November 2019 - Diabetes Research Connection

Diabetes Research News
November 26, 2019

Islet Transplantation May Have Long-Term Benefits for Type 1 Diabetes.

Islet transplantation is not a new concept, but it is one that scientists are continually trying to refine and improve. A major challenge with this procedure is rejection or destruction of the transplanted cells. However, researchers followed up with a group of 28 patients who had undergone islet transplantation and found that 10 years later, there were still lasting benefits.

A recent study looked on how patients fared a decade after receiving transplants. Fourteen of the patients received only an islet transplant, while the other 14 had a kidney graft in addition to the islet transplant. Regardless of procedure, researchers found that “28% remained completely independent of exogenous insulin” after 10 years, a slight decrease from the 39% who were independent of insulin use after five years. However, even those participants who did return to needing insulin had improved glycemic control and a lower exogenous insulin requirement than prior to transplantation. In addition, they had fewer severe hypoglycemic events.

A major factor in the effectiveness of the transplant was graft function. Those individuals who had optimal graft function maintained insulin independence longer than those who had poorer graft function. Immunosuppression was used to help support graft survival, but there were some serious adverse events as a result. In the 28 participants, there were eight instances of infections or skin carcinomas and 11 diabetes-related events that were cardiovascular.

Five participants experienced symptomatic cardiovascular events and six experienced asymptomatic myocardial ischemia. One person died of a stroke. However, researchers report that “mortality rate in patients similar to those in the current study but who did not undergo islet transplantation is three to four times higher with causes of death largely being severe hypoglycemia or ischemic heart disease.”

It is encouraging to see that a decade after islet transplantation, participants are still experiencing positive outcomes in regarding to diabetes management, with some maintaining insulin independence. As researchers continue to learn more and are able to refine and improve islet transplantation, more patients may benefit long-term from this treatment option and potentially achieve insulin independence.

Diabetes Research Connection (DRC) stays abreast of the latest findings in the field and provides critical funding for early career scientists to pursue research related to type 1 diabetes. It is through this work that improved treatments become available and scientists enhance their understanding of the disease. Learn more about these efforts and how to support existing projects by visiting https://diabetesresearchconnection.org.

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Diabetes Research News
November 18, 2019

Could Closed-Loop Systems Improve Blood Glucose Management?

One of the latest technologies being tested for managing type 1 diabetes is a closed-loop system. This system uses a continuous glucose monitor (CGM) to measure blood glucose levels. When blood sugar begins to rise outside of the target range, it sends information to an insulin pump to automatically administer insulin. When blood sugar begins to fall, insulin is not administered. It is a closed loop because the patient is not deciding when to inject insulin or how much, but rather the system does so automatically.

A recent study involving 168 individuals with type 1 diabetes between the ages of 14 and 71 were part of a six-month trial using a closed-loop system. One hundred and twelve people were randomly assigned to the closed-loop group while the remaining 56 people used a sensor-augmented pump and were considered the control group. All 168 participants completed the trial. There were no incidences of hypoglycemia and only one incidence of diabetic ketoacidosis, which occurred in the closed-loop group.

The results showed that the closed-loop group remained in the target range for glucose levels (70-180 mg/dL) a greater percentage of time than those in the control group. On average, their time in the target range increased from 61% to 71%, while the control group remained around 59%. In addition, the closed-loop group spent less time with glucose levels above 180 mg/dL or below 70 mg/dL. Throughout the duration of the six-month trial, participants in the closed loop group remained in closed-loop mode (with the system automatically managing glucose monitoring and insulin administration) a median of 90% of the time.

While the closed-loop system is not perfect, these findings show that it improved time spent in the target glucose range, which is desirable in diabetes management. It also reduces the manual tracking and input from individuals with type 1 diabetes in managing the disease. While more research and testing are needed, it is a step in the right direction toward developing what many refer to as an “artificial pancreas.”

Diabetes Research Connection (DRC) is interested to see how this system will continue to advance and improve diabetes management in the future and continues to follow its progress. These types of devices play an integral role in supporting individuals with T1D and helping them to maintain more normal blood glucose levels. The DRC supports early career scientists in pursing novel research studies geared toward improving understanding, diagnosis, and treatment of T1D with the goal of one day finding a cure. Learn more about these efforts and how to help by visiting http://diabetesresearchconnection.org.

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DRC & Research News
November 9, 2019

Arielle Schube World Diabetes Story

My story began during the summer of 2016, the summer before my freshman year of high school. In July, I went to camp for three weeks in San Bernardino, California. The first week of camp I went on a four-day hiking trip to Sedona, Arizona in 100-degree weather. During the hiking trip, I felt a slight cold coming on, I assumed it was from heat and physical exhaustion. When I returned to camp after the hiking trip, I found myself in my own personal hell. At night, I lay on the cold, bathroom floor tile because my body was too hot for my bed and I was too weak to climb down from the top bunk every time I felt the urge to throw up. I could not take it anymore. I dragged myself to the nurse’s office and begged the nurse to take me to a hospital. After hours of convincing the camp nurse that something serious was happening to me, she finally agreed to take me down the mountain to the local hospital.

