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Helping Drive Technology Advancements

Diabetes Patients Are Helping Drive Technology Advancements

Managing type 1 diabetes is an around-the-clock job. Patients must always be aware of what their blood sugar level is, whether it is trending up or down, whether or not to administer insulin, and if they do need insulin, how much. While there have been many advancements in technology to help with monitoring and insulin administration, the development and approval process is often long and drawn out. There are a limited number of devices approved by the government for use.

Patients with type 1 diabetes have begun taking their health into their own hands and improving treatment options. There are free directions online for how patients can connect their continuous glucose monitor (CGM) and their insulin pump with their smartphone to create a closed-loop system that tracks their blood glucose and automatically administers insulin as necessary. This type of artificial pancreas is something that researchers and pharmaceutical companies have been working on for years, but to date, there is only one commercially available closed-loop system available for use in Canada.

Jonathan Garfinkel, a Ph.D. candidate in the Faculty of Arts at the University of Alberta, took his chances and used the patient-created instructions for setting up the closed-loop system two years ago, and it has been life-changing. Previously, he was having a lot of difficulty managing his blood sugar overnight, and it would drop dangerously low. With the closed-loop system, his blood sugar has become much stabler overnight, and he is not tasked with regularly doing finger pricks and figuring out insulin dosing on his own.

These advancements in technology that patients with diabetes are developing have prompted pharmaceutical companies to quicken their own pace when it comes to getting devices created and approved for commercial use. Patients are becoming increasingly more comfortable with technology and relying on smartphones, sensors, and other devices to help them stay abreast of their health.

Garfinkel himself is also working on a project to advance technology for diabetes treatment. He is in the process of developing “a more affordable glucose sensor that would sit on top of the skin, rather than being inserted subcutaneously.” It was a project he began in collaboration with Mojgan Daneshmand, an engineer and Canada Research Chair in Radio Frequency Microsystems for Communication and Sensing, who was unfortunately killed in a plane crash in January 2020. Garfinkel is continuing the work that they started together and was awarded a U of A seed grant to help.

There are so many young researchers with incredible potential who can benefit from funding that will allow them to carry out their plans and see the results. The Diabetes Research Connection provides up to $50K in funding to early-career scientists to empower them in moving forward with their novel research projects focused on type 1 diabetes. These opportunities open doors to improving the prevention, treatment, and management of type 1 diabetes, as well as improving quality of life, minimizing complications, and one day finding a cure. Learn more by visiting https://diabetesresearchconnection.org.

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Exploring Challenges with Hybrid Closed-Loop Insulin Delivery Systems

There are many different options for managing diabetes from manually checking blood sugar and administering insulin to using a hybrid-closed loop insulin delivery system that does the work automatically with some human input. This type of insulin delivery system, also referred to as an artificial pancreas, was designed to improve diabetes management and blood sugar control without as much demand on patients.

However, a recent study found that nearly one-third of children and young adults stopped using the hybrid closed-loop system within six months. Some of them even discontinued use of a continuous glucose monitoring (CGM) system. The study involved 92 participants with type 1 diabetes who had an average age of 16. Each participant began using the Medtronic 670G system in manual mode for two weeks before switching to auto mode. They received follow-up training via phone within one month after starting auto mode, then were seen in a clinic every three months during the next six months.

The Medtronic 670G system uses CGM data to automatically control basal insulin delivery. This can help manage changes in blood sugar more quickly and administer the correct amount of insulin without patient input. If boluses are needed, however, the individual must enter their carb count and blood glucose number manually.

Researchers found that use of auto mode continued to decrease over the 6-month trial period, dropping from 65.5% during the first month to 51.2% by the sixth month. In total, 28 youth stopped using the hybrid closed-loop system within the first six months, and 21 of those 28 stopped using CGM as well. This raises the question as to whether CGM use posed some barriers to success and continued use of the hybrid closed-loop system.

The study did show that while participants used the artificial pancreas, their time spent within range for blood glucose improved from 50.7% to 56.9%, and their HbA1c levels decreased from 8.7% to 8.4%.

Understanding the strengths and challenges of artificial pancreas use in children and young adults can help researchers to make improvements and adjust systems for better results and continued use. Hybrid closed-loop therapy is just one option for managing type 1 diabetes, and it is important for individuals to find what works best for their situation.

Diabetes Research Connection is committed to providing early-career scientists with the funding necessary to support research designed to prevent, cure, and better manage type 1 diabetes. Funding is critical to continue advancing understanding and therapies for the disease. To learn more about current projects and donate, visit https://diabetesresearchconnection.org.

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Increasing Protective Factors to Reduce Risk of Type 1 Diabetes

Despite decades of research, scientists have yet to develop a cure for type 1 diabetes since it is a complex disease that is impacted by and interacts with many processes within the body. However, they have made significant advancements in understanding and managing the disease. Now, more focus is being put on preventing the development of type 1 diabetes.

