achieve remission, but the goal is to keep their blood sugar under good control, says Dr. Gwendolyne Jack, endocrinologist and clinician-educator at Weill Cornell Medicine in New York City. To achieve this, she says, some patients will continue to need lifelong medication, including insulin. Thats OK. That is not a failure on their part, Jack says.
But the impact of a diagnosis on patientsand the desire many patients have to control blood sugar without medication or insulinshouldnt be ignored, Taylor and others emphasize. Survey results published in Diabetic Medicine in February 2018 show this is the No. 1 question patients want researchers to answer about the disease: Can Type 2 diabetes be cured or reversed, what is the best way to achieve this, and is there a point beyond which the condition cant be reversed?
Taylor acknowledges that many people with the chronic condition see it as something the doctor will deal with patients often get help with controlling blood sugar, but their goal isnt remission. However, at least 40% of people with Type 2 diabetes hate their condition and would go to lengths to get rid of it, he says. They describe the moment of diagnosis as a hammer blow. Many doctors do not understand that.
Toward A Less Burdensome Injectable
The two new trials assessed the safety and efficacy of a modified version of insulin called insulin icodec.
This has a long half-life, roughly 196 hours, making it ideal as a once-a-week treatment. Half-life refers to the time that it takes the body to metabolize and excrete half of the original dose of a medication.
Both of the studies were phase 2 trials . These can include 100300 participants with the same health-related issue who receive doses and use or undergo treatment methods shown to be safe in earlier phase 1 studies.
In both of the new trials, every participant was also taking an oral glucose-reducing medication that was not insulin, such as metformin. The studies were then randomized, which means that the participants were randomly assigned to get further doses and medications.
Both were also open-label trials , which means that the researchers and participants knew what treatments they were using.
Each study was conducted slightly differently and included varying numbers of participants with type 2 diabetes who were from different countries.
One study included 205 participants, from the U.S., Germany, Hungary, Poland, Spain, Croatia, and Slovakia, who were not currently using insulin.
The other study included 154 participants, from the U.S., Canada, Czechia, Italy, and Germany, who already use insulin. The researchers followed them for 23 weeks to assess how best to transition from daily to weekly insulin injections.
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Scientific Hurdles When Researching A Cure For T2d
- Rodents do not replicate human T2D in the lab
- Detailed studies of humans are extremely difficult or impossible
- Activating beige fat cells in humans may alleviate diabetes, but they’re very difficult to isolate and study in humans
- T2D is a multi-organ disease affecting both insulin secretion by beta cells in the pancreas, and insulin signaling to its target tissues of liver, muscle and body fat. This makes it extremely difficult to determine the cause of the disease.
Treatment For Type 2 Diabetes
There’s no cure for type 2 diabetes, but patients may be able to manage their condition by eating healthy, staying active through regular exercise, and maintaining a normal weight. But sometimes this just isn’t enough.
Medication treatment for type 2 diabetes often begins with oral metformin, a drug that is the backbone of oral diabetes treatment regimens. From there, different drug classes may be added to metformin, and for some patients, the use of injectable insulin may be necessary.
- Insulin is a hormone the body needs to utilize the glucose from food to provide energy for the body.
- In type 1 diabetes, the pancreas makes no insulin and it must be replaced. In type 2 diabetes, either the pancreas either doesn’t make enough insulin, there is resistance to the effects of insulin, or both.
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Basal Insulin Analogs With Glucagon
The combination of GLP1 mimetics with basal insulin reduced the risk of hypoglycaemia and weight gain induced for intensive insulin regimens in T2DM patients. Preliminary evidence suggests that the addition of a basal insulin to a GLP1 mimetic with or without oral therapy, provide improvements in basal and postprandial glucose control, with less weight gain, reduced risk of hypoglycaemia and increased satisfaction. Data from the DUAL I extension and DUAL II randomized trials, the novel fixed combination of insulin degludec and liraglutide , effectively lowered HbA1c across a range of measures, implying suitability for patients with either early or advanced T2DM. LixiLan is a new once-daily single injection fixed-ratio combination of lixisenatide, and insulin glargine. Results from the Lixilan-L trial, showed that LixiLan successfully met the primary study endpoint of demonstrating a statistically superior reduction in HbA1c compared with insulin glargine.
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.
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The Issues With Blood Sugar Levels
In diabetes, an A1C level refers to a persons blood sugar level.
An A1C test measures the average blood sugar level over a 3-month period. The higher the A1C level, the higher the risk of complications from diabetes.
