MediTalk are interested in hearing patients’ honest opinions, thoughts and unique experiences.

The goal is to learn from patients and gain insights into their needs and expectations regarding diabetes management and their use of technology so they can find ways to improve it.

Study details

The study consists of:

• 90 minute interview (virtual)

Honorarium

To compensate you for your time, there is a £90 incentive for those who take part.

To see if you’re eligible, complete the form below and a MediTalk representative will contact you by your chosen method to verify your eligibility.

MediTalk are interested to talk to you about your experience living with type 2 diabetes.

Study details

The study consists of:

• 90 minute interview (virtual or face-to-face)

Honorarium

To compensate you for your time, there is a £95 or £115 incentive for those who take part depending upon the method for interview.

To see if you’re eligible, complete the form below and a MediTalk representative will contact you by your chosen method to verify your eligibility.

Diabetes research
is uncovering new details each week helping us to understand diabetes from a wide variety of angles.

However, within each individual area, research can often appear slow paced, with new steps taking several months or years to become apparent.

This article looks at the progress that has been made through 2012.

Insulin pill

Taking

insulin as a pill
rather than needing injections has been a hope for many but has proved a difficulty to achieve for researchers.

The challenge has been to develop a pill that can effectively transport insulin into the blood without the insulin being broken down by the body’s digestive system.

In May 2012, Novo Nordisk announced they were getting closer to making this a reality but, to date, we have not seen significant evidence to substantiate the claims.

• Read more:
  
  Insulin drug being tested to replace diabetes injections

Insulin nasal spray

Researchers have looked at some funny places to deliver

insulin
into, with the nose being amongst these locations.

In November, the University of Sunderland declared the development of a unique nasal spray that would form a gel inside the nose to deliver insulin into the blood in a controlled fashion.

We await to see what next steps Dr Hamde Nazar’s team will take in the development of the spray.

• Read more:
  
  Insulin nasal spray could offer alternative to daily injections

Cannabis compounds as a type 2 diabetes treatment

The

cannabis
plant contains cannabinoids compounds which have been found, in animal studies, to lower cholesterol in the blood and lower fat in organs such as the liver. Fat in and around organs such as the liver and pancreas has been linked with the development of insulin resistance and other health markers associated with metabolic syndrome and type 2 diabetes.

• Read more:
  
  Cannabis could be used in fight against obesity and type 2 diabetes

Artificial pancreas

Developments have been made in 2012 in commercially available technology for treating type 1 diabetes, including more accurate

continuous glucose monitors
now available.

Trials have been run to test out

artificial pancreas systems
which take in data from continuous glucose monitors, make sense of the numbers and then instruct an insulin pump to deliver an appropriate rate of insulin.

Research in 2012 has also seen improvements in sensing blood glucose levels:

• 
  Artificial pancreas breakthrough for diabetes treatment
• 
  Sensors for artificial pancreas being developed for diabetics

Saliva for testing sugar levels

Above we talked about the use of the inside of the nose for delivering insulin into the blood, now we’re looking at the mouth which scientists have identified as a way to measure sugar levels.

Research shows that as blood sugar levels rise, so does the sugar levels of other liquids in the body including the sugar levels in tears and saliva. One of the difficulties with measuring the sugar levels in these fluids is that the concentration of glucose is much smaller than in blood and therefore achieving accuracy is far from easy.

In January, researchers at Brown University in the US reported the development of a sensor that is able to measure these very small concentrations.

• Read more:
  
  New diabetes device developed that checks saliva instead of blood

Snake venom to treat type 2 diabetes?

Venom as a treatment? Those that are sceptical may be reminded that the now commonly prescribed drug for type 2 diabetes, Byetta, was discovered and initially derived from the saliva of the venomous gila monster, a lizard found in southwestern states of the US.

Back to snakes again, initial research by a British-Australian collaboration was published in September revealing that the toxins in snake venom could open the door to new treatments. Research is at a very early stage though.

• Read more:
  
  Snake venom may have potential to treat diabetes

In recent years, there has been a wealth of research studies showing low-carb diets to be very effective for people with diabetes.

Despite the success of low-carb diets, the UK still advises people with diabetes, and the population in general to consume a

low-fat diet
that is much higher in carbohydrate.

As more and more research supporting low-carb diets appear, the recommendation to follow a low-fat diet is becoming more and more

controversial

Low-carb research and type 2 diabetes

Research into low-carb diets in people with

type 2 diabetes
typically show that low-carb diets are at least as good as low-fat diets.

Low-carb diets tends to perform significantly better in terms of:

• 
  Improved blood glucose levels (HbA1c)
• 
  Greater rates of remission – able to control diabetes well without the need for medication

Low-carb diets are usually either as effectives, or slightly more so, than low-fat diets in terms of:

• Reduced
  
  insulin resistance
• Achieving
  
  weight loss
• Improving
  
  cholesterol levels
• Lowering
  
  blood pressure levels

Improved remission

A 2014 study by the Second University of Naples, showed that a low-carbohydrate Mediterranian diet produced

significantly greater remission rates
than a low-fat diet.

The study showed that the low-carb diet led to 14.7% of participants achieving remission in the first year and 5% achieving remission after six years.

By comparison, those following the low-fat diet had remission rates of 4.1% after the first year and 0% after six years.

Lower HbA1c

When low-carb and low-fat diets have been directly compared, low-carb diets have typically outperformed the low-fat diets.

Rock et al. (2014): A

comparison of equal calorie slimming club diets
showed the low-carb diet to be more effective in reducing HbA1c, body weight, triglycerides and total cholesterol.


^[278]

Mayer et al. (2013): A low-carb diet outperformed a low-calorie, low-fat diet that was supplemented with the weight loss drug Orlistat. The results showed similar weight loss, whereas the low-carb diet was most effective at reducing HbA1c levels and dependence on medication.


