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Inhaled insulin and tech for type 2: new research presented from the American Diabetes Association

Our research impact scientists

Every year, over 10,000 scientists meet up at the American Diabetes Association’s Scientific Sessions to share results from major new diabetes research studies. Here are some of the most exciting developments, from inhaled insulin to stem cell transplants.

Vertex’s venture into man-made beta cells

Stem cells can be coaxed to shape-shift into other types of cells in the body, including insulin-making beta cells. Scientists are using them to produce a man-made supply of beta cells that could be transplanted into people with type 1 diabetes, replacing those that the immune system has destroyed. 

Biotech company Vertex have been running a clinical trial to test a pioneering stem cell treatment, which they call VX-880. At ADA the team presented the latest promising updates from the first 12 people who’ve received the treatment.

Before the trial, participants had an average HbA1c of 61.7 mmol/mol (7.8%) and were taking around 40 units of insulin per day. They also had dangerous hypo unawareness and a history of severe hypos. And none of them were producing any traces of their own insulin.

After the treatment, participants who had a full dose of VX-880 started to produce insulin again, and saw their blood sugar levels improve significantly. All 12 participants reduced their HbA1c to under 53 mmol/mol (7%), spent more than 70% of time with blood sugar levels in a target range, and had no severe hypos.

After six months, seven participants were no longer injecting any insulin and two reduced the amount of insulin they inject by around 70%. Importantly, all the participants who were followed up after a year were no longer having severe hypos, even with a lower HbA1c.

The trial now has almost 40 participants enrolled and is recruiting globally, helping the team to gather more evidence about the safety and potential of VX-880.

But these exciting findings suggest highlight the potential of growing beta cells from stem cells to transform how type 1 diabetes is treated. This is an area the Type 1 Diabetes Grand Challenge is propelling forward in the UK, to make sure treatments reach people with type 1 sooner. 

Inhaled insulin shows promise in type 1 diabetes

Findings from a pivotal trial looking at the use of inhaled insulin in people with type 1 diabetes were announced at the ADA Scientific Sessions.

Everyone with type 1 diabetes needs to take insulin, either by injecting it multiple times everyday, or using an insulin pump. But researchers are searching for easier ways to use insulin, including by inhaling it.

This works like an asthma inhaler. Insulin comes in a powdered form and when you breath it in using an inhaler, it goes into your lungs. And from there, it gets into your blood.

In the INHALE-3 trial, 123 adults with type 1 diabetes were divided into two groups. One group used inhaled insulin (called Afrezza), plus a long-lasting insulin over 17 weeks. While the other group kept their normal insulin regime – taking their quick-acting insulin with injections or pumps.

The researchers found that more participants using inhaled insulin had improved HbA1c levels, compared to standard care.

  • 21% of people on inhaled insulin improved their HbA1c by 5 mmol/mol (0.5%) or more. This compared to only 5% of those with standard care.
  • For participants who had an HbA1c of 53 mmol/mol (7%) or more at the start of the study, 21% who tried inhaled insulin reduced their HbA1c to below 53 mmol/mol by the end of the study. Whereas no one in the standard care group did.

More than half of the people on the trial said they’d like to continue using inhaled insulin after the study. But the findings also showed that inhaled insulin wasn’t for everyone. 26% of participants in the inhaled insulin group saw their HbA1c increase by 5 mmol/mol (0.5%) or more. This compared to 3% using standard care.

Inhaled insulin has not been approved for use in the UK yet. But these results show its potential to offer people with type 1 diabetes an alternative way of taking insulin.

Technology triumphs for type 2 diabetes

Diabetes technology, like continuous glucose monitoring (CGM) and hybrid closed loop systems, are transforming the lives of people with type 1 diabetes in the UK. But research to understand how they could benefit people with type 2 diabetes has been lacking.

At ADA, a new set of studies illuminated the potential for these technologies to improve blood sugar levels in people living with type 2 diabetes too. This positive impact was seen both in people who were taking insulin, or not.

A world-first study of the Omnipod 5 hybrid closed loop system, involving 305 adults with type 2 diabetes, showed the tech reduced blood sugar levels. Average HbA1c levels went from 72 mmol/mol (8.2%) to 57 mmol/mol (7.4%) over 13 weeks.  

We also heard about real-world data from over 6,000 people with type 2 diabetes treating their condition with insulin who had been using CGM. Researchers compared their blood sugar levels before and after using CGM for a year.

Using CGM helped people reduce their HbA1c levels by around 10 mmol/mol (1%). And CGM use led to a 50% reduction in hospitalisations from diabetes or other causes.  

Similar positive results were found in people with type 2 diabetes who weren’t using insulin. CGM meant that they spent four more hours a day in target blood sugar range.

The next steps of these studies will be to test the technologies in different groups of people with type 2 diabetes and check if the benefits last for the longer term.

These findings demonstrate how tech could transform how people manage their type 2 diabetes day-to-day and help them live healthier lives. We want to see everyone who could benefit having access to the technology they deserve. And research like this is vital to build the case.

Tackling kidney complications in children with type 1

Medicines called SGLT2 inhibitors are prescribed to manage blood sugar levels in type 2 diabetes. Researchers also found out they can protect kidneys in people with type 2 diabetes, as they help the kidneys to filter extra sugar out of the blood.

A team of researchers in Canada wanted to find out if SGLT2 inhibitors could help children with type 1 as well, and shared their findings at ADA.

The team recruited 98 children and young people with type 1 diabetes to the ATTEMPT study. Half of them were chosen at random to be treated with a low dose of the SGLT2 inhibitor dapaglifozin, while the other half were treated with a harmless placebo. Everyone carried on taking insulin as normal.

Over 16 weeks, the team measured how well the children’s kidneys were working, their HbA1c, and if there were any side effects from the treatment. They found that the children who’d been taking dapaglifozin saw their HbA1c drop by around 5 mmol/mol (0.5).

And, importantly, they saw an improvement in their kidney function. There were also no side effects linked to taking dapaglifozin.

Now we need more research to see how long these benefits could last for, but these early findings are paving the way to new treatments for young people with type 1 diabetes to protect against kidney disease.

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