The American Diabetes Association (ADA) is focused on improving the lives of all people affected by diabetes. While Type 2 makes up the majority of those individuals, Type 1 is a priority of the nonprofit health organization as well. In 2016, 37 percent of the nonprofit’s total research budget was apportioned to projects relevant to Type 1.
Smart Insulin Patch
One recent project, started in early 2015, that would benefit people with Type 1 as well as those with advanced Type 2 requiring insulin, is the smart insulin patch. ADA Pathway to Stop Diabetes scientist Zhen Gu, a professor in the Joint University of North Carolina/North Carolina State University Department of Biomedical Engineering, published a paper in the biomedical journal, Proceedings of the National Academy of Sciences, describing the development of the new patch that could replace painful and burdensome injections.
The smart insulin patch, made of thin silicon, is about the size of a penny. It includes more than 100 microneedles, each one approximately the size of an eyelash. The microneedles house live beta cells that can sense when blood glucose levels are high and send a rapid release of insulin into the patient’s bloodstream. The live beta cells (cells responsible for making insulin) are said to reduce the risk of complications and last longer than the synthetic insulin that was previously preloaded in the patch.
The final prototype is expected to include glucagon (the hormone responsible for counteracting insulin) into the device as well. This will make the smart insulin patch effective in correcting both high blood glucose levels as well as low blood glucose levels (hypoglycemia), a dangerous potential side effect of taking insulin.
Scientists have tested the smart insulin patch technology in mouse models, where it was discovered that the device was able to effectively lower blood glucose levels for up to nine hours. The positive result paves the way for continuing research in live animals and eventually clinical trials for humans.
Immunotherapy Clinical Study
British researchers published results from a small clinical trial showing immunotherapy treatment is safe for people with Type 1 diabetes. Science Translational Medicine published the findings from the study in August 2017, reporting that the immune system therapy showed promise in maintaining insulin production in people who were newly diagnosed with the disease.
The immunotherapy treatment is comparable to an allergy shot in how it works in that it is supposed to stop the immune system from attacking the body, specifically the beta cells found in the pancreas responsible for making insulin.
Scientists determined that people who develop Type 1 diabetes likely do not produce enough of the right kind of T-regs, immune cells that can aid in the suppression of immune attacks, or the T-regs aren’t working as they should. So, researchers developed the treatment called peptide immunotherapy using disease-related autoantigens, substances that cause autoimmune attacks, in an attempt to “re-educate” the immune system and induce more, or more effective, T-regs.
The study involved 27 patients with Type 1 diabetes who had been diagnosed with the disease within the past 100 days. The participants were divided into three groups, including a group given placebos (dummy pill). Those taking the placebos increased their insulin-use by 50 percent over a 12-month period.
Although, all of the participants still required daily insulin, researchers asserted that the need for less insulin over time can lessen complications and improve patients’ overall quality of life.
Additional trials are needed to determine how often the immunotherapy treatments would need to be administered and what benefit, if any, it would have in people who have had Type 1 diabetes for a longer amount of time, whose beta cells are likely more severely damaged or altogether gone. Detectable C-peptide (a substance created along with insulin) levels in patients might also make a difference in this or future treatments.
One of the study’s authors and professor of clinical immunology at King’s College in London, England, Dr. Mark Peakman, said the next step “will be bigger trials to test whether the therapy can halt beta cell damage.”
Beta Cells Transplantation
Researchers with the ADA are working on ways to enhance the survival of beta cells for eventual successful transplantations for patients with Type 1 diabetes. The goal of such treatment is to replace insulin injections and provide better control of blood glucose levels.
Currently, there is a shortage of sufficient donor cells, further complicated by the fact that it takes several donors to transplant one recipient. The survival rate of these stem cells contained on islets, or small isolated masses of one type of tissue, is also very low, with 80 percent of transplanted islets dying from exhaustion. However, there is evidence to suggest that these beta cells can be trained to survive exposure to oxygen and nutrient shortages experienced before and after transplantation.
The ADA contends that stem cell technology resulting in an unlimited source of beta cells may very well be a reality in the next several years. Research to determine how best to use these new cells, how they live and function after transplantation, and how to control the body’s immune responses to the transplanted tissue, to avoid rejection or subsequent cell and tissue death, will be essential in the potential realization of an eventual cure for diabetes.