Thousands of diabetes researchers gathered last week in Hamburg for the European Association for the Study of Diabetes (EASD) annual meeting to share their latest knowledge and breakthroughs. Here we recap some of their top discoveries.
Re-evaluating type 2 diagnosis in women
Dr Adrian Heald from Salford Royal Hospital presented new research suggesting the threshold for diagnosing type 2 diabetes in women under 50 years should be lowered to avoid missing potentially thousands of missed cases of the condition.
Women are on average diagnosed with type 2 diabetes at a later age than men. In Dr Heald and team’s latest study, researchers explored if this might in part be down to sex differences in HbA1c levels.
HbA1c is a test used to make a type 2 diabetes diagnosis. It tells us about average blood sugars levels over the last three months. An HbA1c test measures what’s called glycated haemoglobin. This is something that’s made when the glucose (sugar) in your blood sticks to your red blood cells.
Researchers think that red blood cell survival is shorter for menstruating women because menstrual blood loss causes more cells to be replaced. And this could make a HbA1c test less accurate, causing cases of missed type 2 diagnoses in younger women.
To find out more, the researchers examined HbA1c tests across laboratories in the UK from over one million people. They looked at sex and age differences of those who had not been diagnosed with diabetes and had an HbA1c of equal to or less than 48 mmol/mol (6.5%) - the recommended cut-off point for diagnosing diabetes.
They found that at a HbA1c of 48 mmol/mol, 50% fewer women under the age of 50 could be diagnosed with type 2 diabetes compared to men. While for women over 50, this decreased to only 20% fewer diagnoses.
Based on their findings, the researchers estimated that 35,000 currently undiagnosed women under the age of 50 in England would be diagnosed with type 2 diabetes if the HbA1c diagnosis threshold was lowered from 48 to 46 mmol/mol (6.5% to 6.4%) for them.
Dr Lucy Chambers, Head of Research Communications at Diabetes UK, said:
“More research on sex differences in thresholds for a type 2 diagnosis is needed to inform any changes to clinical practice. In the meantime, we encourage clinicians to follow the current guidance of not ruling out type 2 diabetes based on a one-off HbA1c below the diagnostic threshold.
“Receiving an accurate and timely diagnosis ensures that women get the treatment and support needed to manage their type 2 diabetes and avoid long-term complications, including heart disease where sex-based inequalities in care already contribute to poorer outcomes for women.”
Semaglutide stands up in the real-world
A range of drugs, called GLP-1 analogues, which are used to manage blood sugar levels and weight in people type 2 diabetes continued to make news at the EASD annual meeting.
New findings were revealed from a real-world study involving more than 23,000 people with type 2 diabetes who used semaglutide for up to three years. Semaglutide is sold under the brand names Ozempic, Wegovy and Rybelsus.
The drugs work by mimicking the effects of hormones that we make in our gut, which tell our bodies when to release insulin and when signals should be sent to our brains to make us feel full.
The study, led by researchers in Israel, is the first to investigate long-term use of the drugs in people’s real life, outside of clinical trials. Results showed that 6 months after starting the drug, people had:
- Lowered their HbA1c by on average 9mmol/mol (from 60 mmol/mol (7.6%) to 51 mmol/mol (6.8%))
- Reduced their body weight by 4.7 kg (from 94.1 kg to 89.7 kg).
Importantly, the researchers found that both these benefits were maintained in the longer term over three years of follow-up. People who took semaglutide as prescribed – consistently taking it once weekly – saw the biggest long-term benefits.
In this group, HbA1c remained reduced by 9mmol/mol after two years and by 6mmol/mol after three years. Whereas body weight was reduced by 6.0 kg after two years and 5.8 kg after three years.
Esther Walden, Deputy Head of Care at Diabetes UK, said:
“Whilst it is good news that evidence from the real-world on the benefits of semaglutide supports results from clinical trials, the global shortage of these drugs remains an issue. We are calling for continued action to ensure ongoing and sufficient supply of GLP-1 medications to people living with type 2 diabetes.”
Stem cell therapy to bring back beta cells
Researchers at a US company called Vertex have busy been testing a pioneering new treatment uses stem cells to replace insulin-producing beta cells in people with type 1 diabetes.
We told you all about this trial and the exciting results from the first participant in 2021.
Since then, more people have taken part, and we heard the latest at EASD. Six adults with type 1 diabetes, who all have no hypo awareness and a history of severe hypos, have now received a transplant of the lab-made beta cells (called VX-880).
The results continue to be impressive – all six participants have seen improved blood sugar levels and more time in target blood sugar range, while three people have been able to stop taking insulin altogether.
Tests also confirmed that all participants are producing their own insulin in response to food. This is exactly what a functioning pancreas would do and suggests the manmade beta cells are working as they should.
Although the results show huge promise, people treated with VX-880 have to take immunosuppression drugs to prevent their immune systems from attacking the replacement cells. And this does come with a risk of side effects.
The future goal is to create a version of the treatment that does not need immunosuppression drugs. Vertex are now working on enclosing the cells in a device that would protect them from immune system as well as genetically modifying the cells, so they won’t trigger an immune attack.
Beta cell replacement treatments have the potential to move us towards a new era in type 1 diabetes treatment, moving us beyond insulin.
And to get us there faster, the Type 1 Diabetes Grand Challenge, our partnership with JDRF and the Steve Morgan Foundation, is investing in game-changing research to find new and even more effective beta cell replacement treatments.
Dr Lucy Chambers, Head of Research Communications at Diabetes UK, said:
“While there’s still much work to do to get these types of therapies into clinical practice, this trial and other research programmes such as the UK’s Type 1 Diabetes Grand Challenge, are bringing us closer to the day when living with type 1 diabetes no longer requires relentless, round-the-clock self-management, and short- and long-term complications are a thing of the past.
“We eagerly anticipate the next tranche of results and the start of the UK-based trial of Vertex’s therapy.”
Hybrid closed loop can transform type 1 management during pregnancy
Pregnancy can be a particularly stressful time for women with type 1 diabetes, as it becomes more challenging to manage blood sugar levels. In turn, this can increase risk of the complications during pregnancy, birth and beyond.
New research led by Professor Helen Murphy from the University of East Anglia has told us more about the life-changing benefits diabetes technology can have during pregnancy.
At Diabetes UK, we funded Professor Murphy to lead a decade of pioneering, world-first studies to test and develop hybrid closed loop technology (also known as the artificial pancreas) for pregnancy.
In her latest research, presented at EASD, Professor Murphy and team ran a study involving 124 pregnant women with type 1 diabetes. From 10 weeks into their pregnancy until they gave birth, the women either used hybrid closed loop technology or insulin injections or regular pumps to manage their type 1 diabetes.
Compared to traditional insulin therapy, women who used the technology spent more time in the target blood sugar range for pregnancy (68% vs 56%). These improvements were seen without additional hypos and without additional insulin. Women using the technology were also less likely to have blood pressure complications during pregnancy.
Importantly, women using hybrid closed loop also had fewer appointments and out-of-hours calls with healthcare professionals, suggesting the technology could also be time saving for pregnant women.
Dr Lucy Chambers, Head of Research Communications at Diabetes UK, said:
“The draft NICE recommendations for hybrid closed loop technology rightly acknowledge its benefits for pregnant women with type 1 diabetes prioritising them for access, and this study reinforces the importance of making the technology available to them.
“With the final NICE guidance for England and Wales expected by the end of this year, it is vital that hybrid closed loop technology is backed by national funding to ensure it can be offered fairly to all pregnant women with type 1 diabetes.”