^[279]

Westman et al. (2008): A low-carb ketogenic diet was compared with a low- glycemic index diet. The low-carb group had a significantly greater reduction in HbA1c than the low-GI diet group. (17 mmol/mol compared with 6 mmol/mol). The low-carb group also showed the greatest improvements in terms of improved cholesterol levels and reduced dependency on diabetes medication.


^[79]

Low-carb research and type 1 diabetes

Whilst most research studies into low-carb and diabetes focus on type 2 diabetes, there has been a few studies that have looked at the effects of the diet for

type 1 diabetes

The studies that have been carried out have been limited to one research team from the Department of Medicine at Blekingesjukhuset, in Karlsham, Sweden.

Nielsen et al. (2012): This study looked at the effects of a diet of 75g of

carbohydrate
per day on adults with type 1 diabetes. Whilst there was no control group involved, the study showed that those adhering to the low-carb diet had a significantly lower HbA1c (46 mmol/mol) after four years of following the diet to those that were not able to keep to the diet (57 mmol/mol).


^[195]

Some monumental milestones occurred in 2016 as diabetes research further evolved.

One of the more remarkable developments was the halting of

type 1 diabetes
in mice for six months, while further strides were made into oral insulin and the artificial pancreas.

The low-carb diet remained a prominent discussion point within

type 2 diabetes
research, and there was substantial technological progress in helping people manage diabetes.

Type 1 diabetes research

Harvard University researchers made a significant breakthrough in January when they showed type 1 diabetes could be halted for six months in mice. Less than a month later, human testing began in a separate study to see if stem cells could eliminate the need for

insulin injections
in type 1 diabetes, while progress was made too with the developments of an insulin pill and smart insulin patch.

• 
  January 2016: Scientists make type 1 diabetes breakthrough by halting disease for six months
• 
  February 2016: Stem cell testing begins on human type 1 diabetes patients in bid to eliminate insulin injections
• 
  March 2016: Updated insulin smart patch could control blood glucose levels without injections
• 
  August 2016: New insulin pill developed by American researchers could treat type 1 diabetes

Type 2 diabetes research

The

low-carb diet
received further validation from scientists when its benefits were compared to a high-fat diet, while Newcastle University’s very low-calorie diet (VCLD) also achieved impressive results among people with type 2 diabetes.

Scientists began more experiments into beige fat, which could lead to future treatments that counteract obesity and the development of type 2 diabetes.

• 
  February 2016: Low-carb diet leads to decreased medication among type 2 diabetes patients, research finds
• 
  March 2016: Very low calorie diet can reverse type 2 diabetes for six months
• 
  July 2016: Mediterranean diet can lower risk of type 2 diabetes, cancer and cardiovascular events
• 
  August 2016: Breakthrough into beige fat research could combat obesity and type 2 diabetes

Artificial pancreas developments

In 2016, the

artificial pancreas
was tested across more clinical trials and study participants than ever before, with the device shown to help both children and adults. A key trial was announced in September when the University of Cambridge was given European Commission funding to see if the artificial pancreas could transform type 1 diabetes management in children.

• 
  August 2016: Artificial pancreas could transform treatment for pregnant women with type 1 diabetes
• 
  September 2016: European Commission funds artificial pancreas trial in children with type 1 diabetes
• 
  November 2016: Artificial pancreas improves blood glucose control in type 2 diabetes
• 
  November 2016: Less fear of hypos noted in type 1 diabetes artificial pancreas study

Blood glucose testing devices

For years researchers have been striving to make blood glucose testing less invasive, particularly as children often find finger pricking very unpleasant. In 2016, we were shown that several research avenues are being pursued to make non-invasive testing devices more available for the diabetes community.

• 
  January 2016: Development of breathalyser test to monitor blood glucose levels begins
• 
  March 2016: Graphene sensor patch measures glucose levels in sweat and provides treatment
• 
  May 2016: Microwave device could monitor blood glucose levels in people with diabetes
• 
  September 2016: New smart contact lens monitors blood sugar levels in the blink of an eye

Research into genes is gradually building up a greater understanding of the different forms of diabetes.

Gene research can involve understanding how genes work as well as identifying and understanding how variants and mutations of genes can lead to the development of different health problems.

For the likelihood of developing diabetes based on parents or siblings with the condition, see

diabetes and genetics

How genes work

Genes provide instructions for the proteins in

our body
that control the functioning of our bodies. The human body has about 25,000 genes.

Genes can take on different forms and this variation can explain why we are each different. Variations or mutations of certain genes can lead to increased susceptibility to certain diseases and health conditions.

Genes linked with Type 2 diabetes

In type 2 diabetes, the body develops

resistance to insulin
and, as a result, needs to compensate by producing more insulin which, over time, can lead to the insulin producing beta cells in the pancreas burning out.

Researchers have found over 60 different genes that have been associated with type 2 diabetes.

This emphasises how type 2 diabetes can be a particularly complicated condition to understand.

Variants of certain genes have been found to be associated with increased risks of type 2 diabetes.

A gene known as KCNJ11 helps to regulate the intake of potassium by our cells but mutations of the gene can lead to our body producing too much insulin, a condition known as

hyperinsulinemia
and commonly experienced by people with type 2 diabetes.

The gene PPAR-γ (PPAR-gamma) is involved in decreasing the inflammatory response in our

blood vessels, and can help to prevent us from developing heart disease. PPAR-γ also helps to dictate where fat is stored, helping to ensure fat is stored under the skin rather than in muscle, which can lead to the development of insulin resistance.

Variants of the gene PPAR-γ have been found in people type 2 diabetes and a medication for type 2 diabetes,

Actos (pioglitazone), actively works to stimulate the PPAR-γ receptor.

