Type 1 Diabetes Science Is Having a Moment

From scientificamerican.com

By Jeanna Bryner

Living with type 1 diabetes today is leaps and bounds easier than it was decades ago. Things are only getting better 

A little more than a century ago a diagnosis of type 1 diabetes was a death sentence. Today, thanks to extraordinary scientific progress, many people with type 1 diabetes—especially in developed countries—can enjoy long, healthy lives. I’m profoundly grateful that my older son, now 16, was born into this era of possibility. His diagnosis in 2020 came at a time when innovation and advocacy had transformed what it meant to live with this chronic autoimmune disease. I’m excited to share this Innovations In special report, in which we explore the remarkable advances reshaping the landscape of type 1 diabetes research and care.

Miriam Martincic

Science journalist Carrie Arnold tells the stories of visionary entrepreneurs working toward an artificial pancreas—a closed-loop system that seamlessly integrates insulin pumps and glucose monitors to mimic the function of healthy beta cells. For many, this breakthrough feels like a cure.

Yet the pursuit of a true cure continues. Health journalist Tara Haelle delves into promising options, including beta cell transplants that would eliminate the need for immunosuppressive drugs. She also highlights the monoclonal antibody teplizumab, approved in 2022, which can delay the onset of symptomatic type 1 diabetes by five years or more in some people—a milestone in preventive medicine.

As the science races forward, the number of type 1 diabetes cases is surging. Statistical visualizations by data journalist Miriam Quick and senior graphics editor Jen Christiansen illustrate this troubling trend and expose the stark disparities in care. In wealthy nations such as the United Arab Emirates, a child diagnosed with type 1 diabetes may live nearly a full life. In contrast, a child in Niger could lose up to 50 years compared with the national average.

Associate editor Lauren J. Young introduces us to five exceptional individuals working to close these gaps—among them a radiology specialist who joined forces with fellow mothers to distribute insulin and establish education outreach across Venezuela, as well as clinicians trying to ease distress over diabetes and improve mental health. Their stories are deeply moving.

Health reporter Liz Szabo explores the strides in preventing or halting diabetic retinopathy, the leading cause of blindness in working-age adults. Science journalist Rachel Nuwer describes advances in genetic screening to identify kids at high risk of developing type 1 diabetes. That information could become life-altering as new treatments emerge.

Although managing type 1 diabetes will continue to be a 24/7 endeavour for now, I have realistic hope that a cure will emerge in my son’s lifetime.

This article is part of “Innovations In: Type 1 Diabetes,” an editorially independent special report that was produced with financial support from Vertex

https://www.scientificamerican.com/article/advances-in-type-1-diabetes-science-and-tech/

What’s Next in Diabetes Care: Innovations and Insights

From beyondtype1.org

By Melanie Batchelor, MHS, RD, LDN, CDCES & Dan Trecroci 

The Advanced Technologies & Treatments for Diabetes (ATTD) Conference in Amsterdam was buzzing with breakthroughs across the diabetes spectrum. 

Here’s a simple wrap-up of three themes that stopped us in our tracks.

Theme 1: Looking beyond the type of diabetes

No longer one-size-fits-all, new tech and meds are tackling every type of diabetes.

For years, type 1 diabetes (T1D) and type 2 diabetes (T2D) lived in separate worlds, with different meds and tech. 

At ATTD, we saw those walls coming down. It’s less about the type and more about what helps.

Insulin pumps for type 2 diabetes

• Automated insulin delivery, once only for people with T1D, is now working wonders for folks with T2D as well. 
• In one study, A1c dropped from 8.2% to 7.3% in just 13 weeks. 
• People needed less insulin.

Insulin pumps during pregnancy

In the UK, women with T1D are using automated insulin pumps (aka automated insulin delivery—or AID—systems) throughout pregnancy—a time when blood sugar can be chaotic. 

The result? 

• More time in range.
• Healthier weight gain.
• Smoother transitions into postpartum. 

Moms loved the tech so much, they kept using it after giving birth.

CGMs for prediabetes

• People without diabetes are now trying out continuous glucose monitors (CGMs) like the new over-the-counter Dexcom Stelo. 
• Real-time data helps them understand how food, sleep and exercise impact blood sugar. 
• 84% of users with prediabetes said they’d give it a go.

