Diabetes research advances

Cautious optimism.

That’s the point of view of diabetes professionals as they look at current research into the care and treatment of this difficult chronic condition.

“We’ve made huge strides in the last 15 years – huge,” said Dr. Robert Ratner, chief scientific and medical officer for the American Diabetes Association. “That’s going to continue.”

Diabetes is a condition in which the body’s pancreas does not produce the proper amount of insulin, a hormone that’s required to maintain a balanced level of blood sugar. Failure to address this condition can result in serious health problems, including heart trouble, kidney and nerve damage and bone disorders. The most common form of diabetes is type 2, which commonly occurs in people older than 40. Type 1 diabetes typically appears in childhood or adolescence.

In recent years, researchers have made significant advances in three areas: improving the measurement of glucose levels in the blood, increasing the speed and precision of insulin-dispensing into the body, and reducing side effects from medications.

In fact, diabetes research made big news just in the last few months. In October a research team at Harvard University announced that it had grown millions of insulin-producing human beta cells in a test tube, and then successfully lowered blood sugar levels in test mice injected with those cells.

That’s a big step forward, said Gregory Deines, DO, Spectrum Health Medical Group, because it may mean a much simpler approach to diabetes care – some day.

“The next step will be to test in higher mammals, like chimpanzees or other primates,” explained Dr. Deines, who is division chief, Diabetes & Endocrinology. Primate testing will take place for years before tests on humans will begin, to be certain there are no side effects.

“Conservatively, we’re probably six years from when the first humans will be tested,” Dr. Deines said, a figure the ADA’s Dr. Ratner did not dispute. But up until the 2014 announcement, scientists “didn’t even know how” to generate beta cells in significant quantities, he said. “So this is a big step.”

Better monitoring

A quicker advance will come with the release of what is being called an “artificial pancreas,” an option that may be only a few years away, Dr. Ratner said.

The name implies a replacement organ implanted into a body, but it’s not that dramatic. An artificial pancreas will be a smart device, worn by diabetes patients, that continuously monitors glucose levels and then automatically dispenses the correct amount of insulin under the skin using a small medical tube called a cannula.

Several artificial pancreases are already being tested at the human testing level, though the devices aren’t yet ready for U.S. Food and Drug Administration approval, Dr. Ratner said.

Already on the market are monitoring devices, also worn on the body, that continuously detect a person’s glucose level without the need for blood from a finger – the standard method of glucose level detection for more than 30 years. They’re a step or two short of being an artificial pancreas, but a significant advance nevertheless.

Increased durability of these devices has enabled many with diabetes to be quite active. One device, from Medtronic Co., has been coupled with an insulin pump that will turn off insulin dispensing in the event of hypoglycemia, an improperly low level of blood sugar.

Many, if not most people with diabetes still use the finger-stick method to test their glucose levels.  But “accuracy and precision of these (monitoring) devices is getting better, and they’re getting more coordinated with insulin pumps,” Dr. Ratner said.

Fast-acting insulin

Even the insulin hormone itself has improved dramatically. Insulin from animals, often pigs, was used just a few decades ago by those with diabetes. Human insulin is now the standard. And fast-acting insulin has become available, which can be helpful in avoiding big swings in blood sugar levels. In 2014, Mannkind Corp. announced it had received FDA approval for what it calls “ultra-rapid-acting” insulin, which will be taken through inhalation, and which will achieve peak insulin levels within 14 minutes.

Stepped-up research – much of it through the American Diabetes Association and Juvenile Diabetes Research Foundation – has been beneficial with type 1 and type 2 diabetes. More than a dozen classes of pharmaceuticals now treat type 2 diabetes, and several of them don’t cause weight gain or hypoglycemia, both long-time concerns for patients.

Despite all of these advances, “we’re not where we’d like to be,” Dr. Ratner said.

Future research offers even more promise, such as manipulating gut bacteria to modify our immune function and our metabolism, and developing oral medications that teach the brain to control eating urges.

Replacing improperly functioning beta cells in the pancreas of those with diabetes – the end result of that Harvard research – is a distant but highly desirable goal. Replacing an entire pancreas with a donor pancreas is possible now but highly specialized because of inherent difficulties in organ transplants. That process will not become more common without significant advances in the biochemistry of the anti-rejection process, Dr. Deines said.

And doctors still worry about getting more people tested for blood-sugar levels, given the potential harm of complications from undiagnosed and untreated diabetes.

While more than 29 million people in the United States are estimated to have type 1 or type 2 diabetes, about 25 percent of those people don’t know they have it because they haven’t been tested.

The U.S. Preventive Services Task Force has said that every American older than age 45 should be tested for diabetes because the likelihood of type 2 diabetes increases with age.