The future of managing diabetes: Can we find a cure?
Reviewing treatments for diabetes cure
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With over 537 million affected worldwide, diabetes is a global health crisis. Efforts to discover a diabetes cure continue, bringing hope to millions.
Contents
Diabetes Type 1 therapy
Managing Type 2 diabetes
Future of diabetes care?
Diabetes leads to vision loss, kidney problems, heart disease, and stroke. The global diabetes population is predicted to reach 783 million by 2045. The World Health Organization sees diabetes as a widespread issue.
Although diabetes affects many worldwide, there is currently no cure for any form of the condition. While treatments can ease symptoms, long-term health issues persist for those with diabetes.
Diabetes disrupts insulin regulation, essential for glucose absorption, leading to elevated blood sugar levels. Although symptoms may overlap, the distinct types of diabetes progress differently.
Type 1 diabetes causes the immune system to attack the insulin-making beta cells in the pancreas. On the other hand, type 2 diabetes involves insulin resistance, where insulin’s ability to lower blood sugar diminishes over time.
The biotech sector aims to create innovative diabetes therapies and pursue the ultimate goal: finding a cure. Explore the latest developments in the field and their impact on diabetes management.
Management of type 1 diabetes
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Substituting absent cells with cell therapy
Cell therapy offers significant promise in finding a diabetes cure, particularly for type 1 diabetes. Restoring the absent insulin-producing cells may restore regular insulin production and potentially cure individuals.
Initial efforts to transplant pancreatic cells have been mostly unsuccessful, primarily because of immune responses that reject and eliminate the transplanted cells. The scarcity of donors is also a constraint.
In 2016, the Diabetes Research Institute (DRI) reported that the initial patient administered with their miniature pancreatic remedy no longer required insulin treatment. The system engineered by DRI imitates the pancreas’ natural function, monitoring blood sugar levels and dispensing the appropriate insulin dosage.
“This might signal the start of a fresh era in islet transplants. Our main aim is to avoid the necessity for lifelong anti-rejection treatment.”
Camillo Ricordi, Head of the DRI
Evotec, a German company, is also working on a stem cell-driven beta cell replacement therapy in early stages. After Sanofi exited the partnership, Evotec will independently advance the therapy towards trials starting in 2024.
A team at Rice University has created a novel biomaterial-encapsulation method for treating type 1 diabetes without the need for immunosuppression. This approach involves using biomaterial capsules to shield transplanted cells from immune attacks, with the added benefit of easily identifying the most compatible biomaterial through a unique tagging system.
A team from the Baker Heart and Diabetes Institute in Australia has uncovered a groundbreaking method to regenerate insulin-producing cells within the pancreas. By utilizing FDA-approved medications originally designed for cancer treatment, such as GSK126 and Tazemetostat, they target the EZH2 enzyme in human tissue, enabling pancreatic ductal progenitor cells to function akin to beta-cells. This innovation offers hope for type 1 diabetes patients by enhancing glucose sensing and insulin production, potentially reducing reliance on insulin injections. The discovery presents a promising outlook for a cure for type 1 diabetes across various age groups.
In 2023, the FDA sanctioned Lantidra as the inaugural cellular therapy for type 1 diabetes patients. Administered in a single injection into the liver, this innovative treatment involves allogeneic islet beta cells releasing insulin, potentially eliminating the need for additional insulin intake by some patients. If the initial injection proves insufficient, a supplementary procedure may be conducted.
Targeting the source using immunotherapy
In type 1 diabetes, the immune system gradually attacks and destroys insulin-producing cells. Halting this process in time could protect the cells and potentially lead to a cure.
Imcyse, a Belgian company, aims to halt type 1 diabetes through an immunotherapy that targets immune cells attacking the pancreas. Initial trials indicate the approach is safe with potential clinical advantages.
In 2023, the company finished recruiting participants for the phase II IMPACT trial for IMCY-0098, their leading imotope aimed at halting diabetes advancement by redirecting the immune system’s attack on beta-cells. Imotopes safeguard the autoimmune pathway without affecting other immune functions. Efficacy data is anticipated by early 2024.
Shortly post-diagnosis, approximately 10% of insulin-producing cells continue to function within three to six months. Shielding the remaining beta cells post-halting the autoimmune attack can sustain insulin production.
Pierre Vandepapelière, Chief Executive Officer at Imcyse
ActoBio Therapeutics, a Belgian company under the US firm Precigen, is conducting a unique phase I/II clinical trial to halt type 1 diabetes progression. They utilize cheese-making bacteria to administer two medications that activate regulatory T cells, guiding the immune system not to harm insulin-producing cells.
“It presents a safe oral therapy to be administered temporarily, aiming to potentially enable individuals with type 1 diabetes to reduce or postpone insulin usage,” commented Pieter Rottiers, head of Precigen ActoBio.
In 2023, significant advancements in diabetes immunotherapy have emerged. A pioneering medication, Teplizumab, aimed at altering the advancement of new-onset type 1 diabetes in children, has displayed encouraging outcomes. Through clinical trials, it has shown the potential to revolutionize the treatment approach for early-stage diabetes in young individuals, with a focus on sustaining insulin production. This could greatly influence the long-term management of the condition and enhance patient well-being. Patients who received the drug retained more of their remaining beta-cells compared to those who were given a placebo.