Not only was I screaming and moaning the entire drive down because the pain endured, but I was also experiencing small blackouts. By the time all the blood tests were completed, I was barely conscious. Soon, a doctor approached me and said, “You have type 1 diabetes.” I looked at him, then my counselor, and then the doctor again. I almost wanted to laugh and say, “What? This is a joke, this isn’t happening, right?” Then I looked at my counselor and said, “Where are my parents?”

The only memory I have after the doctor gave me the devastating news is lying in a helicopter with paramedics on either side of me. I spent the next five days in the hospital, the first two days in the ICU. When I was diagnosed, I was in a diabetic coma. I had Diabetic Ketoacidosis (DKA), a serious life-threatening complication of diabetes where the body produces excess ketones and if left untreated, can be fatal. My blood sugar was over 800 mg/dL and my blood tests showed that I’d been living with type 1 diabetes (T1D) for three months prior to my diagnosis. At the age of 13 years old I advocated for myself, for my life and for my future. If I did not have the will to fight, it is very likely that I would not be here today. My near-death experience has changed my life and will continue to shape my daily actions, thoughts and feelings. My desire to live life to the fullest and courage to speak publicly about my disease is what motivates me every day to push through the difficult days living with T1D.

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DRC & Research News
November 9, 2019

The Story of a Combat Veteran Making a Difference in the T1D Community – Naithen Schirmer

Today is a day we honor all veterans and give thanks for their sacrifice. As a combat veteran, I know firsthand the sacrifices made daily by those who serve or have served. When I was a young boy, I would sit around and listen to the men in my family share their stories about their time in the military and knew that I would follow in their footsteps one day.

In 2009, I joined the Army and soon after was deployed to Iraq with the 2nd Brigade Combat Team, 1^st Infantry Division. While in Iraq, I advised and assisted in training the U.S. military personnel as well as the Iraqi Army and Iraqi Special Forces in night vision special electronics, thermal imagery and tactical satellite communications.

I’ll never forget a conversation I had with a local Iraqi towards the end of my time there. I was at Camp Liberty in Baghdad and the U.S. was shutting down the base and handing everything over to the Iraqi’s. During my time in Iraq, I did not interact much with the local civilians, but since we were transitioning this base over, I was able to. After connecting with one man in particular, I realized that we had the same goals. Even though we came from different cultures and were very different from each other, we both wanted the same things; love, to do right by our family and keep them happy, healthy and safe. Finding a connection like this in the middle of a war zone was rare and something I will always remember.

After four years of service with the storied 1^st Infantry Division, aka the Big Red One, I was medically retired and pursued a Bachelor of Science degree in Marketing from Point Loma Nazarene University. My heart for service did not end with the military. After graduating with my degree, I began a career in the nonprofit sector. Several of my family members have diabetes so I know how devastating the disease is. Working with the Diabetes Research Connection (DRC) as the Administrative Assistant is incredibly rewarding because I have an opportunity to be a part of a community working hard to find a cure. The early-career scientists I have the pleasure of working with at DRC have innovative research ideas and it gives me hope that their scientific breakthrough may be what leads to a cure for my family members and all those affected by type 1 diabetes.

Being involved in the community is important to me so I also volunteer my time at the Veterans of Foreign War as a Junior Vice Commander, a mentor to children of military personnel who have either died in combat or due to PTSD-related suicide while serving on active duty at a local nonprofit called Active Valor, and as the Podcast Creator and Director for Triple B Adventures.

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Diabetes Research News
November 4, 2019

Improved Transplantation of Islet Organoids May Support Type 1 Diabetes Treatment

One approach to treating type 1 diabetes is transplanting insulin-producing beta cells into the body, or cells that can develop to perform this function. However, there are still many challenges in getting the body to accept these cells without extensive immunosuppression. Even still, the cells often have a limited survival rate.

In a recent study, scientists examined the potential of creating insulin-producing organoids to regulate blood sugar and treat type 1 diabetes. They combined dissociated islet cells (ICs) with human amniotic epithelial cells (hAECs) to form islet organoids, or mini pancreas-like organs. These organoids, which can contain multiple types of cells and cell functions, were transplanted into the portal vein because the area is easily accessible and has a low morbidity rate.

In similar approaches, researchers have been faced with cell death due to poor revascularization of the transplanted cells as well as inflammation. However, in this study, they found that by introducing hAECs, they were able to curb some of these effects. hAECs not only secrete proangiogenic growth factors, but anti-inflammatory growth factors as well including insulin-like growth factors and associated binding proteins. Furthermore, they produce high levels of hyaluronic acid which suppresses tumor growth factor β and stimulates VEGF-A production which supports improved revascularization. They also found that hAECs improved protection of IC-hAEC organoids against hypoxic stress thereby reducing risk of cell death.

Results showed that 96% of diabetic mice who received IC-hAEC organoid transplants achieved normoglycemia within one month. The median rate for this process to occur was 5.1 days. In addition, at one-month post-transplant, the mice showed similar glucose clearance as non-diabetic mice.

While this study has only been performed on mouse models so far, the goal is to achieve similar results in human trials. Additional research and testing are needed to determine if the process is translatable. This approach has the potential to improve management of type 1 diabetes and could lead to a possible cure for the disease if results are sustainable in the long-term.

Though not involved in this study, Diabetes Research Connection (DRC) supports advancements in type 1 diabetes research and treatment by providing critical funding to early career scientists. It is these types of studies that assist in transforming the future of diabetes care. Click to learn more about current projects and provide support.

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