In a recent study, researchers at the Pacific Northwest National Laboratory found that by increasing levels of growth differentiation factor 15 (GDF15) in non-obese diabetic mice, they were able to reduce the risk of developing type 1 diabetes by more than 50 percent. Although there are more than 387 pancreatic proteins in the body associated with T1D, the researchers discovered that GDF15 was significantly depleted in pancreatic beta cells of individuals with T1D.

By increasing GDF15 levels in the non-obese diabetic mice, it helped to protect islet cells from immune system attack. Researchers are seeking to determine whether this may be used to create more effective therapies for the treatment and prevention of the disease in humans. While more research is needed, it is a step in the right direction.

Diabetes Research Connection (DRC) is following these findings to see how they impact future diabetes research and treatment options. It is these types of studies that open doors for advancements in the field and an increased understanding of the disease. The DRC supports early-career scientists in pursuing novel, peer-reviewed research studies focused on the prevention, treatment, and management of T1D and eventually finding a cure. To learn more about current projects and support these efforts, visit https://diabetesresearchconnection.org.

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Genetic Testing May Improve Prediction of Type 1 Diabetes Risk

The cause of type 1 diabetes is complex. There is not a single gene responsible for the disease, and both genetics and environment play a role. Plus, there is currently no way of preventing the disease from occurring. However, scientists believe that they can better predict which children and teenagers are at higher risk so their health can be monitored more closely and treatment started before they develop potentially life-threatening diabetic ketoacidosis.

A recent study found that a simple genetic test that compares an individual’s gene profile to 82 genetic sites that are known to be associated with type 1 diabetes can identify those who are most at risk. The test only costs $7 and uses a saliva sample, so no blood draws or painful testing are required. If an individual is flagged as high risk, they can then have autoantibody screening conducted to look for the presence of four islet autoantibody biomarkers of the disease. The presence of two or more autoantibodies further identifies an individual at increased risk. Autoantibody tests are slightly more expensive at $75 each.

While family history does increase risk of type 1 diabetes, it is not a guaranteed indicator, and more than 90% of people who develop the disease do not have a family history. This genetic test could help to differentiate between those at high risk and those at low risk so there are fewer unnecessary tests that occur, and individuals who could benefit from closer monitoring can be more accurately identified.

According to the study, “The general population risk of type 1 diabetes is about 4 out of 1000, and those with a positive genetic test now have a risk of about 4 out of 100.” Testing may allow doctors to provide more targeted care and treatment for the disease and support individuals in better managing their health. As research continues to advance, scientists learn more about the risk factors, biomarkers, genetic sites, and environmental factors that all contribute to the development of type 1 diabetes. In turn, this can enhance prediction, prevention, and treatment of the disease.

Diabetes Research Connection (DRC) supports early-career scientists in growing the body of knowledge that exists regarding type 1 diabetes by providing critical funding for research projects. Studies are focused on preventing and curing the disease as well as minimizing complications and improving quality of life. Learn more about current projects and how to support these efforts by visiting https://diabetesresearchconnection.org.

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Type 1 Diabetes Poses Significant Financial Burden

Managing type 1 diabetes (T1D) is not only time consuming, it is also expensive. Costs include not only the basics to manage the disease such as testing supplies, insulin, continuous glucose monitors, and insulin pumps, but also those related to hospital care for complications or outpatient care. In addition, there are lost wages due to disease-related situations, as well as indirect costs. These expenses can quickly add up.

A recent study looked at the estimated lifetime economic burden for individuals with T1D versus those without. The results showed that the difference between the two groups over the course of 100 years (a lifetime), was $813 billion. The model projected costs for 1,630,317 individuals with T1D and the same number without. It followed simulated patients year by year from the time they were diagnosed until they passed away.

According to the study, “Diabetes contributes $237 billion in direct medical costs per year or 7% of the nation’s $3.3 trillion spent on health care, which is higher than the annual health care expenditures for other chronic diseases, such as cancer (5%) and heart disease/stroke (4%).”

Not only did individuals without T1D experience lower costs, they also had higher life expectancy rates. Patients with T1D are at increased risk for disease-related complications which can further impact life expectancy and financial burden. Currently, T1D is a progressive disease, and it is something that affects individuals for the rest of their lives because there is no known cure. It must be managed 24 hours a day, 7 days a week, 365 days a year.

The extreme difference in lifetime societal burden and economic burden between these two groups demonstrates the need for continued research related to T1D. The ability to prevent or delay disease development or progression, or to cure the disease, could have major financial cost savings. The results of this study were estimated given available data and modeling capabilities, so they may underestimate the true impact.