Moreover, the increased application of AI in the discovery and repurposing of drugs could hasten progress in researching diabetes immunotherapy.
Automated therapy using a synthetic pancreas
Individuals lacking insulin-producing cells might consider the ‘synthetic pancreas,’ an automated tool monitoring glucose and administering insulin akin to a healthy pancreas.
“Type 1 diabetes differs significantly from typical illnesses. Insulin demands fluctuate daily, making it challenging for patients to predict their needs,” stated Roman Hovorka, a University of Cambridge Professor.
His team is focused on creating a program that can precisely forecast a patient’s real-time insulin needs, enabling the management of insulin delivery through a pump.
The FDA has broadened approval for Tandem’s closed loop system to include children aged two and above. The Control-IQ Technology tracks blood sugar levels and, when combined with continuous glucose monitors (iCGMs) and compatible pumps, can adjust insulin delivery automatically.
Substituting human supervision with algorithms may enhance patients’ ability to manage their blood sugar effectively and reduce long-term complications. Yet, automating insulin treatment completely faces obstacles. Speedier insulin varieties are essential for promptly responding to blood sugar fluctuations. Furthermore, existing algorithms must enhance substantially for precise forecasting.
Treatment for Type 2 diabetes
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Boosting insulin creation
“In the last ten years, more than 40 new medications for diabetes have been authorized. Yet, a concerning fact remains: most type 2 diabetes patients struggle with managing blood sugar levels,” explained Kurt Graves, CEO of Intarcia.
GLP-1 receptor agonists, a key player in type 2 diabetes therapy, stimulate insulin release and inhibit glucagon secretion in beta-pancreatic cells.
GLP-1 medications made waves in 2023, praised for their impact beyond diabetes, notably in managing cardiovascular issues and obesity. Originally for diabetes, their benefits expanded to other weight-related illnesses in 2023.
By 2023, two studies revealed significant advantages of these therapies. In the U.S., 529 individuals using Semaglutide for diabetes and Wegovy for obesity witnessed doubled heart enhancements after a year. Additionally, among 17,000 people with heart conditions and extra weight, Semaglutide users had a 20% lower chance of heart issues.
A novel advancement involves combining treatments such as Tirzepatide, which merges GLP-1 and gastric inhibitory polypeptide (GIP) actions into a single molecule, acting as a co-agonist. This unique dual effect boosts insulin release, decreases hunger, and affects fat cells, resulting in better glucose management and weight reduction. Studies are investigating a fresh GLP-1/GIP/glucagon blend to elevate weight loss by upping energy expenditure.
Standard dosing for GLP-1 therapies, typically administered via injections, is progressing with fresh medication distribution methods. Advances comprise an orally usable form of GLP-1 and an innovative hydrogel slow-release mechanism that might necessitate dosing only every four months, improving treatment convenience and compliance.
Although GLP-1 therapies are mostly safe for Type 2 diabetes, the advanced drugs and broader usage in other conditions require extended safety assessments. Typical side effects include queasiness and throwing up, prompting worries about potential implications in certain situations like surgery and the importance of precise drug dosage supervision. Accessibility is further hindered by the high expense of these treatments, with current monthly costs estimated at around $1,000, demanding lifelong use for patients.
Aiming at the microbiome
Over the last ten years, researchers have recognized the significant impact of the microorganisms residing within and on our bodies on our well-being. The human microbiome, particularly the gut microbiome, has been associated with numerous long-term conditions, such as diabetes.
Individuals with diabetes often exhibit an imbalanced microbiome makeup, showing lower diversity in their gut microbiome in contrast to those without the condition.
In 2017, a study by the University of Amsterdam demonstrated that fecal transplants, transferring a healthy person’s microbiome to a diabetic individual’s gut, temporarily improved insulin resistance in obese type 2 diabetes patients. Subsequent findings in 2021 mirrored this effect in newly diagnosed type 1 diabetes patients.
Several companies are working on microbiome-focused diabetes treatments. In 2023, French biotech Valbiotis completed the TOTUM 63 clinical trial, addressing prediabetes and early type 2 diabetes. This study, carried out at the Institute of Nutrition and Functional Foods (INAF) of Laval University in partnership with the Quebec Heart and Lung Institute, validates TOTUM 63’s effectiveness in lowering glycated hemoglobin, a critical diabetes indicator. Its mechanism includes inflammation reduction, hormone regulation, and enhanced post-meal metabolic reaction.
New possibilities in diabetes treatment are emerging through microbiota research. Pharmacomicrobiomics, examining drug-microbe-host interactions, shows promise for personalized type 2 diabetes care. Investigating microbiota imbalances and insulin resistance may open avenues for novel type 2 diabetes studies.
Despite its potential, the microbiome field is relatively new and its intricate nature poses challenges in proving causation rather than just correlation. The true capabilities of the microbiome in diabetes management will become clearer as more treatments undergo clinical testing.
What lies ahead for diabetes therapy?
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By 2032, the diabetes medication market could hit $118 billion, with new technologies emerging.
Studies focus on nanotechnology for responsive insulin release, suggesting polysaccharide NP as a promising choice.
Increasing investments are made in diabetes treatment with some forward-thinking contributors driving progress.
No matter what lies ahead, it will surely have a significant impact on the lives of many globally.