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The Future of Diabetes Treatment

December 6th, 2018 | Endocrinology | Article

Type 1 diabetes affects millions of people in the US alone. What’s worse is that the majority of patients do not achieve good control of their blood glucose levels. Management of type 1 diabetes has traditionally been cumbersome, time-consuming, and expensive, so better treatment methods are sorely needed.

For those of us who are living with or who have a family member living with type 1 diabetes, we are probably well acquainted with the promises of pancreas transplants, islet stem cell therapy, and other science fiction. But what types of advances can we realistically hope for in the next 5 to 10 years? Or maybe even in the next 2 years?

Current, well-established options that are still pretty sci-fi

We have really come a long way in producing tools and medications to more easily manage diabetes. Insulin pumps and continuous glucose monitors are now pretty common and are generally covered by insurance, which is a huge step from traditional syringe-and-vial shots of insulin. This traditional method relies on the patient guessing how many carbs they just ate, the patient’s ability to properly load a syringe, and hefty trial and error when the carefully measured doses don’t give the expected result of a healthy blood glucose level.

Two years ago, the FDA actually approved an artificial pancreas system that monitors blood glucose and injects insulin in response to glucose changes, keeping glucose levels in a more optimal range more often. The technology is not quite good enough to replace all insulin shots, since patients must still give themselves calculated doses of insulin at mealtime, but researchers are working on this. One of the major things to worry about with this system is coming into contact with magnets or radiation, which can result in calibration and serious dosage issues. This system is available by prescription.

Experimental treatments that show true promise

Pancreatic islet transplantation is happening now in experimental conditions and is not available for everyone, but initial results have been positive. One of the major downsides to this procedure is having to take immunosuppressants so that the body’s immune system doesn’t attack the foreign objects (the transplanted cells). There are, however, scientists working on solutions to this that may remove the need to take immunosuppressants. Pancreas transplants come with high risks and are not indicated for patients with type 1 diabetes unless they have already had another organ transplant (e.g. kidney) and are already taking immunosuppressants. Risks and downsides of a full pancreas transplant include taking life-long immunosuppressants, possible infection or other complications from the surgery itself, and the expense. Plus, a healthy pancreas is hard to come by, so wait lists could be long.

One group of scientists claims to be able to predict with “almost 100% accuracy” who will develop type 1 diabetes based on a genetic predisposition involving the HLA-DQ8 gene. That alone is science fiction. Some medications, such as a blood pressure medication called methyldopa, are being used in clinical trials to inhibit the process that is thought to lead to progression of diabetes via this gene. The current research on this, however, is limited to small-scale trials and needs to be confirmed with larger sample sizes; the next study is already planned to begin in 2019.

The real bottom line

New technology is great, but if it is only just as good as what is already on the market, is it really helping anyone? Noninferiority studies for new devices will only go so far in truly helping people with diabetes. Superior efficacy or improved quality of life measured with validated, reliable tools (or both) could be argued to be clinically relevant outcomes. Improving quality of life in these patients is especially important since the intensive treatment and management regimens are thought to possibly lead to the high incidence of comorbid psychiatric disorders. And, as always, research should strive to show safety and efficacy in larger, more representative samples to get a more accurate picture of how a drug or device will work in the real world.