2 March 2016
Insulin pumps, immune systems and improving activity levels
Chris Askew opened the Diabetes UK Professional Conference this morning with a question. "Given the fact that diabetes really is the health challenge of our time, what part do we play in in meeting that challenge?"
Framing the purpose of this conference right at the start, researchers and healthcare professionals will spend the next three days presenting their work and challenging the status quos in the research and care of diabetes.
Here’s a summary of the first session.
Are insulin pumps the answer?
Simon Heller presented findings from the REPOSE trial, comparing the effects of the insulin pump in adults with Type 1 diabetes to insulin injections.
Interestingly, the trial found no real difference between the two when it came to HbA1c levels, but the insulin pump did seem to slightly improve quality of life measurements. The striking impact appeared to come from the structured educationDAFNE course, offered prior to starting either therapy, both groups (using the pumps or injections) benefiting.
As Simon emphasised, we can’t expect insulin pumps to fix Type 1 diabetes - self-management needs to be the first port of call.
Targeting the immune system
Colin Dayan took to the stage to give us an update on theMultiPepT1De trial , investigating antigen-specific immunotherapy as a treatment for Type 1.
This is where people are given fragments of beta cells. The theory: the immune system (that’s recognising beta cells and attacking them) could be encouraged to become tolerant to the beta cells. Just like a vaccine.
At this stage, it’s too early to look at effectiveness. There were signs that the therapy could preserve beta cells, but the trial was too small. However, the study did suggest that peptide immunotherapy is tolerated by those that took part and, importantly, doesn’t make Type 1 any worse. This might not sound like much, but these are incredibly important questions that need to be answered before we can move forward. Now that it appears we’re moving into an era of low-risk immunotherapy, it’s time for researchers to work together to establish the benefits. That’s what the Diabetes UK-funded T1D consortium is all about.
Parth Narendran and Rob Andrews then presented early results from theEXTOD trial, investigating the benefits of exercise for Type 1 diabetes. We know that exercise can improve fitness and wellbeing, and reduce insulin requirements, but there’s some evidence to suggest that exercise could actually preserve beta cells. First, Parth and Rob looked at the potential barriers to exercise: why don’t people do it? Interestingly, one of the reasons that cropped up was that healthcare professionals had advised them not to. When looking a bit deeper, they found that while healthcare professionals felt confident in providing advice, knowledge levels were relatively low. The second study compared normal care to an exercise programme in a small number of people, to investigate any beneficial effects of the exercise. The results were promising and have paved the way for a larger trial to confirm whether exercise could have any beneficial effects on beta cell survival and function.
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