Gender equity in diabetes tech

• The Medtronic 780G insulin pump is helping both men and women stay in range—even during hormonal shifts like menstruation. 
• It’s adaptive, smart and proof that tech can help close the gender gap in diabetes care.
• Both men and women hit 72% time in range on the 780G pump.

• For women, the pump helped smooth out glucose swings during menstrual cycles.

GLP-1s for… everything?

• GLP-1 meds like tirzepatide and semaglutide are branching out.
• Originally for diabetes and weight loss, now they’re showing benefits for heart failure, sleep apnoea, joint pain and liver disease. 
  • Tirzepatide helps people with heart failure breathe easier and avoid hospital stays.
  • Semaglutide helps reduce knee pain and protects kidneys, even in people without diabetes.
    • It can even reverse prediabetes in some people—81% of those taking it had normal blood sugar again.
  • Survodutide (a new cousin of semaglutide) is helping with a liver condition called MASH.
  • Tirzepatide also significantly reduced sleep apnoea symptoms by more than 60%.

GLP-1s in type 1 diabetes? Yup.

Tirzepatide has shown promising benefits for people with T1D, including:

• Helping with weight loss.
• Improving glucose control.
• Enhancing kidney and heart health, even after accounting for weight loss.

This could be a major shift in how we think about GLP-1 use for T1D.

Bottom line: 

• We’re entering a new era where tools and medications are transitioning from one “type” of diabetes to another. 

• These advancements are even extending into other health conditions.

• The best tech or med? It’s the one that works for you.

Theme 2: TIR, TITR and the TING thing

Are we aiming for good blood sugars… or perfect ones?

We’ve all heard of time in range (TIR): the percent of time blood sugar stays between 70 and 180 mg/dL. 

Now, two new terms are popping up:

• TITR (Time in Tight Range): 70–140 mg/dL
• TING (Time in Normal Glycemia): 70–99 mg/dL

What’s normal blood sugar for someone without diabetes?

• A recent study looked at 153 people (ages 7 to 80) who don’t have diabetes.
• They spent 96% of the day in the “tight range” of 70–140 mg/dL.
• Another study found that
  • People without diabetes: only 15 minutes/day over 180 mg/dL.
  • People with prediabetes: about 45 minutes/day over 180 mg/dL.
  • People with diabetes: around 6.5 hours per day over 180 mg/dL (that’s about 27% of the time!).

Why this matters

• Some experts now wonder, should people with diabetes aim for tighter ranges too?
• The Medtronic 780G system shows that people with diabetes using tech can hit about 50% TITR.
• But if the target is 96% (like in people without diabetes), and someone gets 50%—is that a failing grade?

What makes it harder for people with diabetes?

That kind of pressure could actually make diabetes management harder.

Unlike someone without diabetes, people with diabetes have to juggle:

• Insulin doses
• Meals & snacks
• Hormones
• Illness
• Stress
• Sleep
• Exercise
• Technology

And all of this… every single day.

So being in the “normal” range all the time? Not always realistic.

Why doctors are talking about TING

• Studies show the more time in normal ranges, the lower the risk of complications.
• Some experts see TING as a more “precise” goal—others argue not everyone wants (or needs) to aim for perfection.

Theme 3: Toward a cure

It’s not sci-fi anymore—real people are already seeing real progress.

This year, one in four sessions at ATTD was focused on curing T1D.

And the energy was electric.

Here’s a peek at what’s happening in labs, hospitals and trials

Whole pancreas transplants

• Effective, but big surgery and lifelong meds. Only for a small number of people.

Islet cell transplants

• Instead of the whole pancreas, just the insulin-making cells are transplanted. 
• Some new versions include “shields” to protect them from immune attacks—no need for full immunosuppression.

Encapsulation devices

• Think of them as high-tech armour for new beta cells—they keep the bad stuff (like an immune system in attack mode) out and let the good stuff in.

Immune system reboot

• Researchers are developing ways to “retrain” the immune system so it stops attacking the pancreas in the first place.

A new era in diabetes care: Hope for the future

From expanding treatment options to ground-breaking research, progress is happening. 

With each breakthrough, we move closer to better care, improved quality of life and—one day—a cure.

https://beyondtype1.org/whats-next-in-diabetes-care-innovations-and-insights/