There were also certain limitations to the study, including data that was only recent up to 2016 and did not include costs associated with CGMs, insulin pumps, or hybrid artificial pancreas systems. Complication-related costs were derived from data on patients with type 2 diabetes because it was not available for patients with type 1 diabetes. However, the general message does not change: finding a way to delay, prevent, or eliminate disease progression is essential, in addition to minimizing complications.

Diabetes Research Connection (DRC) is committed to advancing research around type 1 diabetes by providing critical funding to early-career scientists. Through their novel, peer-reviewed studies, they can improve understanding of the disease as well as treatment options. To learn more about current projects and support these efforts, visit https://diabetesresearchconnection.org.

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Studying Environmental Factors Related to Type 1 Diabetes

While genetics do play a role in the development of type 1 diabetes (T1D), researchers also believe that environment contributes as well. There is no singular cause of T1D, and all of its risk and protective factors are yet unknown. However, one study is striving to build a comprehensive understanding of diverse environmental factors and the role they may play in children developing T1D.

Researchers launched The Environmental Determinants of Islet Autoimmunity (ENDIA) several years ago and recently received an additional $8.25M in funding to keep it going for another three years. Over the past seven years, they have enrolled 1,500 participants, which includes babies ranging from pregnancy up to six months in age who have at least one immediate relative with T1D. The babies are seen every three to six months until they reach at least age three.

The study looks at a wide range of environmental factors in an effort to gain a better understanding of what increases or decreases risk of developing type 1 diabetes. Factors include “growth during pregnancy and early life, the method of delivery (natural birth versus caesarean section), the mother’s nutrition during pregnancy, infant feeding (breastfeeding and/or formula), the duration of breastfeeding and the child’s nutrition, the child’s immune system and when the child received vaccines and exposure to viruses during pregnancy and early life.”

Not only did it take a long time to recruit participants, it will take several years to gather and analyze the long-term data in order to identify potential risk or protective factors and how each child was affected. With millions of people living with T1D, this study may help to improve treatment and prevention in the future, possibly leading to a vaccine one day.

Diabetes Research Connection (DRC) will continue to follow this study and see how results progress and what discoveries are made. In the meantime, the organization provides critical funding for early career scientists pursuing research on various facets of T1D. Studies are focused on preventing or curing diabetes, as well as reducing complications and improving quality of life for individuals living with the disease. Visit https://diabetesresearchconnection.org to learn more about current projects and support these efforts.

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Scientists Found a Way to Generate Insulin-Producing Beta Cells

More than one million people in the United States are living with type 1 diabetes according to statistics from the Centers for Disease Control and Prevention. There is a strong push to improve management of the disease and find a cure. The more researchers learn about T1D, the more precise their prevention and treatment methods become.

A recent study reveals that improvements in stem cell therapy have reversed T1D in mice for at least nine months and, in some cases, for more than a year. One of the challenges that scientists have faced with using human pluripotent stem cells (hPSCs) is that it can be difficult to zero differentiation in one specific type of cell. Often multiple types of pancreatic cells are produced. While there may be an abundance of cells that scientists want, the infiltration of excess cells that are not needed diminishes their impact (even though they are not harmful).

Scientists at the Washington University School of Medicine in St. Louis have found a way to generate insulin-producing beta cells without creating as many irrelevant cells. Their approach focuses on the cell’s cytoskeleton, which is its inner framework. Through this process, they were able to produce vast amounts of beta cells that are able to normalize blood glucose levels.

When transplanted into severely diabetic mice (blood glucose levels above 500 mg/dL), the cells effectively reversed the effects of diabetes and brought blood sugar levels down into target range within two weeks. Normoglycemia was maintained for at least nine months.

This is a major step forward in stem cell therapy and the use of hPSCs to potentially cure diabetes one day. There is still more testing and research that needs to be done before this approach is applied to human trials.

Ongoing research is essential for finding a cure for T1D. Diabetes Research Connection supports these efforts by providing critical funding to early-career scientists pursuing novel research studies on the disease. By giving them the means to complete their projects, these researchers can continue to advance knowledge and treatment options. Learn more about current studies and how to help by visiting https://diabetesresearchconnection.org.

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Improved Beta Cell Function of Transplanted Islet Cells in T1D

One of the major challenges of using transplanted islet cells in the treatment of type 1 diabetes is cell death. Due to cellular stressors, poor oxygenation or vascularization, autoimmune response, and other factors, not all transplanted cells survive, and this can make treatment less effective. The body needs functional insulin-producing islet cells in order to effectively regulate blood sugar levels.