• Read about symptoms and treatment of
  
  type 2 diabetes

Genes linked with Type 1 diabetes

Type 1 diabetes is an autoimmune condition whereby the body’s immune system targets and kills off useful cells. In type 1 diabetes, it is the insulin producing beta cells in the pancreas that are targeted for destruction.

Over 50 genes have to be associated with type 1 diabetes but, as yet, research has yet to understand why the

immune system
may target pancreatic beta cells. The gene KIAA0350 is one these genes and is known to be expressed by pathogen killing immune cells (NK cells).

• Read about symptoms and the treatment of
  
  type 1 diabetes

Diabetes MODY

MODY stands for maturity onset diabetes of the young and is the name given for range of different forms of diabetes which are typically recognised in

children with diabetes

MODY is a more rare form of diabetes and is believed to account for between 1 and 2% of cases of diabetes. Despite being less common, the genetic reasons for MODY are better understood than type 1 and type 2 diabetes.

Each different type of MODY is connected with a variant of a particular gene and is given a different number.

• Read more on
  
  Diabetes MODY

The purpose of our Diabetes Surveys section is to gather data from which we can draw results; such as which areas are getting good, bad or average diabetes health care.

We can then present conclusions relating to diabetes in the UK, and perhaps even influence public policy if we get a good enough response.

If you have an issue that is bugging you about diabetes, and you would like us to conduct a survey, please mention it in the Diabetes Forum

Current surveys

• Take the Diabetes Forum Survey 2022 »

Diabetes research networks in the UK are part of the UK clinical research network. Diabetes research networks help to support and ensure delivery of high quality clinical research studies.

This helps to make

diabetes research

more effective and, ultimately, push towards a diabetes cure.

Are diabetes research networks present in the UK?

Due to the large and growing importance of diabetes in UK public health, the Department of Health launched a National Institute for Health Research Diabetes Research Network in 2005.

What do diabetes research networks do?

The NIHR diabetes research network helps the UK to establish prevalence of diabetes, understand

diabetes risk factors

, and develop new strategies to both treat and prevent diabetes and diabetes complications.

The NIHR DRN also helps to disseminate these strategies into clinical practice.

The DRN is effectively health service infrastructure to support clinical research in diabetes.

Which diabetes research networks are available in the UK?

There are 4 major diabetes research network available in the UK.

The NIHR DRN

The DRN consists of a network of primary and secondary care centres throughout the UK that is supported by the Department of Health.

The DRN conducts high-quality clinical research in both academic and commercial fields. The co-ordinating centre manages eight Local Research Networks (LRNs) designed to encompass the whole country.

The NIHR DRN is just one part of the part of the National Institute for Health Research Clinical Research Network and works closely with Networks in Scotland, Northern Ireland and Wales to support clinical research across the UK, of which more below.

Scottish Diabetes Research Network

The Scottish Diabetes Research Network (SDRN) began in 2006, commissioned by the Chief Scientist Office (CSO) of the Scottish Government.

The goal of the SDRN is to improve the quality and up the quantity of diabetes research in Scotland, as part of the UK Clinical Research Collaboration (UKCRC).

Diabetes Research Network Wales

The Diabetes Research Network Wales (DRN Wales) unties researchers, clinicians and patients to make the quality of diabetes research and care better.

The Diabetes Research Network Wales aims to address the health burden caused by diabetes in Wales.

The DRN Wales is funded by the Welsh Office of Research and Development for Health and Social Care (WORD).

Northern Ireland Clinical Research Network

NICRN was established to support the clinical research community in Northern Ireland. NICRN aims to promote research in Northern Ireland, build partnerships and relationships within the network and research

community

, hit targets and maintain a network studies portfolio.

The NICRN also facilitated

training and education

and maximises research opportunities.

Type 1 diabetes
is an autoimmune disease which, when triggered, causes the body’s own ‘killer’ T cells to kill off the pancreas’s insulin producing beta cells.

Diabetes vaccines attempt to stop the T cells from attacking the body’s own cells.

Studies have been

able to treat diabetes in mice, but a working vaccine in humans has yet to receive pharmaceutical approval.

Diamyd vaccine trial

Diamyd Medical
is a Swedish company that is undertaking a trial in humans to see if their antigen vaccine can slow down or even halt type 1 diabetes at an early stage of its development.

Phase III of the trial has been split into two regions, Europe and the USA, with 320 participants taking part in each.

Should the European trial prove successful, Diamyd Medical could apply as early as by the end of 2011, to market the vaccine in Europe.

Update: 10 May 2011

Phase III trials in Europe showed the

Diamyd treatment failed to preserve beta cell function past 15 months

The company is considering how to proceed with research and development of the treatment.

Nanoparticle vaccine

The University of Calgary is one of the universities that have

successfully developed a vaccine that works in mice
The vaccine is novel in that it uses tiny nanoparticles armed with antigens to stimulate the body’s ‘regulatory’ T cells which help to police the ‘killer’ T cells.

Essentially, this prevents the response of the ‘killer’ cells from getting out of control and killing the body’s precious beta cells.

News of the breakthrough appeared in April 2010 and the license to develop the vaccine is held by Parvus Therapeutics, part of the University of Calgary.

Natural immunomodulators

A collaboration between King’s College London and Bristol University was awarded a 10 million Euro grant early in 2010 to continue their research to find a potential vaccine against the anti-immune effects of type 1 diabetes.

The two universities have been working together for a number of years and will be using the grant to pool leading minds to investigate new solutions.

Dr Colin Daya, Director of the Clinical Research Unit at Bristol Royal Infirmary (BRI), points out that their research is less into that of a vaccine, as a vaccine is one which boosts the immune system, whereas the

research
to prevent type 1 diabetes is more about modulating the body’s immune system.

