USA: The Surge in Type 1 Diabetes, and the New Ways to Fight It

From webmd.com

By Sara Novak

Cases of type 1 diabetes —  an autoimmune condition where the body attacks insulin-producing beta cells — are rising faster than ever, climbing about 42% in since 1990. That’s a huge increase in a disease that’s expensive, incurable, and still shortens lifespan by more than a decade. 

But the number of new and emerging treatments is surging too, and experts say we’re in the most promising era of type 1 diabetes treatments in history, with new medications that slow the disease’s progression, advanced insulin delivery systems, inhalable options, and drugs that improve insulin resistance. It’s a shift in the management of a chronic lifelong disease for patients who are often diagnosed in childhood.

“These patients are living much longer than they used to with an improved quality of life,” said Kupper A. Wintergerst, MD, a paediatric endocrinologist and executive director of the Wendy Novak Diabetes Institute. 

Experts attribute the rise in type 1 cases to a few factors. Genetics play a role in who will get type 1 diabetes, increasing a patient’s risk by about 40%. And in people with an increased risk, certain environmental factors may serve to nudge them toward getting the disease. For example, infections in early childhood like mumps, rubella, and influenza B as well as childhood obesity and certain environmental factors like antibiotics overuse, vitamin D deficiency, and the hygiene hypothesis — which suggests that kids who aren’t exposed to enough microorganisms in childhood may end up with an overactive immune system — may also be playing a role.

Additionally, certain chemicals found in foods and drinking water, including PFAS, dioxins, and arsenic, may jolt inflammation in the body. Once these chemicals build up in the bloodstream, it triggers a chronic inflammatory state, which contributes to the immune system mistakenly attacking and destroying its own insulin-producing beta cells in the pancreas. Over time, this lack of beta cells causes the body to stop making insulin, which starts to raise blood sugar. 

Researchers are responding with new treatment strategies that leverage a slowed progression of the disease while also more accurately monitoring and regulating blood sugars, which all work to extend lifespan. The number of patients living past 65 has tripled in the last four decades.

Slowing Progression of the Disease 

Type 1 diabetes is usually diagnosed in childhood, though it can develop in adulthood, too. A new medication, called teplizumab (Tzield), has been shown to slow the disease’s progression, potentially staving off the disease for two or three years. It’s now for patients either before they’re diagnosed or early after a diagnosis. Once patients have tested positive for two or more type 1 diabetes-related autoantibodies, they’re considered eligible for the medicine. They may also have abnormal blood sugar levels but don’t yet have other symptoms of type 1 diabetes like excessive thirst, frequent urination, slowed wound healing, and excessive hunger.

Ways to Avoid Needing Insulin

What factors play a role in your blood sugar level, and how can they keep you from needing insulin?

The medication works by binding to CD3 proteins on the surface of the white blood cell, helping to block the autoimmune attack. The medication must be started a few weeks or months after diagnosis. While it’s not good for all patients, it can be helpful especially for children in staving off this life-altering condition for up to three more years of childhood. 

“For patients who are early on in their type 1 disease, this medication can help prolong the beta cell function that is remaining and decrease how much insulin a person needs, depending on when it’s used in their disease course,” said Bethany L. Gottesman, MD, a paediatric endocrinologist at Phoenix Children’s in Phoenix, Arizona.

Patients need to visit a facility that offers infusion services over the weekend. These infusion centres are available throughout the country. You can also contact the TZIELD COMPASS Support Program to find a centre near you. 

Beyond slowing the progression of the disease, the next step would be preserving beta cell function indefinitely, which would prevent the disease. Stem cell-derived beta cells are designed to mimic the function of natural beta cells, restoring function to damaged cells before the damage can to type 1 diabetes. A stem cell-derived treatment called zimislecel has shown promising results in early trials, but it is about a decade away from being available to patients, according to experts.

Improved Insulin Delivery Systems 

Science has revolutionized insulin delivery systems, which now do a much better job of mimicking the pancreas — because they measure sugars beneath the skin and between cells and communicate with the insulin pump. A sensor inserted just beneath the skin measures the interstitial fluid that surrounds cells. After that, software built into the device analyzes the glucose data, sending a message to the insulin pump to deliver insulin through a small needle that penetrates the skin. The data gathered from the cells is transmitted wirelessly to a smartphone or directly to an insulin pump.

“As sugar levels rise or fall, the pump can respond by decreasing or increasing the amount of insulin that’s delivered through an algorithm,” said Wintergerst. 