Poor glycemic control increases the risk of diabetes complications such as retinopathy, nephropathy, neuropathy, and cardiovascular disease, Gabbay said. American Diabetes Association recommends an A1C goal of less than 7 percent.
In people with type 2 diabetes and overweight or obesity, modest weight loss improves glycemic control and reduces the need for glucose-lowering medications, and more intensive dietary restriction can substantially reduce A1C and fasting glucose and promote sustained remission of the disease, he said.
However, many people with type 2 diabetes find it challenging to reach their A1C goals through diet and exercise alone. This is where tirzepatide might be helpful.
In the clinical trials, researchers reported that a significant number of participants prescribed tirzepatide achieved an A1C of less than 7 percent.
With the highest dose, they were seeing an average 2.0 lowering of the A1C, which is just incredible when theyre starting with an A1C of 8 percent. We dont see that with any other agents that we have right now, Dr. Laurie A. Kane, an endocrinologist at Providence Saint Johns Health Center in Santa Monica, California, told Healthline.
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.
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Is There A Cure For Type 1 Diabetes
One of the first things people ask when theyve been diagnosed with type 1 diabetes is: is there a cure? The truth is, while type 1 diabetes can be managed with insulin, diet and exercise, there is currently no cure. However, researchers with the Diabetes Research Institute are now working on treatments to reverse the disease, so that people with type 1 diabetes can live healthy lives without medication.
In Clinical Trials Treatment Proved More Effective Than Other Therapies Evaluated
- For Immediate Release:
- May 13, 2022
Today, the U.S. Food and Drug Administration approved Mounjaro injection to improve blood sugar control in adults with type 2 diabetes, as an addition to diet and exercise. Mounjaro was effective at improving blood sugar and was more effective than the other diabetes therapies with which it was compared in clinical studies.
Given the challenges many patients experience in achieving their target blood sugar goals, todays approval of Mounjaro is an important advance in the treatment of type 2 diabetes, said Patrick Archdeacon, M.D., associate director of the Division of Diabetes, Lipid Disorders, and Obesity in the FDAs Center for Drug Evaluation and Research.
Type 2 diabetes, the most common form of diabetes, is a chronic and progressive condition in which the body does not make or use insulin normally, leading to high levels of glucose in the blood. More than 30 million Americans have type 2 diabetes. Despite the availability of many medications to treat diabetes, many patients do not achieve the recommended blood sugar goals.
Glucagon-like peptide-1 and glucose-dependent insulinotropic polypeptide are hormones involved in blood sugar control. Mounjaro is a first-in-class medicine that activates both the GLP-1 and GIP receptors, which leads to improved blood sugar control. Mounjaro is administered by injection under the skin once weekly, with the dose adjusted as tolerated to meet blood sugar goals.
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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.
And Thats Just For Type 1
For type 2 diabetes, researchers have found evidence that beta cells do not burn out and die as previously thought, but instead revert to more primitive cells or ones with altered function, leading some scientists to believe that if they can prevent this dedifferentiation or somehow push dedifferentiated cells to turn back into beta cells, they could prevent or cure type 2.
Findings like these represent a shift in our thinking, says Richard J. Santen, MD, president of the Endocrine Society and professor of medicine, endocrinology, and metabolism at the University of Virginia School of Medicine in Charlottesville. We are learning much more about the biology of diabetes, and it is beginning to pay major dividends. As time goes on, our increased understanding will play a key role in altering the course of the disease.
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Three Key Factors In Dental Diseases That Help Us Understand Type 2 Diabetes
The mouth-body connection gives some more perspective on how to influence type 2 diabetes. These include vitamin D, sleep, and the gut microbiome.
First, the health of your gut is critical to your overall health. This is because your gut is home of trillions of microbes called the gut microbiome. These microbes work in symbiotic and antagonistic relationships within your body. A 2017 study using multiple therapies to manipulate the gut microbiome composition, found they could impact the individuals health more rapidly. This study also found manipulating the gut microbiome as an effective way to avoid insulin resistance and therefore prevent diabetes.
The plot thickens.
Through choosing which microbes to favor through diet, probiotics, and more it appears possible support glycemic control and improves treatments for people who are diabetic.
Second, researchers have found vitamin D plays a functional role in maintaining glucose tolerance through improving insulin sensitivity and modulating secretion. One study found vitamin D supplementation may reduce insulin resistance.
I believe vitamin D has health roles all over the body, I wrote a four-part series on it. Make sure youre getting enough sunshine or supplementing.