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Highlights from the American Diabetes Association's Scientific Meeting 2022

The American Diabetes Association (ADA), is the leading voluntary health organisation for diabetes in the U.S. Every year they hold the world’s largest scientific meeting focused on diabetes research. This year the meeting took place from 3-7 June in New Orleans and brought together thousands of researchers from all over the world. Here are a few highlights from the ground-breaking research that was shared.

A game changer for weight loss

Obesity affects 650 million people worldwide and is a key risk factor for type 2 diabetes. Many people find losing weight through diet and exercise alone a real struggle, so we urgently need new treatments to help people living with obesity. 

Researchers at Yale University School of Medicine have been investigating a potential new medication, called tirzepatide. The drug has just been approved in the U.S. to help people living with type 2 diabetes manage their blood sugar levels. It works by replacing hormones we naturally release that control how quickly our stomachs empty and signal to our brain that we’re full. And it also mimics hormones that tell our bodies how and when to release insulin. 

In a landmark clinical trial announced at ADA, researchers wanted to see if tirzepatide could also help people living with obesity to lose weight. The trial involved 2,539 people living with obesity or overweight, but who didn't have type 2 diabetes. Participants were either treated weekly with a low, medium, or high dose of tirzepatide, or with a harmless dummy injection called a placebo.

The results showed that nine out of 10 participants treated with tirzepatide were able to lose weight, with some losing up to 22.5% of their body weight over 72 weeks. The average weight loss for those on the highest dose was 24kg. In comparison, those treated with the placebo were only able to lose on average around 3% of their body weight over the same time period. 

The findings also showed that the treatment was safe. Some people did report some digestive side effects, but these were generally quite mild.

Living with obesity or overweight is a major risk factor for type 2 diabetes, so these results are an exciting step towards a new era in type 2 diabetes prevention. But the drug isn’t yet approved to treat obesity outside of a research setting. 

Dr Ania Jastreboff, who worked on the trial, said:

Obesity should be treated like any other chronic disease—with effective and safe approaches that target underlying disease mechanisms, and these results underscore that tirzepatide may be doing just that.

Hacking closed loop technology

Type 1 diabetes can be really tough to manage day-to-day. Wearable technologies like continuous glucose monitoring (CGM) and insulin pumps have started to ease the burden, but they still need careful input from the wearer, as the two systems work independently.

Some people with type 1 diabetes started to ‘hack’ their CGMs and pumps to get them to talk to each other and work together to manage blood sugar levels. When a pump is able to deliver the right amount of slow-acting insulin based on a CGM reading, this is known as a closed loop system. Diabetes tech companies have adopted this idea and written their own closed loop instructions, or algorithms.

Researchers at the University of Otago, New Zealand, used some of the ‘DIY’ closed loop algorithms originally written by people with type 1 diabetes and compared those results to commercially available algorithms. 

Just under 100 people with type 1 took part in the study and were randomly assigned either a DIY or commercial algorithm for their closed loop system. Over 24 weeks, researchers found that participants who used a DIY algorithm had their blood sugars within their target range about 14% longer than people who used a commercial one.  

And 60% of the DIY participants had blood sugars in range for at least 70% of the time, compared to only 15% of the commercial algorithm participants. But using any kind of closed loop system was found to massively reduce the risk of both dangerously low and high blood sugar levels. 

Dana Lewis, diabetes researcher, founder of the DIY closed-loop movement, OpenAPS, and study investigator said:

We were encouraged to see the greatest improvements in time in range were in those who had the lowest time in range at the start of the study. This supports the finding that a wide range of people with diabetes who want to use this technology could benefit from it, regardless of their outcomes with previous therapies.

The researchers want people with diabetes and healthcare professionals to use these results to help tailor the best closed loop algorithm for each individual person.

AI for type 2 diabetes remission

Technology is already widely used to help us keep track of our health data, such as activity, heart rate and sleep. A group of researchers has been harnessing the power of artificial intelligence (AI) to monitor health data of people living with type 2 diabetes, and use this to give personalised advice via an app to help them go into remission. Being in remission means that your blood sugar levels are below the diabetes range, without you needing to take any diabetes medication. 

The study lasted six months and 262 people with type 2 diabetes took part. Just under 200 of them used the app and 63 were treated with standard type 2 diabetes care. Those using the app wore sensors that collected health data, including on their steps, sleep, blood sugar levels and blood pressure. An AI system called Whole Body Digital Twin then interpreted this data and gave personalised feedback on nutrition, sleep, activity and breathing guidance.

The researchers found that 95% of the app users were able to reduce their HbA1c from an average of 9% (75mmol/mol) to less than 6.5% (48mmol/mol), while coming off all diabetes medication or only taking metformin. And around 84% of the app users were in remission after around six months.

These early results show the potential of innovative technologies to help people put their type 2 diabetes into remission. As a next step, the researchers plan to run a larger and longer study to confirm their findings. 

Bringing back beta cells

Last year researchers at biotech company Vertex announced early results from a pioneering trial testing a new stem cell treatment. Stem cells have a unique ability to shape-shift into any type of cell in the body, including insulin-producing beta cells. Scientists are using stem cells to develop treatments to replace the beta cells that have been destroyed in people with type 1 diabetes.

In Vertex’s trial, people receive an injection of these manmade beta cells, in a treatment called VX-880. The initial results from the first person to receive VX-880 were impressive – three months after the treatment the participant was making their own supply of insulin and had reduced the amount of insulin they were injecting from 34 units to just three units a day, a drop of 91%. Their HbA1c also dropped from 8.6% (70mmol/mol) to 7.2% (55mmol/mol).

At ADA, scientists gave us an update and showed that eight months after the stem cell treatment, the first participant was able to stop injecting insulin altogether. The Vertex team also announced early findings from a second participant treated with VX-880. After five months they were able to reduce the units of insulin they were injecting by 30%, and spent more time with safe blood sugar levels. 

Professor James Markmann is Chief of the Division of Transplant Surgery at Massachusetts General Hospital, and treated the first participant. He said:

The potential impact of this treatment on patients cannot be overstated. This study shows a significant leap forward in the potential treatment of patients with type 1 diabetes.

Although these first 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 Vertex researchers are early on in their initial trial and there’s still a lot of work to do before we can be confident that the treatment is safe and effective. The study’s next steps are to roll out VX-880 to more individuals living with type 1 diabetes to check the treatment’s safety and work out the right dose to use. Then larger trials, involving hundreds of people, will be needed to test how effective the treatment is at helping to control blood sugar levels and how long the benefits last for.

 

This is just a tiny glimpse of all the brilliant research that was shared at the ADA. And you can explore more research we’re funding to transform the lives of those living with diabetes.

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