A recent study found that coculturing allogeneic islet beta cells with mesenchymal stromal cells (MSCs) may improve not only cell survival, but function as well. After donor cells are procured, they must be cultured and tested before being transplanted. This can generate significant cellular stress including hypoxia or low oxygenation, which can in turn lead to cell death. However, researchers found that MSCs support islet cells during this culture period by improving oxygenation and insulin secretion.

They also found that in response to these stressors, MSCs actually initiate mitochondria transfer to the islet beta cells.  This may improve mitochondrial ATP generation which plays an integral role in controlling insulin secretion. As a result, as glucose levels around the beta cells increased, so did their production and secretion of insulin.

Researchers experimented with this coculturing process with both mouse cells and human cells and found that human cells have a greater response and higher level of MSC-mediated mitochondria transfer that occurs. Though more extensive testing is necessary, these results show that MSCs may be an essential part of clinical islet transplantation and improved efficacy of beta cell function in treating individuals with type 1 diabetes.

Diabetes Research Connection (DRC) is interested to see how this study evolves moving forward and what it may mean for future therapeutic treatments for the disease. The DRC, though not involved in this study, provides critical funding for early career scientists pursuing novel, peer-reviewed research projects for type 1 diabetes. Learn more about current projects or how to support these efforts by visiting https://diabetesresearchconnection.org.

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Type 1 Diabetes Vaccine Shows Positive Results

In an effort to prevent or delay the onset of type 1 diabetes, researchers have been striving to create an effective vaccine. One of the challenges is that there are many different subgroups of type 1 diabetes, meaning not all patients respond the same. A recent study found that patients who had a specific human leukocyte antigen (HLA) showed a “positive and statistically significant dose-dependent treatment response” to the Diamyd vaccine, especially when given four doses rather than two.

Compared to patients who received a placebo, those who received a higher number of doses of the Diamyd vaccine had a “statistically significant treatment effect of approximately 60%” within 15 months. These findings may help to advance the development of antigen-specific immunotherapy options for individuals with type 1 diabetes leading to improved treatment or management of the disease.

Diabetes Research Connection (DRC) is interested to see how this vaccine continues to evolve moving forward and what it could mean for the prevention of type 1 diabetes in the future. Though not involved with this study, the DRC provides early career scientists with funding necessary to conduct novel, peer-reviewed research projects around type 1 diabetes in an effort to improve understanding, prevention, treatment, and management of the disease. To learn more or donate to a current project, visit https://diabetesresearchconnection.org.

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Improved Protection for Transplanted Stem Cell-Derived Islets

Insulin-producing beta cells are essential for effective blood sugar control. However, in individuals with type 1 diabetes, these cells are mistakenly destroyed by the immune system. That means exogenous insulin must be used instead to manage blood sugar. For years, scientists have been researching ways to replace or reproduce these islet cells. Two of the most common challenges faced, however, have been the need for long-term immunosuppression to protect transplanted cells from rejection, and limited availability of donor cells.

A recent study found that an improved source of encapsulation may protect islet cells from an immune response without decreasing their ability to secrete insulin. By using a conformal coating that is only a few tens of micrometers thick (as opposed to hundreds of micrometers thick), not only could insulin flow more freely through the encapsulation, so could oxygen, nutrients, and glucose as well. Yet larger immune cells were still unable to penetrate the barrier. In addition, the thinner coating allowed for more cells to be contained in a smaller space, and the capsule could be implanted in a wider range of locations so long as there was strong vascular function.

The encapsulated cells were implanted in NOD-scid mice and compared with non-coated stem cells as well as human islets. There were no statistically significant differences in performance of the cells and their ability to regulate glucose levels. The mice all showed a reversal in diabetes with the transplanted cells and returned to hyperglycemia once the cells were explanted.

The use of a microencapsulation method allows for more variability in placement of transplanted cells and helps protects against hypoxia-induced islet death and cell rejection. Furthermore, the thinner coating enabled islets to obtain better oxygenation because they are closer to blood vessels. It also allowed insulin to be secreted more quickly because it flowed more freely through the barrier.

One drawback that researchers noted was that encapsulated islets are unable to shed dead cells because they are contained within the capsule and have a lower absolute quantity of insulin secretion when compared to non-coated stem cell-derived islets.

Through this study, the researchers concluded that, “CC (conformal-coated) mouse islets can reverse diabetes long-term in a fully MHC-mismatched model.” While additional research is necessary to explore the effectiveness of this process in humans, it is a step in the right direction toward one day potentially curing type 1 diabetes.

Though not involved with this study, Diabetes Research Connection (DRC) stays abreast of the latest advancements in the field and provides critical funding to early career scientists pursuing novel research studies for type 1 diabetes. It is through these types of projects that researchers are able to improve quality of life for individuals living with the disease and move closer to finding a cure. To learn more about current DRC-funded projects or support these efforts, visit https://diabetesresearchconnection.org.

 

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