New research constantly uncovers new diabetes drugs that are developed by biotechnology and pharmaceutical companies through several clinical trial phases.

To be approved for use amongst people with diabetes, new

diabetes drugs and medications
must go through stringent testing to ensure their efficiency.

Most new diabetes drugs serve a specific purpose, such as better controlling blood glucose or increasing the efficiency of another medication.

Drugs can take up to 10 years to come to the market. When drugs are referenced in the media about their positive impact on mice or other test subjects, it is often several years before they are tested on humans.

The following diabetes drugs are currently under development.

Diabetes drug treatments currently in development

• 
  New drug treatments for Type 1 and Type 2 diabetes
• 
  New drug treatments for Type 2 diabetes
• 
  New drug treatments for Type 1 diabetes
• 
  New drug treatments for diabetes complications

New drug treatments for Type 1 and Type 2 diabetes

The following drug is in development for the treatment of both type 1 and

type 2 diabetes

NN1250/Insulin Degludec/Tresiba

NN1250/Insulin Degludec is being developed by Novo Nordisk and has reached phase 3 clinical trials. This is a completely neutral, soluble, and subcutaneous ultra-long-acting new-generation insulin that lasts for over 24 hours. This

insulin
is designed for basal insulin treatment of both type 1 and type 2 diabetes mellitus. Also under development is NN5401/Insulin DegludecPlus.

Update:

Insulin Degludec was launched in the UK in February 2013 under the trade name Tresiba, but was

rejected for use by NHS Scotland
in April.

New drug treatments for Type 2 diabetes

LY2405319

LY2405319 is a new drug being developed by Eli Lilly. The drug is in a new class of treatments known as FGF21 analogues. FGF21 stands for fibroblast growth factor 21, which is a hormone in the body that stimulates glucose uptake of adipose cells (fat cells).

In initial phase 1 human studies, the drug has shown beneficial effects on

blood lipid levels, blood glucose levels and reduction in body weight.

At time of writing, September 2013, the medication has yet to undergo trials into its long term safety.

• Read more:
  
  New type 2 diabetes drug improves blood sugar, body weight and cholesterol levels

Albiglutide

Albiglutide is a GLP-1 agonist, and therefore in the same class of drugs as the medications exenatide (Byetta), liraglutide (Victoza) and lixisenatide (Lyxumia). The drug is being developed by GlaxoSmithKline plc and was

submitted for European marketing approval
in March 2013.

Aleglitazar

Aleglitazar is a in a class of drugs known as ‘dual PPAR modulators’. Dual PPAR modulators are insulin sensitizers and work in a similar to drugs such as Pioglitazone (

Actos
) and the recently banned Rosiglitazone (

Avandia
).

Aleglitazar is currently in phase 3 trials to determine its safety. With Aleglitazar in the same drug class as Avandia, a drug which was withdrawn from the market in Europe over concerns about increased heart disease, the drug will particularly need to show it does not impact upon cardiovascular health.

Update:

In July 2013,

Roche ended development
of the medication after safety showed it to be associated with an increased risk of bone fractures, kidney problems and heart failure.

New drug treatments for Type 1 diabetes

DiaPep277

DiaPep277 is being developed by Teva/Andromeda biotech and is currently at phase 3 clinical trial stage. DiaPep277 falls into the class of injectable synthetic peptides, and is made up of 24 amino acids that are derived from the human heat shock protein 60 (HSP60).

This particular peptide helps to modulate immune system function by diminishing or entirely blocking the destruction of beta cells by the immune system. This helps to preserve beta-cell function amongst people with new-onset

type 1 diabetes
mellitus.

Phase 3 studies are expected to be completed in 2014.

MGA031/hOKT3γ1/teplizumab (Ala-Ala)

This drug is being developed by Eli Lilly/MacroGenic. It is currently at phase 3 and is an intravenously humanised anti-CD3 MAb which could help to inhibit autoimmune response that damages pancreatic beta cells.

The drug is designed for patients with recent onset type 1 diabetes aged 8 or over.

Results of a phase 3 studies showed promise with newly diagnosed patients with type 1 diabetes showing increased C-peptide levels, a measure of the production of the body’s own insulin, in comparison with patients not on teplizumab.

• Read more:
  
  Drug shows promising results in fight against type 1 diabetes

GAD-alum/rhGAD65

GAD-alum/rhGAD65


is being developed by Diamyd Medical/Ortho-McNeil Janssen Pharmaceutical. This vaccine helps to preserve beta cell function amongst recent-onset type 1 diabetes mellitus and has also reached phase 3 clinical trial. The vaccine is injectable subcutaneously.

In May 2011, the vaccine delivered disappointing results in European phase 3 trials and the American phase 3 study has been halted as a result. Read the news:

Diamyd type 1 diabetes vaccine stalls in European trials

In 2013, a new trial is planned to test Diamyd in combination with vitamin D and the anti-inflammatory drug Ibuprofen.

Otelixizumab

Otelixizumab is under development by Tolerx/GlaxoSmithKline and failed to meet a phase 3 goal in March 2011. This is an MAb (monoclonal antibody) that is intravenous and injectable anti-CD3. This MAb may serve to block the function of T cells that erroneously attack and destroy

pancreatic
beta cells. These cells produce insulin and their destruction is behind diabetes in many type 1 patients.

The MAb is also thought to stimulate regulatory T cells that may help protect effector T cell damage. The medication is designed to treat new onset type 1 diabetes mellitus.

