The Renaissance in Diabetes Technology and Therapy
By Andrew Briskin
During the European Association for the Study of Diabetes 2022 annual meeting, diaTribe hosted its ninth annual “Solvable Problems in Diabetes” panel discussion, where speakers discussed new therapies for type 2 diabetes, type 1 prevention, the future of diabetes technology, and more.
Current advancements in technology and therapy are coming to light at a pace never before seen in the world of diabetes. Several of the world’s leading experts in diabetes care gathered to discuss this “renaissance” in diabetes, covering a vast array of topics spanning the past, present, and future of diabetes care.
The panel was co-moderated by diaTribe founder Kelly Close and Dr. Alan Moses, chair of diaTribe’s board of directors, and former chief medical officer at Joslin Diabetes Center.
Speakers on the panel included:
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Dr. Stephanie Amiel, emeritus professor of diabetes research at King’s College London and consultant physician at King’s College Hospital
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Dr. Julia Mader, associate professor of medicine in the Division of Endocrinology and Diabetology at the Medical University of Graz, Austria.
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Dr. Tina Vilsbøll, clinical professor and head of clinic at the Steno Diabetes Center in Copenhagen, Denmark
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Dr. Anette-Gabriele Ziegler, Director of the Institute of Diabetes Research at the Helmholtz Center in Munich, Germany
To sum up the “renaissance” of advancements in diabetes technology and therapy in a 90-minute panel is no easy task. But panelists took on the challenge, exploring the topics of new medications for type 2 diabetes and weight management, immunotherapies to delay or prevent type 1 diabetes, future challenges toward finding a cure for type 1, and innovations in diabetes technology.
The conversation started with a focus on the latest medications for type 2 diabetes, and what panelists saw as the future for these therapies. Drugs like SLGT-2 inhibitors, GLP-1 receptor agonists, and tirzepatide (approved as Mounjaro in the US) can help people prevent complications, assist with weight loss, and safely lower glucose in ways never seen before.
Looking toward the future, Vilsbøll mentioned she hopes to see fewer people with type 2 diabetes on insulin, as these new medications provide benefits to protect against complications and lower glucose levels. Unlike insulin, these medications do not have the added risk of weight gain or hypoglycemia.
“There is a demand from patients that they want glucose-lowering drugs that they can lose weight and live longer with,” she said. “In many countries, with modern triple therapy [metformin, GLP-1, and SGLT-2] as the backbone, we use less insulin. I would only recommend [basal/bolus insulin therapy] in the late stage of the disease.” Panelists later touched on tirzepatide, where they agreed that the weight loss properties of the drug are very encouraging, especially when thinking about the potential for reducing the risk for heart disease through weight management.
The conversation shifted to a discussion on new research in delaying, or potentially preventing a diagnosis of type 1 diabetes for individuals most at risk. In particular, speakers highlighted teplizumab, a drug that, while not yet available, many hope will be approved by the FDA later in 2022. In clinical trials, teplizumab was shown to delay a diagnosis of type 1 diabetes in those who are at risk.
“The [potential] delay from [teplizumab] may mean three more years of non-insulin. It is also a time to prepare yourself, your caregivers, and the family,” said Ziegler. However, she added that even if eventually approved there won’t be much use of this drug unless people are screened to assess their risk for developing T1D.
“If you speak about prevention, you need to identify people that are at risk and would benefit from prevention,” she said. “We want to identify people from the broad population and make this therapy available to everybody…” referring to screening a broader group for T1D risk using a blood test for autoantibodies.
Staying on the topic of type 1, Amiel provided insights on the advancements and possibilities for a cure for type 1 diabetes. In recent years, several companies have developed therapies that could potentially replace an individual’s non-functional insulin-producing beta cells with new stem-cell-derived beta cells, specifically designed to produce insulin.
While the possibilities are exciting and early data from the first participant to receive this treatment is promising, Amiel cautioned that this “cure” will still require many years of work even if it is successful.
“I think it still might be a little premature to bring “cure” back into the conversation,” she said. “[Research has advanced tremendously] but we still face the problem of [immune] rejection since these are transplants, and if they are foreign to the patient, then you have the transplant reaction to deal with. If they are exactly like beta cells, the immune system that destroyed the old beta cells will also destroy new ones.”
Amiel also added a perspective on the psychological toll that the idea of a “cure” could have on many people with type 1. When asked how to determine if a beta cell therapy is successful or not, Amiel replied, “Ask the patient. The idea of getting diabetes again is psychologically tough, so people in these trials need a lot of support. If they do become insulin independent everyone is thrilled, but the fear that you may not sustain that for a prolonged period of time does need handling.”
At various points throughout the panel, speakers touched on emerging diabetes technologies, such as automated insulin delivery systems, connected insulin pens, and possible continuous ketone monitors. Though many people do not monitor their ketones regularly, Mader suggested that this might make it possible to prescribe SGLT-2 inhibitors for more people with type 1 diabetes, since SGLT-2 inhibitors can increase the risk for diabetic ketoacidosis in people with T1D.
Mader also touched on the impact of telehealth and data-sharing technology that has become so crucial, especially during the COVID pandemic. “Remote patient monitoring and remote outpatient clinic, help us keep up with patient care and keep in contact with patients. Providers could discuss data remotely with patients, whether that be CGM data, glucose data, or insulin data, and help people customize their therapy as they need it.”
However, she also mentioned the need for a more standardized and organized way for healthcare providers to maximize the benefits of viewing data. “What we lack is the platform where we as healthcare providers can bring the data together,” she said. “It usually comes in bits and pieces and is difficult to pull it together, so we need a place where we can download and look at weight loss associated with exercise and diet to keep track of it.”
In summary, the past few years have been an exciting time in the advancement of diabetes technology, research, and care, providing hope for continued success in the future. Dr. Moses, panel moderator, concluded the discussion, saying, “diabetes discovery and the application of new tools really have achieved renaissance status,” he said, “but there is ever so much more to do.”