The algorithm is the computer programming process that tells the glucose monitoring system when more insulin is required, all based on data it’s collected on blood sugar in the body as well as other potential inputs such as how many carbohydrates a person consumes.

The system can provide extra insulin, for example, if it looks like a patient’s blood sugar is going to spike. Still, these insulin delivery systems require the user to input the size of a meal or the amount of carbohydrates that a patient is consuming in order to know whether blood sugar is going to go up or go down in the near future, which can make it more difficult for young children.

Experts contend that these more optimized systems help patients deal with type 1 diabetic burnout — when people with diabetes become mentally and physically exhausted as a result of all the demands that are put on them in terms of diet and glucose monitoring. This can be a concerning issue especially among children with diabetes who are new to the disease and must tend to their blood sugar for years to come, said Michael Yafi, MD, director of the Pediatric Endocrinology Division at McGovern Medical School at The University of Texas Health Science Center in Houston.

When patients are better able to monitor their condition with ease, they’re more likely to be able to stay on track with their blood sugar. This way they’ll avoid experiencing the organ damage caused by elevated blood sugars, which over time damages the body’s blood vessels and nerves, leading to blurred vision, kidney failure, neuropathy, and early death as the body’s systems break down.

Inhaled Insulin for Both Kids and Adults 

The inhaled insulin Afrezza provides rapid delivery of insulin to patients after a meal or after exercise to help stabilize blood sugar levels. People with type 1 diabetes will still need insulin injections or an insulin pump to provide a steady, continuous supply of insulin for longer periods of time, but inhaled insulin can provide additional help for people who need a boost of insulin after eating a meal. It can also reduce the risk of hypoglycemia or low blood sugar after exercise because it’s faster acting than the injectable version. For example, in patients who eat carbohydrates before exercise to prevent the low blood sugar that impacts their performance, it can keep the body from overcompensating and causing high blood sugar. 

Afrezza has already been approved for adults and is likely to be approved for children by the end of 2025, giving patients additional options while also easing some of the needle fatigue. Still, it does have its drawbacks, said Gottesman.

“It’s not meant to be used if you have lung disease, and some pediatric patients have asthma. This is also true of older patients with type 1 diabetes, who are more likely to have other lung diseases,” she said. 

Gottesman added that the insulin only comes in set doses, which for the youngest children might not be appropriate. It’s typically not as exact as rapid-acting injections. 

Inhaled versions of insulin provide a convenience factor for patients. It’s also discreet for children who are embarrassed by their condition or don’t want to inject themselves with needles in public places like at school. Newer versions of inhaled insulin are also in development, perhaps supplying a version of insulin that’s liquid rather than powder, which would reduce respiratory irritation. Aerami Therapeutics has a liquid formulation in development, though it’s unclear when it will be ready for the public.

It might seem obvious: In type 1 diabetes, the problem is lack of insulin production. In type 2, it’s insulin resistance – the body still makes insulin but can’t use it effectively. 

But that clear-cut distinction doesn’t always hold. Many people, including children, with type 1 diabetes develop insulin resistance, too. Despite lacking natural insulin, their bodies can become resistant to the insulin they do receive, for a number of reasons including excess weight, medications, smoking, puberty, and pregnancy.

This overlap has led researchers to explore treatments once thought to be reserved only for type 2 diabetes — including GLP-1 medicines like Ozempic and Wegovy — to help patients drop excess weight and stave off or improve insulin resistance, said Alexandra De Lellis, a nurse practitioner at Parkview Endocrinology in Fort Wayne, Indiana. 

While type 1 diabetes is mostly an autoimmune disease, insulin resistance can be a secondary issue that causes additional complications when the body resists insulin, causing an increase in the amount of insulin required for patients. This happens when the cells don’t react efficiently to insulin as a result of excess body weight, a genetic predisposition, or certain medications. 

“Insulin resistance plays a large role especially for type 1 patients diagnosed in adulthood but also those who were diagnosed younger,” said De Lellis. It can be frustrating for these patients who feel like their insulin isn’t having the impact it should because the body is resisting it. 

A study published this year in Frontiers in Endocrinology found that GLP-1s were a “potential adjunctive therapy in [type 1 diabetes] to reduce weight and improve insulin resistance.” Studies have shown that GLP-1s can reduce blood sugars levels by between by 0.21% and 0.96%, while also reducing weight and the amount of insulin that’s required of type 1 patients.

https://www.webmd.com/diabetes/news/20250819/surge-type-1-diabetes-new-ways-fight