New drug treatments for diabetic complications

Arxxant

Eli Lilly appear to have come one step closer to cracking one of the diabetes drug mysteries – how to target the complications caused by the disease. Arxxant, a new drug from Eli Lilly, promises to block the enzyme thought to be responsible for the damage leading to these

complications

Arxxant (also known as ruboxistaurin) has been submitted to the FDA (Food and Drug Administration) for approval in treating

diabetic eye damage

Update:

Phase 3 trial goals were not met and development of the drug was discontinued in 2012.

Understanding the root

causes of diabetes
has eluded researchers for many years now.

The way in which the immune system causes the destruction of precious beta islet cells within the pancreas of

type 1 diabetics
is generally understood to be the key.

The ultimate goal, which has so far proved elusive, is a

cure for diabetes, which could potentially be available for both types of diabetes through stem cell research.

What are stem cells?

Stem cells are a form of cell that is yet to develop a specific set of traits. However, what stem cells have in abundance is the potential to develop into a number of different forms.

What is stem cell research?

Stem cell research covers the scientific study of these stem cells. Stem cell research allows researchers to grow specific varieties of human cells in the lab and research how they behave and interact under different conditions.

Stem cells open up a wide spectrum of diabetes research possibilities. In one example of diabetes stem cell research, researchers took cells from human intestine cells and disabled a gene which enabled the cells to produce insulin.

Where do stem cells come from?

Stem cells for the treatment of diabetes are able to come from a variety of sources.

These include foetal tissue from:

• Embryos
• The placenta
• Umbilical cord
• 
  Bone marrow
• Blood cells
• Teeth

Stem cells in the research of type 1 diabetes

Within recent years, stem cell research has become a very important part of the scientific understanding of type 1 diabetes.

Research has demonstrated that stem cells can be grown in the lab.

In 2004, the University of Pittsburgh grew insulin producing beta cells by introducing two genes ‘cdk’ and ‘cyclin d’ via a virus.

The researchers were able to deactivate the virus and also prevent stem cells from growing further. The research could lead to a better availability of beta cells for future research purposes.

Progenitor cells

Progenitor cells, related to stem cells, are another exciting avenue of research. Like stem cells, progenitor cells are able to take on the form of a number of different types of mature human cells, however, unlike stem cells, progenitor cells cannot divide indefinitely.

Progenitor stem cells have been used to grow

insulin
producing cells, under lab conditions, from intestinal cells and undeveloped pancreatic cells.

Stem cells use in islet cell transplants

To cure type 1 diabetes, stem cell replacement needs to be more than simply a case of swapping insulin-producing cells from a

healthy
pancreas with those destroyed by diabetes in a diabetic patient.

Numerous complications preclude this as a simple treatment. Islet cell transplants are one form of procedure that has proven effective.

In type 1 diabetes, the

body’s immune system
becomes programmed to attack the beta cells, so the patient must take immuno-suppressant drugs to prevent this happening.

In the future, it may be possible to grow islet cells from patient’s existing islet cells, however, a patient with type 1 diabetes would still need immune suppressants to prevent the cells being destroyed.

• Read more on
  
  islet cell transplantation

Bone marrow transplantation is an experimental procedure which has had some success in enabling people with

type 1 diabetes
to come off insulin injections.

However, bone marrow transplantation is a relatively untried and risky procedure.

How could bone marrow transplants treat type 1 diabetes?

Type 1 diabetes results from the body’s immune system targeting and killing its own beta cells, which produce insulin, in the pancreas.

Even if people receive

islet cell transplants, their immune system will still try to kill off the transplanted cells so transplant recipients need to take immunosuppressive drugs to prevent or delay their transplanted cells being destroyed.

Bone marrow transplantation is an attempt to reset the body’s

immune system
to no longer attack the pancreas’s insulin producing cells.

How is a bone marrow transplant carried out?

The process detailed follows that used by Dr Julio Voltarelli.

The first stage was to remove a sample of stem cells from the patient’s existing bone marrow.

The next stage involved the patients receiving a high dosage of immunosuppressive drugs to destroy the immune system in the body.

With no immune system to defend the body, patients were kept in isolation away from sources of infection.

The bone marrow stem cells were then transplanted back within the bone marrow.

Was bone marrow transplantation successful in treating type 1 diabetes?

Dr Voltarelli treated 23 patients that had been newly diagnosed with type 1 diabetes and followed the patients up at intervals.

A follow up carried out in 2009 showed that 12 patients had been able to stay free of insulin injections for over 3 years and another 8 received only intermittent injections through a five year period.

One patient did not respond to the transplant and needed to go back onto insulin straight away. 2 other patients needed to go back onto insulin after 1 month and 5 months. 1 patient contracted pneumonia and 2 other patients developed late endocrine dysfunction.

Is bone marrow transplantation for diabetes available on the NHS?

Bone marrow transplantation for type 1 diabetes is still in an experimental treatment and is not available on the NHS.

There are significant risks of contracting

infections
involved in shutting down the immune system prior to the transplant as well as risks of complications developing after the procedure.

Many people with diabetes already know about the importance of islet cells, and how important these pancreatic cells are in determining whether a person is

diagnosed with diabetes
and what type of diabetes they have.

Islets are cell groups within the pancreas which are comprised of beta cells – the cells that make

insulin, the hormone that regulates blood glucose levels.

Recent

advances in medical science
have allowed islet transplantation – replacement of destroyed beta cells using cells harvested from donors.

Islet cells and diabetes

Amongst people with

type 1 diabetes, pancreatic beta cells are destroyed. This means that regular insulin delivery (via injections or an insulin pump) is the only way to stay healthy.

For some people with type 1 diabetes, it is very difficult to achieve and maintain stable

blood sugar levels

Islet cell transplants vs pancreas transplants

Islet transplants are a safer option than pancreas transplants.

