AN “artificial pancreas” has been hailed as the biggest breakthrough in diabetes care in a century.
More than 150,000 people with type 1 could be eligible for the “hybrid closed-loop technology” in the greatest advance in treatment since the discovery of insulin 100 years ago.
Diabetes is already among the top three most common health conditions in the UK and shows no signs of slowing down.
It affects an estimated five million of us, costing the NHS £14billion a year, with a further 13.6million people at risk.
The face of diabetes treatment is about to change for hundreds of thousands of patients.
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The National Institute for Health and Care Excellence (Nice) last week recommended the hybrid closed-loop system for patients in England and Wales, following the move in Scotland in 2022.
The technology works by linking an insulin pump and continuous glucose monitor (CGM) — both attached to the skin for days at a time — with a computer algorithm that can calculate the amount of insulin someone needs.
The insulin is automatically delivered by the pump when the patient needs it.
With this so-called artificial pancreas, there is no need for finger-prick tests or insulin injections.
The treatment could cost around £2,000 to £3,000 per patient. Dr Partha Kar, national speciality adviser for diabetes and diabetes co-lead at NHS England, said the announcement from Nice was “amazing news”.
He said: “This tech might sound sci-fi-like but it means people with type 1 diabetes can get on with their lives without worrying about glucose levels or medication.”
Natalie Balmain, 37, from Manchester, who has lived with type 1 diabetes since she was 20, recently started using a Dexcom G6 sensor and Omnipod 5 insulin pump as part of the closed-loop technology.
The actress — who last year won Channel 4 reality show Make Me Prime Minister — says: “To say it’s been a game-changer is an understatement. Since I started using it my blood glucose has been within range over 90 per cent of the time, which never happened before, and my HBA1C (long-term blood glucose level) is predicted at 6.8, the lowest in my life.
“I’m sleeping through the night for the first time in over 16 years, and I feel like a different person. It takes away my fear, while improving my control and likely extending my life and reducing my risk of long-term complications. I’ve never taken life for granted and this has given me a real chance to appreciate everything for so much longer.”
Rachel Connor, director of research partnerships at type 1 diabetes charity JDRF, says: “Type 1 diabetes is currently a relentless, life-long and life-threatening condition, which places a massive burden on people who live with it. But research is changing that picture.
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“There are constant developments happening that could change life for people with type 1 diabetes.”
New treatments, AI screenings and repurposing of existing drugs are among the advances changing the landscape of both type 1 and type 2 diabetes care.
When Toronto medics Dr Frederick Banting and Dr John Macleod were awarded the Nobel Prize for Medicine 100 years ago after discovering insulin, the life expectancy of someone diagnosed with diabetes was two years — essentially a death sentence.
Now, life expectancy is not affected by the diagnosis of the condition, as long as it is managed well.
Diabetes treatment has come a long way, but higher life expectancy means spending longer with the condition, and potentially other illnesses that patients are more likely to get, such as heart disease and stroke.
Here, on World Diabetes Day, we look at the pioneering work of scientists, offering hope of a better future for millions.
FEWER INJECTIONS
AN experimental once-weekly insulin treatment called icodec worked just as well as daily injections, according to phase 3 trials published in October by theUniversity of Surrey.
Professor Russell-Jones, who led the research, says: “Missed injections can affect glycaemic control, and a lack of consistency in the treatment has been linked to increased rates of diabetic ketoacidosis, a serious complication of the condition that can be life-threatening.
“Reducing insulin injection frequency could lessen the burden of treatment for some people with the condition.”
What’s more, last week a team from the University of Alberta in Canada revealed they had made advances in a process which turns a patient’s own stem cells into insulin-producing pancreatic cells – so making the prospect of injection-free treat-ment closer.
Study leader James Shapiro says: “What we are trying to do here is to peer over the horizon and try to imagine what diabetes care is going to look like in 15, 20, 30 years from now.”
EXISTING DRUGS
SOME advances are already right under our noses.
Researchers from the University of Chicago have found that an existing drug called A-difluoromethylornithine (DFMO) inhibits an enzyme in the body which contributes to type 1 diabetes, and helps protect and restore cells altered by the disease.
DFMO is traditionally prescribed for a sleeping-sickness disease and for excessive facial hair in women.
Researchers hope the drug could be repurposed to treat type 1 diabetes and reduce dependence on insulin as a sole treatment.
VOICE TECHNOLOGY
BEING diagnosed with type 2 diabetes could one day be as easy as speaking a few words.
Significant vocal differences between those with and without the condition were found when they were asked to record a phrase into their phone.
Health technology company Klick Labs, in Canada, then developed an AI model that was able to detect type 2 diabetes by voice with 89 per cent accuracy.
Jaycee Kaufman, a scientist from the Canadian lab, says: “Current methods of detection can require a lot of time, travel, and cost.
“Voice technology has the potential to remove these barriers entirely.”
The sooner that type 2 diabetes is diagnosed, the better, as it can reduce the risks of patients developing complications.
SHAKE DIET
A NEW NHS low-calorie diet plan is helping type 2 diabetes patients to go into remission.
Studies show the soup and shake diet helped patients lose an average of 11kg (1st 10lb) in a year, with 36 per cent then going into remission after two years.
Food intake is cut to 800 calories a day for the first three months before food is slowly added back into the diet.
The diet was rolled out to patients in England earlier this year with the aim of reaching all parts of the country by March 2024.
ROOM TEMPERATURE
IT’S recommended to keep insulin refrigerated until it is going to be used.
But it may not be as temperature-sensitive as had previously been thought.
A Cochrane review – considered the gold standard in science – published recently, reported that insulin stored at room temperature for months does not lose its potency.
The findings could change the face of treatment for millions of diabetics living in poor, war-torn and disaster-prone regions where refrigeration is difficult to maintain.
One study found that in temperatures that mimic fluctuations of tropical countries, the medication could last up to three months.
EYE IMPLANT
A TINY device that contains insulin-producing pancreatic cells has now been developed by researchers in Sweden.
It would be inserted between the iris and cornea, and in mouse studies the implant has been found to stay in place for several months.
While not yet tested on people, in theory the implant could be used to treat type 1 patients by releasing insulin via the eye.
Study author Anna Herland says: “As the eye does not have resident immune cells we avoid these first reactions from the immune system.”