Islet transplantation is safer because if the body rejects the transplant, it is better for the body to reject a part of the orga, the islet cells, than the entire orga, the pancreas, as the pancreas performs more functions than just

insulin production

A further reason for why islet cell transplantation is safer is that it is a less critical operation to insert islet cells than it is transplant a complete pancreas.

Islet cells that the pancreas has destroyed are replaced using cells from donor pancreases.

How do islet cell transplants work?

Usually, transplant patients are given islet cells from as many as three donor pancreases. Just like healthy pancreatic beta cells, the donor cells produce insulin in a normal way. This can help to achieve blood glucose stability and lower the amount of insulin required.

Furthermore, in some cases, beta cell transplants may be so effective that the patient receiving transplants can stop insulin administration entirely.

Are islet cell transplants a new thing in the UK?

Islet cell transplantation procedures remain rare in the UK since their origins in 2000 in Canada. Leading diabetes charity

Diabetes UK
set up the Islet Cell Consortium in the UK, bringing together nine different islet research centres. Diabetes UK also raised money to pay for the first ten islet transplantations in the UK, based on the work done in Canada.

So far, Diabetes UK has secured funding for another five transplants, all of which have been carried out at centres in London and Oxford. Nine of the fifteen operations conducted to date have been successful.

So will islet cell transplantation become more widespread?

Islet cell transplantation is experimental at this stage, and there are no guarantees of its efficiency in letting patients live without insulin. Unfortunately, the pancreas will reject foreign islet cells without

drug treatment
The drugs required to guarantee cell acceptance may lead to serious side effects.

So who gets an islet cell transplant?

At this stage, the procedure is only considered suitable for individuals who cannot control their diabetes, experience dangerous levels of

hypos
and face a dramatically lower quality of life. In these situations, islet cell transplants may be considered.

Has it worked?

So far, one UK patient was able to come off insulin entirely for about a year.

All other patients in the trial lowered their insulin dose, removed the risk of

hypoglycemia, improved blood glucose control and improved their quality of life.

All trial patients have been able to return to a normal lifestyle without the threat of major hypoglycemia.

So I could stop taking insulin entirely with an islet cell transplant?

Although people may be able to entirely stop taking insulin, transplanted islets are supported with a small insulin dose to maintain their health. As well as the anti-rejection drugs, patients take a small

dose of insulin
for this reason.

Cures for both

type 1 diabetes
and

type 2 diabetes
have not yet been discovered, but progress is being made to prospectively cure type 1 diabetes in this generation.

As studies continue, the root causes and mechanism behind both forms of the disease are becoming more clearly understood all the time.

People with type 2 diabetes can go into remissio, but while a cure is still elusive for type 1 diabetes, research from major angles is contributing towards a potential cure.

Type 1 diabetes cure

Researchers are beginning to get excited again that a cure or near-cure treatment could come as early as within the next decade or two. A

diabetes vaccine
diabetes vaccine is consistently being investigated to provide a true biological cure for type 1 diabetes.

The aim is for a vaccine to be created that stops the immune system from attacking the body’s insulin-producing beta cells.

Another cure prospect gaining momentum is

islet cell encapsulation, with stem cells used to create insulin-producing cells that can work without immune system interference.

Type 1 diabetes vaccine

Research into a diabetes vaccine is being made on several fronts, with Selecta Bioscience, a clinical bioscience company, developing a Synthetic Vaccine Particle (SVP) as an immunotherapy for type 1 diabetes.

The vaccine is expected to reprogram the immune system to prevent inflammatory responses to insulin cells, with Selecta currently trialling SVP on mice courtesy of funding from JRDF, a leading global organisation funding type 1 diabetes research.

Elsewhere, the Faustman Lab at Massachusetts General Hospital is currently leading a human clinical trial program to test the efficiency of their Bacillus-Calmette-Guerin (BCG) vaccine. Positive results have already been reported from their Phase I study.

An arthritis drug, abatacept, has also shown it can delay type 1 diabetes progression a year after treatment has been discontinued, with studies again funded as part of JRDF’s Restoration program.

Islet cell encapsulation therapy

In October 2014, the first person with diabetes was implanted with an

islet cell encapsulation system, with insulin-producing cells injected into the body and protected from destruction by the immune system.

Further trials are currently in progress to test its safety among participants with type 1 diabetes, with this treatment set to allow patients to produce their own insulin automatically.

Islet cells are derived from stem cells, the foundation for another advancement made by Harvard University, who have used them to create large quantities of insulin-producing beta cells.

The Harvard team have been able to

manufacture the millions of beta cells
necessary for human transplantatio, and trials could take place within a matter of years.

In the meantime, the need for patients to take immunosuppressive drugs and

insulin
is unavoidable, but a cure for type 1 diabetes is more within reach than ever before.

Should ongoing trials prove successful in negating insulin dependence, with no side effects or issues with safety, an end to type 1 diabetes could yet be discovered.

Type 2 diabetes cure

Clinical resolution or remission of

type 2 diabetes
is a rare but identified medical phenomenon.

Type 2 diabetes may go into remission either through dietary and

fitness
measures, or in some cases through gastric bypass surgery.

However, this isn’t the case for all type 2 diabetes patients and needs further research before clear conclusions can be drawn.

Remissions may not be considered a cure, however, but it may mean type 2 diabetes patients can stop taking medication.

Very low calorie diet

Studies have previously researched whether a

very low calorie diet could allow people with type 2 diabetes to shed levels of fat
in the pancreas and liver.

Consuming 600 calories a day could subsequently reverse, or even eliminate insulin resistance.

This study is to be expanded on
by Diabetes UK, who are funding a research project to see if a very low calorie liquid diet and assisted weight management can send type 2 diabetes into remission in the long-term.

Transplanting for a diabetes cure

Transplanting exogenous beta cells is another form of potential cure that has been attempted, both amongst mice and humans.

However, similar to transplant procedures, this has provoked a strong reaction from the immune system, which attacks the transplanted tissue.

Other cell transplant procedures have been attempted, including

stem cell research
for both type 1 and type 2 diabetes. In most cases, the same mechanism that destroys beta cells in the first instance attacks stem cells.

Stem cell research

Stem cell research is a rapidly growing area of research that is uncovering important new avenues of study each year. Stem cell research has the potential to uncover new ways of treating both types of diabetes.

Stem cell research
has been particularly effective in uncovering a new understanding of type 1 diabetes.

Nanotechnology

Another possible cure may one day come from the microscopic, nanotechnological spectrum. In this instance, tiny insulin implants could meter out insulin to

blood glucose levels
as and when it is required.

This type of cure is theoretically possible, and several scientists are working towards this future.

However, as with other forms of potential diabetes cure, this remains only a distant potential.

Medical science and progress towards a cure

Discoveries that may one day contribute to a diabetes cure do occur often, however. Be it better understanding of the immune system or discoveries in the natural world, advancement towards a diabetes cure may one day be possible.

However, at this stage a diabetes cure remains impossible.

Please check the

Diabetes
News
for updates on potential diabetes cures and news of research on similar areas.

However, this isn’t the case for all type 2 diabetes patients and needs further research before clear conclusions can be drawn.

Remissions may not be considered a cure, however, but it may mean type 2 diabetes patients can stop taking medication.

Diabetes research is one key to the future for all people with diabetes.

Scientists around the world are conducting diabetes research across a phenomenal variety of fields.

This research includes trying to find a cure for diabetes, improving diabetes medication and diagnostics, and making the day to day life of people with diabetes easier to lead.

Diabetes research takes many forms throughout the world.

Read about current diabetes research, developing methods of treatment and how you can get involved with research in the UK:

Research Guides:

Clinical Trials

Diabetes Cure

Diabetes Research Network

Diabetes Vaccines

Diabetes Drugs

Stem Cell Research

There are numerous diabetes research institutions and foundations. In the UK, diabetes research is funded by charitable organisations such as the

Juvenile Diabetes Research Foundation
and the charity

Diabetes UK

Private sector companies also take a strong role in financing diabetes experts to carry out pioneering research to improve diabetes care.

The latest diabetes research is published in diabetes journals such as

Diabetes Care

Diabetes research across the globe

Diabetes research is a global task.

With diabetes increasingly affecting every country in the world, diabetes researchers from across the planet are working towards thousands of different research goals.

It is in this way that major breakthroughs are made, and the future of diabetes care comes one step closer.

Please use the links below to visit some diabetes research portals. If you would like your organisation to be added to this list, please contact us.

Diabetes research

Read more about diabetes research directly at the charity and institutes below.

• Juvenile Diabetes Research Foundation International
• 
  Diabetes Action – Research & Education Foundation

An artificial pancreas uses man-made technology to match the way a pancreas works.

An artificial pancreas is a man-made device that is designed to release insulin in response to changing blood glucose levels in a similar way to a human pancreas.

Artificial pancreas systems are being studied as a possible treatment option for people with type 1 diabetes and type 2 diabetes.

What is an artificial pancreas?

There are three main artificial pancreas systems being worked on by researchers:

• Closed-loop artificial pancreas
• Bionic pancreas
• Implanted artificial pancreas

Closed-loop artificial pancreas

The most widely tested artificial pancreas is a ‘closed-loop

insulin delivery
system’, also referred to as a closed loop artificial pancreas.

Cambridge University has long pioneered research into the closed-loop system: their device is currently being tested on humans under controlled and home conditions.

It is made up of an externally worn insulin pump which communicates wirelessly to a CGM worn as a patch on the skin. The CGM

measures blood sugar levels
and the result is fed into a small computer which calculates how much insulin (if any) needs to be delivered by the insulin pump. The dose is then delivered into the body, completing the cycle.

In 2016, the European Commission announced it will

fund
a Cambridge University trial testing test whether an artificial pancreas can help young children manage type 1 diabetes.

Medtronic is among the other research teams pursuing closed-loop insulin delivery. The biopharmaceutical company released data in September 2016 showing positive results from their

hybrid closed-loop system
; they launched the

MiniMed 640G
artificial pancreas in the UK in March 2015.

Bionic pancreas

In 2015 the world was introduced to the iLet, a bionic pancreas that could help people with type 1 diabetes manage the condition solely through the device.

The bionic pancreas, developed by Dr Edward Damiano’s Beta Bionics firm, automatically controls blood glucose levels, comprising two

insulin pumps
which deliver and insulin and glucagon respectively.

The pumps connect with an iPhone app via Bluetooth enabling communication between the devices that helps calculate the required doses needed. Automated dosing decisions about insulin and glucagon are made every five minutes based on updated

continuous glucose monitor
(CGM) readings.

Damiano’s team aim to have an insulin-only version approved by the US FDA in 2018 and to have the full system approved shortly afterwards.

• 
  Read more about the bionic pancreas

Implanted artificial pancreas

The implantable insulin delivery device features a gel that responds to changes in blood glucose levels. It is being developed by researchers from De Montfort University.

When blood glucose levels are elevated, the gel enables a higher rate of insulin to be released; during lower sugar levels, the gel decreases the amount of insulin it releases. The implantable system could be refilled with insulin on a regular basis.

Latest news on artificial pancreas systems

Artificial pancreas systems have become a hot topic of news in the last few years. Catch up on some of the biggest stories in this area of diabetes treatment.

• (2016):
  
  Less fear of hypos noted in type 1 diabetes artificial pancreas study
• (2016):
  
  Artificial pancreas improves blood glucose control in type 2 diabetes
• (2016):
  
  Artificial pancreas could transform treatment for pregnant women with type 1 diabetes

The International Diabetes Closed Loop trial

A significant trial began in 2016 called the International Diabetes Closed Loop (IDCL) trial. The objective of the study is “for clinical staff to gain experience using the proposed artificial pancreas system named inControl and the inControl Cloud and assess 24/7 in-home usability prior to initiating a large randomized controlled trial”.

The inControl artificial pancreas from TypeZero, which is paired with Tandem’s t:slim insulin pump, will be assessed against a standard insulin pump and CGM (known as an open loop). Cellnovo and Dexcom are among the other companies whose products will be tested in this trial.

Homemade artificial pancreases

Homemade artificial pancreases are an increasingly common development among families who do not want to have to wait to obtain their own from a pharmaceutical firm. But this is only really recommended for competent engineers who are also very familiar with diabetes management.


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As part of the #WeAreNotWaiting movement, tech-savvy people worldwide are building their own devices, including artificial pancreases, to improve their health.

• 
  Read more about homemade artificial pancreases

Can I get an artificial pancreas?

The system is still being tested for safety and effectiveness and, as of 2016, home and clinical trials of the system have been completed in participants with both type 1 diabetes and type 2 diabetes.

Research is being conducted worldwide and each team’s expertise to their respective products is helping to speed up the process of devices coming to market.

The next step for the

researchers
is to test the technology on a larger number of people.

Encapsulated islet cells is a treatment for

type 1 diabetes
that is currently undergoing research and development.

Encapsulated islet cells can be likened to an advanced form of transplantation but has the distinct advantage that the treatment does not require the recipient to take immunosuppressive drugs.

Encapsulated islet cells in the news

• 
  Islet cell implant for diabetes receives USD16 million grant
  
• 
  Implanted islet cells for type 1 diabetes gets approval for human trials
  
• 
  New encapsulation technology for diabetes
  

What are encapsulated islet cells?

Encapsulated islet cells are specific stem cells that are contained in a protective capsule. The capsule is implanted into the body and the

stem cells grow into cells
capable of producing insulin, as well as other hormones.

The capsule is specially designed to allow blood to feed the cells within the capsule with oxygen and nutrients and allowing the hormones, such as insulin, to leave the capsule, whilst preventing

white blood cells
of the immune system from entering the capsule and killing off the islet cells.

Benefits of encapsulated islet cells

If encapsulated islet cells prove to work in humans as well as is hoped, they could produce the following benefits:

• 
  Prevent too high and low sugar levels from occurring
• Eliminate the need to take insulin,
  
  say by injections
  or
  
  insulin pump
• 
  Prevent the need for daily blood glucose tests

Whilst not strictly a cure, but rather a treatment, encapsulated islet cells would represent

a near cure experience
that could see people control their diabetes with minimal management for many months.

The researchers are expecting encapsulated islet cells to be effective for up to 2 years.

What are islet cells?

Islet cells are the cells within the pancreas that produce a number of hormones including the key blood sugar regulating hormones insulin and glucagon. One type of islet cells, called

beta cells, produce insulin and alpha cells produce glucagon.

Why encapsulation helps

Islet cells
can be transplanted but the effects of type 1 diabetes mean that strong immunosuppressive drugs need to be taken. The reason for this is that type 1 diabetes causes the immune system to attack and destroy the insulin producing beta cells.

Whilst immunosuppressive drugs help to prolong the life of beta cells, the effects of the autoimmune attack (attack of the body’s own cells) mean that people that have had a transplant often need to go back to

taking insulin
within a number of months.

The other disadvantage is that immunosuppressive drugs include a number of side effects and reduce the body’s ability to combat infections.

A major strength of encapsulation is that no immunosuppressive drugs need to be taken.

Which companies are developing encapsulated islet cells?

Encapsulated islet cells are currently being developed by the following companies:

• ViaCyte
• Austrianova and Nuvilex

ViaCyte is developing its encapsulated islet cell therapy, known as VC-01, which uses its Encaptra drug delivery system to encapsulated islet cells from a stem cell source.

The collaboration of Austrianova and Nuvilex is developing its Cell-in-Box live cell sulfate-based encapsulation technology which has been tested using islet cells from pigs and hamsters.

Early human trials have already begun for each of these projects.

When will encapsulated islet cells be available?

Even if everything were to go to plan, it would be a number of years before the technology is available.

The

JDRF, that have been involved from an early stage in funding the development of encapsulated islet cells, state that more than $60 million (US) needs to be raised to fund the next 5 years of development.

Diabetes clinical trials are an essential way for the medical research profession to understand more about diabetes and

how it affects us

Before diabetes treatments are used to treat patients, their effects must be carefully tested in clinical phases.

What exactly do clinical trials do?

Clinical trials assess whether treatments are more effective than existing treatments.

People with diabetes
can get involved with this research and participate in research trials to further diabetes knowledge.

So I can volunteer for a diabetes clinical trial?

People with diabetes can participate in clinical studies or trials, and there is often a financial reward. Diabetes clinical trial participants play an important role in understanding treatments that could help thousands or even millions of people. They may also help to prevent diabetes or even

find a cure

Current clinical trials and studies taking place in the UK:

Could participating in a diabetes research trial give me side effects?

Disadvantages or side effects may, in some cases, be a feature of clinical trials, although of course every step is taken to avoid this.

People with diabetes that wish to take part in a research trial should consult with their healthcare team and also discuss clearly with the

healthcare professionals
engaged in the study.

You should be given a clear idea of what to expect before committing to the clinical trial.

Where can I find a diabetes research trial to participate in?

The resource above lists diabetes research trials that people with diabetes can participate in.